Abstract:[Objective] To compare the clinical outcomes of cemented long-stem (LS) versus standard-stem (SS) femoral components in hemiarthroplasty (HA) for unstable intertrochanteric fractures in the elderly. [Methods] A retrospective study was performed on 120 el- derly patients who received HA for unstable femoral intertrochanteric fractures in our hospital from January 2016 to January 2020. Accord- ing to the results of doctor-patient communication preoperatively, 60 patients had cemented LS used, while the remaining 60 patients re- ceived SS. The perioperative period, follow- up and imaging data were compared between the two groups. [Results] All patients in both groups had HA performed successfully without serious complications. There were no significant differences in operation time, intraoperative blood loss, intraoperative fluoroscopy times, postoperative drainage volume, incision healing grade, and hospital stay between the two groups (P＞0.05) , but the LS group had significantly longer incision length than the SS group (P＜0.05) , and the former resumed postopera- tive walking significantly earlier than the latter (P＜0.05) . Of them, a total of 107 patients were followed up for more than 12 months, and there was no a significant difference in the time to return full weight-bearing activities between the two groups (P＞0.05) . The Harris score, hip extension-flexion range of motion (ROM) and hip interna-external rotation ROM increased significantly in both groups over time (P＜ 0.05) , whereas which proved not significantly different between the two groups at any corresponding time points (P＞0.05) . Radiographical- ly, there were no significant differences in the quality of fracture reduction, fracture healing time, and bilateral femoral length discrepancy between the two groups (P＞0.05) . [Conclusion] Both long-stem and standard-stem femoral components used in hemiarthroplasty are effec- tive treatment for unstable intertrochanteric fractures in the elderly without significant difference in term of short-term outcomes, however, the consequences in long term needs to be further studied.

Abstract:[Objective] To evaluate the clinical efficacy of robot-assisted percutaneous cannulated screw fixation of femoral neck frac- tures. [Methods] A retrospective study was done on 68 patients who received percutaneous cannulated screw fixation of femoral neck frac- tures from November 2017 to May 2019. According to preoperative doctor- patient communication, 32 patients received robot- assisted screw placement, while the remaining 36 patients were treated with freehand screw placement. The documents regarding to perioperative pe- riod, follow-up and radiographs were compared between the two groups. [Results] The robot group proved significantly superior to the free- hand group in terms of operation time, intraoperative fluoroscopy times, guide pin positioning times and postoperative walking time (P＜ 0.05) . During the follow-up lasted for (31.4±6.8) months on a mean, the robot group had 1 case of nonunion and 3 cases of femoral head ne- crosis, whereas the freehand group had 2 cases of nonunion and 5 cases of femoral head necrosis. The robot group resumed full weight bear- ing activity significantly earlier than the freehand group (P＜0.05) . The Harris score, hip extension-flexion and internal-external rotation range of motions (ROMs) significantly increased in both groups over time (P＜0.05) , which in the robot group were significantly better than the freehand group at 1 and 3 months postoperatively (P＜0.05) , whereas became not statistically significant between the two groups at the latest follow-up (P＞0.05) . Radiographically, there was no significant difference in Garden index between the two groups (P＞0.05) , while the robot group was significantly superior to the freehand group in terms of the parallelism and dispersion of cannulated screw placement (P＜0.05) . However, there were no significant differences in neck-shaft angle and Tonnis grade for hip degeneration between the two groups at the corresponding time points (P＞0.05) . [Conclusion] Robot- assisted fixation of femoral neck fractures with cannulated screws does shorten the operation time, improve the accuracy of screw placement, and facilitate the early recovery of hip function.

Abstract:[Objective] To compare the short-term clinical outcomes of proximal femur bionic nail (PFBN) versus proximal femoral nail anti-rotation (PFNA) for intertrochanteric fractures in the elderly. [Methods] From October 2020 to June 2021, a total of 40 elderly pa- tients with intertrochanteric fracture of femur were enrolled into this study, and randomly divided into two groups. Of them, 20 patients had fractures fixed with PFBN, while the remaining 20 patients were with PFNA. The perioperative period, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had operation performed successfully without serious complica- tions. There were no significant differences in intraoperative blood loss, incision healing grade and hospital stay between the two groups (P＞ 0.05) . The PFBN group resumed walking significantly earlier than that in PFNA group (P＜0.05) , but the former was significantly greater in terms of operation time and intraoperative fluoroscopy times than the latter (P＜0.05) . All the patients in both groups were followed up for 6~ 9 months, with an average of (7.3±1.1) months. The PFBN group resumed full weight-bearing activity significantly earlier than the PFNA group (P＜0.05) . The VAS score significantly decreased (P＜0.05) , while the Harris score, hip flexion-extension range of motion (ROM) and internal-external rotation ROM significantly increased in both groups over time (P＜0.05) . At 1 month after operation, PFBN group was sig- nificantly better than the PFNA group in term of Harris score (P＜0.05) . Radiographically, there were no significant differences in fracture reduction quality and fracture healing time between the two groups (P＞0.05) . At last follow-up, the PFBN group maintained significantly greater femoral neck-shaft angle than PFNA group (P＜0.05) . [Conclusion] This proximal femur bionic nail for proximal femoral intertro- chanteric fracture in elderly is more stable, allowing walking early postoperatively, which is beneficial to fracture healing and prevent coxa vara.

Abstract:[Objective] To compare the clinical outcomes of open reduction and internal fixation (ORIF) with locking plate fixation ver- sus closed reduction and percutaneous Kirschner wire fixation of Bennett fracture. [Methods] A retrospective study was performed on 52 patients who received surgical treatment for Bennett fracture in our hospital from January 2015 to January 2019. According to preoperative doctor-patient communication, 28 patients had plate used, while the remaining 24 patients had Kirschner wire applied. The data regarding to perioperative period, follow-up and radiographs were compared between the two groups. [Results] All the patients in both groups had cor- responding procedures conducted successfully. The plate group proved significantly superior to the wire group in terms of times of fluorosco- py and the time to return active activity (P＜0.05) , whereas the former got significantly more intraoperative blood loss than the latter (P＜ 0.05) . All the patients were followed up for (18.4±3.6) months on an average, with no a significant difference in the time to resume fullweight bearing activity between the two groups (P＞0.05) . The DASH scores decreased significantly in both groups over time after operation (P＜0.05) , which were not significantly different between the two groups at 1 year after operation (P＞0.05) . Radiographically, fracture align- ment and first metacarpal alignment in both groups significantly improved postoperatively compared with those preoperatively (P＜0.05) , which proved not significant between the two groups before operation (P＞0.05) , whereas the plate group were significantly better than the wire group at the latest follow-up (P＜0.05) . However, there was no significant difference in fracture healing time between the two groups (P＞0.05) . [Conclusion] Both plate and wire for fixation are effective treatment of Bennett fracture, with their own advantages and disadvan- tages. By comparison, the ORIF with plate is more accurate and reliable than the percutaneous Kirschner wire.

Abstract:[Objective] To explore the risk factors of deep vein thrombosis (DVT) in the perioperative period of hip fractures in the el- derly, and to establish a prediction model to guide clinical prediction of DVT. [Methods] A retrospective study was conducted on 384 elder- ly patients who received surgical treatment for hip fractures in our hospital from August 2015 to September 2021. According to the occur- rence of thrombosis, the patients were divided into DVT group and non-DVT group. Univariate and multivariate analysis were performed to identify the risk factors of DVT in lower extremities, and establish the prediction model and evaluate the efficiency of the model. [Results] Among 384 patients, 67 cases (17.5%) developed lower extremity DVT in the perioperative period. In term of univariate comparison, there were no significant differences in terms of age, sex, fracture type, fracture side, ASA grade, time elapsed between the injury and surgery, whether oral anticoagulant, antithrombotic drugs, underlying medical disease, surgical procedure and anesthesia, as well as Hb, HCT, WBC, PLT, fibrinogen, D-dimer, PT and PO2 measured on admission between the two groups (P＞0.05) . However, the DVT group had sig- nificantly longer waiting time before surgery, ≥3 types of comorbidities, higher proportion of blood transfusion and combined fractures, lon- ger operation time, more intraoperative blood loss, and longer APTT than the non-DVT group (P＜0.05) . As results of multivariate binary lo- gistic regression analysis, perioperative blood transfusion (OR=2.565, P＜0.001) , number of comorbidities ≥3 (OR=1.880, P=0.031) , longer preoperative waiting time (OR=1.110, P＜0.001) were the independent risk factors for perioperative DVT of lower extremity. The accuracy of lower extremity DVT prediction equation based on logistic regression results was of 82.8%, with the critical cutoff value of 0.319, the sensi- tivity of 71.6%, the specificity of 60.3%, and the area under the ROC curve of 0.705. [Conclusion] Longer preoperative waiting time, peri- operative blood transfusion and ≥3 kinds of underling medical diseases are the independent risk factors for perioperative DVT of lower ex- tremities. In addition, this DVT prediction model is helpful to judge the risk of thrombosis and prevent it in advance.

Abstract:[Objective] To compare the clinical outcomes of conservative therapy versus surgical treatment of acute patellar dislocation in adolescents. [Methods] A retrospective study was performed on 40 adolescent patients who received treatment for acute patellar disloca- tion in our department from 2014 to 2018. The patients were divided into two groups according to whether intraarticular loose bodies noted by imaging examination. Of them, 23 patients without intraarticular loose bodies were given conservative therapy, while the other 17 pa- tients with intraarticular loose bodies were given surgical repair of medial patellofemoral ligament (MPFL) . The documents regarding earlystage, follow-up and imaging consequences were compared between the two groups. [Results] In the conservative group, all the 23 patients had no adverse reactions and complications during treatment. In the operation group, all the 17 patients were successfully operated on with- out serious complications such as vascular and nerve injury. Patients in both groups were followed up for 3~7 years, with an average of (4.8± 1.1) years. During the follow-up, 1 patient in the conservative group and 1 patient in the surgery group reoccurred patella dislocation, with- out a significant difference in the redislocation rate between the two groups (P＞0.05) . Compared with those pre-treatment, the Kujala and Lysholm scores, as well as the knee extension and flexion range of motion (ROM) significantly increased in both groups at 6 months after treatment and at the last follow-up (P＜0.05) . However, there were no significant differences in terms of Kujala score, Lysholm score and knee extension and flexion ROM between the two groups at any corresponding time points (P＞0.05) . Regarding imaging, the patellar title (PT) and patellar displacement (PD) significantly reduced in both groups at latest follow-up compared with those preoperatively (P＜0.05) . Although there was no significant difference in PT and PD between the two groups before treatment (P＞0.05) , the conservative group had significantly greater PT and PD than the surgical group at the latest folloe-up (P＜0.05) . [Conclusion] Both conservative therapy and surgi- cal repair achieve satisfactory and comparable clinical outcomes for acute patellar dislocation in adolescents. An individualized treatment plan should be made according to the concrete condition of the patient.

Abstract:[Objective] To compare the clinical outcomes of modified unilateral percutaneous vertebroplasty (PVP) versus bilateral PVP for osteoporotic vertebral compression fracture (OVCF) . [Methods] From June 2020 to December 2020, 86 patients underwent PVP for lumbar OVCF. According to doctor-patient communication, 51 patients received unilateral puncture via posterior upper margin of the vertebral body (unilateral group), while the other 35 patients received conventional bilateral puncture (bilateral group) . The perioperative period, follow-up and imaging consequences of the two groups were compared. [Results] All patients in both groups had operation complet- ed successfully, with bone cement leakage in 18 cases of the unilateral group, whereas 13 cases in bilateral group, without serious complica- tions. The unilateral group proved significantly superior to the bilateral group in terms of number of X- ray exposures and hospitalization costs (P＜0.05) , however, the former consumed significantly longer operative time than the latter (P＜0.05) , and there were no significant dif- ferences in bone cement injection amount, bone cement distribution, bone cement leakage, postoperative ambulation time, hospital stay and early VAS score between the two groups (P＞0.05) . During the follow-up lasted for 13~24 months, with an average of (15.8±2.1) months, the VAS scores and ODI decreased significantly (P＜0.05) , while JOA score increased significantly in both groups (P＜0.05) , and there were no significant differences in VAS, ODI and JOA scores between the two groups at any corresponding time points (P＞0.05) . Radiographical- ly, the anterior height of injured vertebrae increased significantly (P＜0.05) , whereas the local kyphotic Cobb angle decreased significantly in both groups postoperatively compared with those preoperatively (P＜0.05) , which proved not statistically significant between the two groups at any corresponding time points (P＞0.05) . [Conclusion] This modified unilateral puncture in PVP does achieve satisfactory clini- cal outcomes for lumbar OVCF, with advantages of optimizing surgical procedure and saving costs, despite of certain learning curve.

Abstract:[Objective] To explore the clinical outcomes arthroscopic reduction and internal fixation (ARIF) through the anterolateral approach for treatment of tibial plateau fractures. [Methods] A retrospective study was done on 95 patients who underwent surgical treat- ment for tibial plateau fractures from January 2018 to January 2020 in our hospital. Among them, 49 patients receive ARIF through antero- lateral approach, while the remaining 46 patients were treated with conventional open reduction and internal fixation (ORIF) according to the consequence of preoperative patient-doctor communication. The perioperative conditions, follow-up results and imaging data were com- pared between the two groups. [Results] All patients in both groups were successfully operated on without iatrogenic injuries to important blood vessels, nerves and meniscus. The ARIF group proved significantly superior to the ORIF group in terms of incision length, operative time, intraoperative blood loss, frequency of fluoroscopy, postoperative drainage, time to return ambulation with crutches, hospital stay and VAS score 3 days postoperatively (P＜0.05) . All patients in both groups were followed up for 12~24 months, with an average of (16.5±3.6) months. Adverse events were 1/49 (2.0%) in the ARIF group, whereas 8/46 (17.4%) in the ORIF group, which was statistically significant (P＜0.05) . The ARIF group resumed full weight-bearing activity significantly earlier than the ORIF group (P＜0.05) . In addition, the ARIF group was significantly superior to the ORIF group in terms of HSS, Lysholm and Rasmussen function scores, as well as knee flexion and ex- tension range of motions (ROMs) at 3 months and the latest follow-up (P＜0.05) . Regarding to radiographic evaluation, the ARIF group had significantly higher Rasmussen anatomical scores than the ORIF group immediately after surgery and at the latest follow-up (P＜0.05) . The articular surface collapse was significantly reduced in both groups immediately after surgery and at the last follow-up compared with those before operation (P＜0.05) , whereas which in the ARIF group were significantly less than those in the ORIF group immediately after surgery and at the latest follow-up (P＜0.05) . [Conclusion] The arthroscopic reduction and internal fixation is considerably superior to the conven- tional open reduction and internal fixation in term of clinical outcomes for tibial plateau fractures

Abstract:[Objective] To compare the clinical outcomes of intramedullary nailing through infrapatellar approach versus suprapatellar approach for tibial shaft fractures. [Methods] The literatures on comparison of suprapatellar and infrapatellar intramedullary nailing for tibi- al shaft fractures published before August 2021 was searched in databases, including PubMed, EMBASE, Cochrane Library, Wanfang data- base, Weipu database and CNKI. The meta-analysis was conducted by using Review Manager 5.3 software, involving the binary variables, such as fracture malunion, fracture nonunion, postoperative infection, and continuous variables, such as operation time, intraoperative bleeding, location of needle entry point, radiation dose, VAS score and Lysholm score. [Results] A total of 13 literatures were included in the study, involving 1 112 cases of tibial shaft fractures. As consequences of the meta-analysis, the suprapatellar approach proved signifi- cantly superior to the infrapatellar approach in terms of fracture malunion (OR=5.43, 95%CI: 2.16~13.65) , accuracy of nail placement (an- teroposterior MD=1.74, 95%CI: 1.22~2.27 and lateral MD=2.25, 95%CI: 1.35~3.16) , postoperative pain score (MD=0.81, 95%CI: 0.64~ 0.98) and Lysholm score (MD=-5.26, 95%CI: 6.52~4.00) . However, there were no statistically significant differences between the two groups in terms of non-union of fracture (OR=0.95, 95%CI: 0.55~1.65) , postoperative infection (OR=0.62, 95%CI: 0.25~1.57) , intraopera- tive blood loss (MD=0.18, 95%CI: 1.71~2.07) and intraoperative radiation exposure dose (MD=8.72, 95%CI: -6.24~23.68) . [Conclusion] The suprapatellar approach is considerably superior to the infrapatellar approach in reducing fracture malunion, improving accuracy of nail placement, reducing postoperative pain and enhancing function recovery after operation, especially for the proximal and distal tibial shaft fractures.

Abstract:In the foot and ankle there are many short bones, joints and ligaments with complex shape and biomechanics. The tissue de- fects of the foot and ankle due to accidental trauma and other reasons have serious impact on the foot's weight bearing and walking function. In recent years, with the continuous development of repair and reconstruction techniques, surgeons have a variety of surgical methods cho- sen. However, how to further reduce the risk of surgery and maximize the recovery of foot and ankle in shape and function has always been a research hotspot and difficult issue in surgical technique. Based on the types of tissue defects in the foot and ankle, this article extensively re- viewed the relevant literature on the repair and reconstruction methods and efficacy for tissue defects in the foot and ankle at home and abroad, and summarized various surgical methods to provide a reference for clinicians.

Abstract:Low back pain caused by intervertebral disc degeneration seriously affects the health of elderly patients, but also brings a huge burden to society and family. Intervertebral disc degeneration begins at age 18, and is accelerated by the age, with biomechanics, bio- chemistry, autoimmune inflammatory response and genetic predisposition factors. Intervertebral disc degeneration is a sequential, cascade pathological process that starts with changes in the microenvironment of intervertebral disc cells and progresses to changes in intervertebral disc structure and function. A major pathological feature is the release of inflammatory cytokines such as interleukin, which increased ex- pression of catabolic enzymes, degradation of extracellular matrix, and intervertebral disc cell apoptosis. As interleukins (ILs) plays an im- portant role in intervertebral disc degeneration, this article reviews the effect of interleukin on intervertebral disc degeneration.

Abstract:Acute hematogenous osteomyelitis (AHO) is one of the most common types of bone and joint infection in children, which should be accurately diagnosed on time and treated early with effective antibacterial drugs to achieve good prognosis. The rational use of an- tibiotics plays an important role in the treatment of this disease. The choice of antibiotics, the mode of administration and the course of treat- ment should be individualized according to the local epidemiology and drug resistance model, the severity of the disease, the virulence of pathogenic bacteria, the underlying diseases and immunity of children and their response to treatment. In addition, the epidemiology of the disease has changed rapidly in the past decade, especially the infection caused by methicillin- resistant Staphylococcus aureus (MRSA) , which poses a new challenge to the treatment.

Abstract:[Objective] To explore the effect of Ginseng Sinitang (GS) on vascular endothelial cells in rabbits with fracture. [Methods] A total of 72 elderly rabbits were randomly divided into 6 groups. Of them, the animals in the blank group, model group and heparin group were given normal saline intragastrically, and those in the 3 GS groups were given the drug in low-dose, medium-dose and high-dose respec- tively for 3 days. Subsequently, femoral fracture was established in 5 groups of rabbits except the blank group. Low molecular weight heparin was given subcutaneously for 7 days in the low, medium and high-dose groups as well as the heparin groups. Serum levels of cortisol (COR) , tumor necrosis factor-α (TNF-α) , interleukin-6 (IL-6) , endothelin (ET-1) and nitric oxide (NO) were detected. The pathological changes of femoral vein were observed by HE staining, while the ultrastructure change was seen by transmission electron microscope. The expres- sions of factors related to NF-κB pathway were detected by RT-PCR and Western blot. [Results] The incidence of deep vein thrombosis was significantly decreased in medium-dose and high-dose groups compared with model group (P＜0.05) . The levels of COR, TNF-α and IL-6 were significantly decreased in medium-dose and high-dose groups at 1, 3 and 7 days postoperatively with significantly change of ET1 and NO 7 days postoperatively (P＜0.05) . HE staining showed that endothelial cells in the model group were shed in different degrees with throm- bus and leukocyte infiltration in the lumen, while GS did relive the above changes. Under electron microscope, the mitochondrial swelling of endothelial cells was reduced and the rough endoplasmic reticulum was slightly expanded in the medium-dose group. The mRNA and pro- tein expressions of TLR4, MyD88 and NF-κB P65 in low, medium and high dose groups were significantly decreased compared with those in model group and heparin group (P＜0.05) . [Conclusion] GS does reduce postoperative stress reaction, improve the morphology and function of vascular endothelial cells, and inhibit the expression of NF-κB pathway related factors in elderly rabbits.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcome of total hip arthroplasty with long-stem cementless femoral component for end-stage hip arthropathy complicated with old subtrochanteric fracture. [Methods] In 2021, a patient with end-stage femoral head necrosis combined with old subtrochanteric fracture was admitted to our department and received total hip ar- throplasty (THA) with long-stem cementless femoral component. The femoral head was removed through the posterolateral approach under general anesthesia, and the acetabular component was placed firstly, and then the subtrochanteric fracture ends was exposed by lengthening the incision distally. After reduction, the fracture end was temporarily fixed with steel plate and cerclage wires. Finally, the long-stem ce- mentless femoral component was inserted in place to fix the fracture, subsequently, the head component was inserted, the hip was reduced and the incision was sutured in layers. [Results] The patient underwent the operation successfully with the hip prostheses in good position on radiographs. One week after operation, the patient was able to walk himself with an assistant device. The Harris score of the left hip was marked as 77, which was satisfactory curative effect. [Conclusion] This total hip arthroplasty with long-stem cementless femoral compo- nent proves effective treatment for end-stage hip arthropathy complicated with old subtrochanteric fracture.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopic superior capsule reconstruc- tion (SCR) with fascia lata autograft for irreparable massive rotator cuff tears (IRCT) . [Methods] From January 2018 to January 2020, 27 patients received the abovementioned surgical procedure for IRCT. After a thorough arthroscopic examination, the degenerated and tensionlose tissue was debrided, and the long head of biceps tendon (LHBT) was cut and fixed, or transferred individually as an appropriate mea- sure. According to the actual defect of the superior capsule, the fascia lata on the ipsilateral thigh was harvested to prepare the graft. The graft was introduced using the pulley technique, secured on the glenoid side and humeral head side with suture anchors, and then sutured with the surrounding tissue. [Results] The operation was performed successfully in all the 27 patients without complications, such as nerve and vascular injury. Subscapularis muscle repair in 20 cases, while LHBT transfer in 20 cases, and LHBT cut in 7 cases were conducted si- multaneously. All of them got incision healed well after operation, and were followed up for (19.4±3.1) months on an average. The CMS, ASES and UCLA scores increased significantly (P＜0.05) , whereas VAS score decreased significantly over time (P＜0.05) . Radiographical- ly, the acromiohumeral distance (AHD) significantly increased postoperatively compared with that preoperatively (P＜0.05) . All the patient maintained good graft appearance on images. [Conclusion] This arthroscopic superior capsule reconstruction (SCR) with fascia lata auto- graft is feasible technique for irreparable massive rotator cuff tears with satisfactory clinical outcomes in short-term.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of pullout of a three-suture net used in ar- throscopic fixation of anterior cruciate ligament (ACL) tibial avulsion fractures. [Methods] A total of 36 patients received abovementioned arthroscopic treatment for Meyer-McKeevers tye II~IV ACL tibial avulsion fractures in our hospital from January 2016 to June 2018. After a thorough arthroscopic examination through the standard anterolateral approach, a lumbar puncture needle with PDS suture was introduced crossed the anterior 1/2 of the tibial attachment base of the ACL. The first Ethibond No.2 wire was replaced and pass the ends under the transverse knee ligament to anteromedial tibial subcutaneously. After two bone tunnels were respectively drilled from the anteromedial tibi- al side to the anteromedial and anterolateral margins of the fractures, the second Ethibond No.2 wire was passed through one side tunnel, the posterior 1/2 of the tibial attachment base of the ACL and the other side bone tunnel. Then, the third suture was introduced on the first suture in the attachment. Finally, all the 3 sutures were pull out tightly, and then tied to reduce and fasten the fracture fragments firmly like a net. [Results] All patients got the operation completed successfully without related complications and infection. At last follow- up, the Lysholm, IKDC, and Tegner scores were significantly increased compared with those preoperatively (P＜0.05) . In terms of imaging, all the patients gained proper fracture reduction with fracture healing time of 12~16 weeks. [Conclusion] This arthroscopic three-suture net fixa- tion does achieve satisfactory clinical outcomes for ACL tibial avulsion fractures. with advantages of simple operation and high safety.

Abstract:[Objective] To evaluate the clinical efficiency of the posterolateral combined with the posteromedial approaches for open re- duction and internal fixation (ORIF) of posterior malleolus fractures. [Methods] From July 2017 to June 2020, 29 patients received ORIF of Haraguchi type Ⅱ posterior malleolus fractures through the posterolateral combined with the posteromedial approaches in our department. Clinical and imaging documents of the patients were evaluated. [Results] All the patients had the operation performed smoothly, with opera- tion time of 72~123 min with a mean of (85.2±18.7) min and the intraoperative blood loss of 30~80 ml with a mean of (47.4±23.8) ml, and good incision healing. All of them were followed up for 15 to 34 months, with an average of (20.1±3.5) months. The AOFAS score, VAS score and ankle range of motion significantly improved over time postoperatively (P＜0.05) . Radiographically, the quality of fracture reduc- tion was excellent in 24 cases, good in 5 cases and poor in 0 case, with an excellent and good rate of 100.0%. All the patients got fracture healed in 11~15 weeks postoperatively, with grade 1 ankle degeneration in 3 patients, which was not significantly different among each time points after operation (P＞0.05) , however, no fracture displacement, fracture nonunion and internal fixation loosening were noted in anyone of them until the latest follow-up. [Conclusion] The posterolateral combined with posteromedial approaches is fully exposed posterior mal- leolus fractures, which is conducive to fracture reduction and fixation with satisfactory function recovery.

Abstract:[Objective] To explore the clinical outcomes of pediatric physeal slide-traction plate (PPSP) for internal fixation of complex distal femoral fractures in children. [Methods] From March 2018 to March 2020, 20 children received open reduction and internal fixation with PPSP for complex distal femoral fractures. The perioperative, follow-up and imaging data were evaluated. [Results] All patients opera- tion performed smoothly without serious complications, and were followed up for more than 12 months. The time to resume full-weight bear- ing activity ranged from 9.5 to 12.0 weeks with an average of (10.7±0.5) weeks. The knee HSS score and ROM increased significantly over time after operation (P＜0.05) . In terms of imaging evaluation, the growth length of femur in all patients increased significantly (P＜0.05) , but the leg length discrepancy (LLD) and the mechanical lateral distal femord angle (mLDFA) remained unchanged significantly (P＞0.05) . At any corresponding time point, there was no significant difference in the femoral growth length between the affected side and the healthy side (P＞0.05) . [Conclusion] PPSP has the advantages of reliable fixation and no restriction on the longitudinal growth of epiphysis, which is an effective choice for the treatment of complex distal femoral fractures in children.

Abstract:[Objective] To explore and analyze the application value of robot-guided percutaneous pedicle screw placement in the pri- mary medical institution. [Methods] A total of 46 patients received internal fixation of thoracolumbar fracture in People's Hospital of Nan- chang County from September 2020 to September 2021. Based on preoperative patient-doctor communication, 22 patients underwent robot assisted pedicle screw placement, while the remaining 24 patients had pedicle screw placed by traditional free-hand technique. The clini- cal and image data were compared between the two groups. [Results] The robot group proved significantly superior to the free-hand group in terms of number of fluoroscopy and operation time (P＜0.05) . The two groups were followed up for 6~8 months, and there was no signifi- cant difference in the fracture healing time between the two groups (P＞0.05) . The VAS scores and ODI scores significantly reduced in both groups postoperatively (P＜0.05) , nevertheless there was no significant difference between the two groups at the corresponding time points (P＞0.05) . The robot group was significantly superior to the free-hand group in Gertzbein-Robbins scale of screw placement accuracy (P＜ 0.05) . The anterior vertebral height and local kyphotic Cobb angle of the injured vertebrae in the two groups were significantly improved af- ter operation (P＜0.05) , whereas which were not significantly different between the two groups at the corresponding time points (P＞0.05) . [Conclusion] The robot-assisted percutaneous pedicle screw insertion does reduce the number of fluoroscopy and operation time, improve the accuracy of screw placement, which has application value for primary hospitals.