Abstract:[Objective] To compare the efficacy of proximal femoral bionic nail (PFBN) and InterTAN intramedullary nail for unstable intertrochanteric fractures of the femur in the elderly. [Method] A retrospective analysis was conducted on 35 elderly patients with unstable intertrochanteric fractures of the femur who underwent surgical treatment in our hospital from June 2021 to December 2022. According to preoperative doctor-patient communication, 16 cases had the fractures fixed with the PFBN, while the remaining 19 cases were fixed with the InterTAN. The perioperative, follow-up, and imaging data were compared between two groups. [Result] All patients in both groups had corresponding surgical procedure completed successfully. Although the PFBN group had significantly greater surgical time [(111.6±15.9) min vs (98.9±15.9) min, P=0.025], incision length [(11.9±0.9) cm vs (10.9±1.1) cm, P=0.006], intraoperative fluoroscopy frequency [(19.2 ± 2.6) times vs (14.6±1.9) times, P＜0.001], and the intraoperative blood loss [(145.6±2.6) ml vs (120.5±31.1) ml, P=0.043], compared to the InterTAN group, the former had significantly earlier postoperative walking time than the latter [(19.1±2.0) d vs (23.8±3.2) d, P＜0.001] . The follow-up period lasted for (14.7±2.6) months in a mean , and the PFBN group had a significantly earlier recovery of full weight-bearing activity than the InterTAN group [(51.6±4.9) days vs (66.7±7.3) days, P＜0.001]. The VAS scores significantly decreased (P＜0.05), while Harris scores, hip flexion-extension ROM, and internal-external rotation ROM significantly increased in both groups over time (P＜0.05). The PFBN group was significantly better than the InterTAN group regarding Harris score [(64.9 ± 5.4) vs (55.0±5.7), P＜0.001] 1 month postoperatively, and [(73.1±4.8) vs (67.7±5.3), P=0.004] 3 months after operation. As for imaging, there was no statistically significant difference in the quality of fracture reduction and fracture healing time between the two groups (P＞0.05). At the last follow-up, the PFBN group remained significantly greater the femoral neck shaft angle (FNSA) (P＜0.05), while significantly less the tip apex distance (TAD) than the InterTAN group (P＜0.05). [Conclusion] The PFBN used for unstable intertrochanteric fractures in the elderly does shorten bed rest time, allows walking under weight early, promotes the recovery of body function, and reduces hip varus.

Abstract:[Objective] To investigate the clinical efficacy of 3D-printed guide leading palmar percutaneous screw fixation versus routine open fixation through dorsal incision for acute waist part fracture of the wrist scaphoid. [Methods] A retrospective research was done on 22 patients who received surgical fixation of scaphoid fracture at the waist part in our hospital from June 2018 to June 2021. According to the doctor-patient discussion, 10 patients underwent 3D printed guide leading percutaneous screw fixation (the guide group), while other 12 patients were treated with routine open fixation through dorsal incision (the routine group). Data of perioperative period, follow-up and images were compared between the two groups. [Results] All patients in both cohorts had operation performed successfully. The guide group proved significantly superior to the routine group in terms of operation time [(39.9±5.5) min vs (108.8±13.7) min, P＜0.001], the total incision length [(0.5±0.5) cm vs (5.9±0.9) cm, P＜0.001], intraoperative blood loss [(0.9±0.4) ml vs (7.8±2.0) ml, P＜0.001], intraoperative fluoroscopy times [(5.4±1.2) times vs (13.4±3.0) times, P＜0.001], hospital stay [(4.8±1.0) days vs (7.2±1.4) days, P＜0.001], and VAS score 7 days after surgery [(2.0±1.1) vs (3.5±1.0), P=0.003]. The follow-up period lasted for 5~27 months, and the guide group resumed full weightbearing activity significantly earlier than the routine group [(7.0±1.3) weeks vs (8.6±1.8) weeks, P=0.031]. In addition, the guide cohort was significantly better than the routine group regarding to Mayo score [(95.5±5.0) vs (83.3±5.4), P＜0.001], the wrist palmar flexion-dorsal extension range of motion (ROM) [(146.8±6.8)° vs (108.0±7.6)°, P＜0.001], the ulnar-radial deviation ROM [(32.0±4.4)° vs (19.9 ±3.1)°, P＜ 0.001], grip strength [(35.2±3.0) kg vs (29.8±5.3) kg, P=0.008] at the latest follow-up. Radiographically, there was no significant difference in fracture healing time between the two groups (P＞0.05), and no internal fixation devices broken or loosened were noted in anyone of them. [Conclusion] The 3D-printed guide leading percutaneous screw fixation of scaphoid fracture has benefits of facilitating surgical operation, better grip strength recovery and better wrist joint function recovery over the conventional open reduction and internal fixation via dorsal incision.

Abstract:[Objective] To study the characteristics of osteoporotic hip fractures complicated with bronchiectasis (BE) for better periop-erative evaluation and management. [Methods] From January 2020 to October 2022, 48 patients with bronchiectasis (the BE group) and 48 patients without BE (the non-BE group) were selected from those who underwent surgical treatment for osteoporotic hip fractures in our hospital. The impacts of BE were analyzed by univariate comparison, pairwise correlation analysis and binary logistic regression analysis. [Results] The BE patients had significantly lower bone mineral density (BMD) T value [(-2.5±0.4) vs (-2.2±0.6), P=0.003] and vitamin D levels [(14.9±2.3) ng/ml vs (18.5±2.4) ng/ml, P＜0.001] than the non-BE group, whereas the former had significantly higher incidence of postoperative acute pulmonary infection than the latter [cases (%), 20 (41.7) vs 5 (10.4), P＜0.001], despite of no significant difference in mortality in a year postoperatively between them (P＞0.05). In term of stratified comparison in the BE patients: the patients with acute pulmonary infection had lower vitamin D levels, higher mortality in a year after surgery, and more severe bronchiectasis severity index (BSI) than those without acute pulmonary infection (P＜0.05). In addition, the death group had lower vitamin D level, longer bed rest time, more severe BSI grade and higher incidence of postoperative acute pulmonary infection than the alive group (P＜0.05). As for pairwise correlation, the BSI grade was negatively correlated with BMD and vitamin D levels, while positively correlated with bed rest duration (P＜0.05). As results of logistic regression, the acute pulmonary infection (OR=9.16, P＜0.05) and intraoperative blood loss (OR=1.11, P＜0.05) were independent risk factors for death in one year after surgery, while high vitamin D levels may be a protective factor for death (OR=0.720, P＞0.05). [Conclusion] The patients with osteoporotic hip fracture complicated with BE usually have reduced bone mineral density and vitamin D levels, and are prone to acute pulmonary infection after surgery. The decrease of BMD and vitamin D levels are related to the BE severity. Postoperative acute pulmonary infection and intraoperative blood loss were independent risk factors for death in 1 year after surgery.

Abstract:[Objective] To search the factors affecting fracture-related infection (FRI) after fixation of lower extremity fracture. [Methods] A total of 5 982 patients received surgical treatment for lower extremity fractures in Tangshan Second Hospital from January 2018 to January 2022. Of them, 83 patients proved FRI were fall into the FRI group, while other 166 patients without FRI were selected as the nonFRI group based on fracture site, fracture operation, gender and age matching. The risk factors related to FRI after lower limb fracture fixation were analyzed by univariate comparison and binary multifactor logistic regression. [Results] Of 5 982 patients who underwent surgical treatment for lower extremity fractures, 83 patients had FRI after operation, with the incidence of 1.4%. The FRI group proved significantly greater than the non-FRI group in terms of smoking [y/n, (36/47) vs (35/131), P＜0.001], diabetes [y/n, (25/58) vs (21/145), P＜0.001], open damage [yes/no, (27/56) vs (18/148), P＜0.001], ASA classification [I/II/III, (31/17/35) vs (29/41/96), P=0.002], BMI [(27.2±3.6) kg/m² vs (25.5±2.7) kg/m² , P＜0.001], operation time [(180.0±48.0) min vs (138.5±44.6) min, P＜0.001], intraoperative blood loss [(351.6±101.5) ml vs (298.5±128.3) ml, P＜0.001], whereas the former had significantly less preoperative ALB than the latter [(34.4±2.4) g/L vs (37.2±4.0) g/L, P＜ 0.001]. As consequences of multi-factor logistic regression, the open injury (OR=3.658, P=0.005), smoking history (OR=2.436, P=0.014), poor ASA grade (OR=1.754, P=0.028), high BMI (OR=1.190, P=0.003), and long operation time (OR=1.021, P＜0.001) were the independent risk factors for FRI after lower limb fracture fixation, while the high preoperative ALB (OR=0.803, P＜0.001) was a protective factor. [Conclusion] The patients with smoking history, prolonged operation time, high BMI, severe ASA grade, and open injury have higher risk of lower limb FRI, and corresponding clinical measures should be taken to prevent it.

Abstract:[Objective] To explore the clinical efficacy of ultrasound-guided closed reduction and percutaneous Kirschner wire fixation for calcaneal fractures in children. [Methods] A retrospective study was conducted on 100 children admitted into our hospital for calcaneal fractures from January 2020 to August 2022. All of them received closed prying reduction and percutaneous Kirschner wire fixation. According to preoperative doctor-patient communication, 55 cases had operation performed under ultrasound guidance (ultrasound group), while other 45 cases were under fluoroscopy (fluoroscopy group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] The ultrasound group proved significantly superior to the fluoroscopy group in terms of operation time [(35.0±6.8) min vs (58.2±10.4) min, P＜0.001] and imaging check time [(325.0±25.6) s vs (600.5±73.5) s, P＜0.001], intraoperative fluoroscopy times [(2.7±0.8) times vs (10.2±2.8) times, P＜0.001], walk time [(3.0±0.5) days vs (3.5±1.0) days, P=0.002] and hospital stay [(4.5±1.6) days vs (5.4±2.0) days, P=0.014]. Compared with those 1 month after surgery, the VAS score, AOFAS score, ankle dorsal-plantar flexion and inversion-eversion range of motions (ROMs) significantly improved in both groups at the last follow-up (P＜0.05). One month after surgery, the VAS score in the ultrasound group was significantly better than that in the fluoroscopy group [(2.0±0.6) vs (2.3±0.7), P=0.023], whereas at other corresponding time points, there was no statistical significance in the above indexes between the two groups (P＞0.05). Regarding imaging, the Bohler's angle, Gissane's angle and articular cartilage collapse height were significantly improved over time in both groups (P＜0.05). The articular cartilage collapse height in the ultrasound group was significantly lower than that in the fluoroscopy group one month after surgery [(2.0±0.7) mm vs (2.5±0.6) mm, P＜0.001], regardless of no statistically significant differences in other imaging indicators between the two groups at any corresponding time points (P＞0.05). [Conclusion] Ultrasound-guided closed reduction and percutaneous Kirschner wire fixation has the advantages of shorter operation time, less radiation damage and less intraoperative bleeding over the fluoroscopy-guided counterpart for calcaneal fractures in children.

Abstract:[Objective] To compare the clinical efficacy of suture combined fixation versus steel wire combined fixation for comminuted fractures of the patellar inferior pole. [Methods] A retrospective study was done on 52 patients who received surgical treatment for comminuted fractures of the patellar inferior pole in our hospital from January 2019 to December 2021. According to preoperative surgeon-patient discussion, 28 patients were treated with suture combined fixation (the suture group), while other 24 patients underwent steel wire combined fixation (the wire group). The perioperative, follow-up and imaging documemts were compared between the two groups. [Results] All patients had corresponding surgical procedures performed successfully, with no serious complications occurred during the operation. Although there were no significant differences in the total incision length, intraoperative blood loss and incision healing grade between the two groups (P＞0.05), the suture group proved significantly superior to the wire group in terms of operation time [(60.7±7.8) mim vs (67.0±8.8) min, P=0.009], intraoperative fluoroscopy times [(2.2±0.5) times vs (4.3±0.8) times, P＜0.001], pain VAS score 5 days postoperatively [(4.5± 0.9) vs (5.5±0.8), P＜0.001], postoperative walking time [(2.2±0.6) days vs (3.0±0.7) days, P＜0.001] and hospital stay [(7.9±0.9) days vs (8.6± 1.3) days, P=0.015]. The follow-up period lasted for (18.3±3.8) months in a mean, and the suture group resumed full weight-bearing activity significantly earlier than the wire group [(10.9±3.1) weeks vs (12.7±2.5) weeks, P=0.031]. The VAS score for anterior knee pain, knee range of motion (ROM), Bostman and Kujala scores significantly improved in both groups over time (P＜0.05), which in the suture group were significantly superior to those in the wire group (P＜0.05), except Bostman score between two groups at 3 months after surgery and the latest follow-up (P＞0.05). As for imaging, there were no significant changes in Insall-Salvati index and patella length in both groups over time (P＞0.05). At all corresponding time points, the suture group had significantly less Insall-Salvati index (P＜0.05), while significantly greater patellar length than the wire group (P＜0.05), additionally, the former got fracture healing significantly earlier than the latter (P＜ 0.05). [Conclusion] The vertical interrupt sutures with Nice knot fixation combined with suture anchor takes benefits of shorter operation time, faster recovery, less complications and no need for a second operation to remove implant over the steel wire counterpart for fixation of comminuted fractures of the patellar inferior pole.

Abstract:[Objective] To analyze the characteristics and related factors of inferior glenohumeral subluxation (IGHS) after plate internal fixation of proximal humerus fractures. [Methods] A retrospective study was done on 152 patients who underwent open reduction and internal fixation (ORIF) with proximal humerus locking plate (PHLP) for proximal humeral fractures in our department from June 2018 to June 2021. The characteristics and related factors of IGHS were analyzed by univariate comparison and multivariate logistic regression. [Results] All patients had ORIF conducted smoothly, however, 58 patients (38.2%) of them were confirmed as IGHS, and the remaining 94 patients (61.8%), were proved non-IGHS based on of standing anteroposterior shoulder X-ray taken 1 week after operation. The patients in the IGHS group were immediately given high-position suspension with forearm sling, and deltoid muscle strength training, namely active and passive shrug exercise. At 1 month after ORIF, 57 patients with IFHS got subluxation disappeared. Regarding to univariate comparison, the IGHS group proved significantly higher ratio than the non-IGHS group in term of Neer type IV fracture [III/IV, (11/47) vs (82/12), P＜ 0.001], subluxation before surgery [yes/no, (28/30) vs (6/88), P＜0.001], deltopectoral approach [deltopectoral / deltoid splitting, (44/14) vs (55/39), P=0.030], and the former consumed significantly longer operation time than the latter [(123.9±35.6) min vs (75.6±20.4) min, P＜ 0.001]. As results of multifactor logic regression, the longer operation time (OR=3.133, P＜0.001), subluxation before ORIF (OR=2.550, P＜ 0.001), Neer type IV fractures (OR=2.347, P=0.023), and deltopectoral approach (OR=1.956, P＜0.001) were the independent risk factors for IGHS. [Conclusion] The IGHS after ORIF with PHLP for proximal humerus fracture is a common phenomenon with good prognosis. The most important factors related to IGHS after plate internal fixation are severe fracture types, inferior glenohumeral subluxation before operation, long operation time and deltopectoral approach.

Abstract:With the development of bone tissue engineering, bone repair materials such as 3D printed polymer materials and biocompatible scaffolders have become a research hotspot in the restoration of bone defects. Among them, poly (lactic acidco- glycolic acid) (PLGA) has good plasticity, biocompatibility and degradability. It is widely used in the research of bone defect repair materials and is an ideal material for bone defect repair. However, its application in repairing bone defects is limited by its poor mechanical properties, lack of osteogenic properties, weak acidity of local microenvironment after degradation, etc. Therefore, it is particularly important to compound it with different materials for modification. Based on the physicochemical properties and degradation mechanism of PLGA, this paper reviews the research on its composite with drugs, biomolecules, inorganic materials and organic materials, providing reference and theoretical support for the future clinical application of this material.

Abstract:Neuropathic pain (NP) after spinal cord injury (SCI) is a refractory complication because it can be severely debilitating and lead to inactivity and psychological problems such as depression and anxiety. There has been no major breakthrough in the treatment of NP and previous studies focused on conservative treatment such as drugs. As an invasive method, spinal cord stimulation (SCS) has been gradually accepted in clinic because of its definite effect and curative effect. However, the research is mainly concentrated in the field of lumbar and leg pain, and the application of upper limb pain after cervical spinal cord injury is few. This paper reports a case who received SCS treatment for upper extremity NP secondary to cervical SCI, and reviews the literature on the treatment of NP by SCS, providing reference for clinicians to handle this condition.

Abstract:Cephalomedullary nail fixation has become a mainstream surgical method for femoral intertrochanteric fractures in the elderly at present. Except for Asian proximal femoral nail anti-rotation-II (PFNA-II), all cephalomedullary nails contain inner locking screws at the tail of the main nail. The initial function of the inner locking screw is to prevent the rotation of the implants in the head and neck. There is a lot of clinical controversy about whether to tighten the inner locking screw during the operation to prevent or preserve the sliding of the implants in the head and neck. By referring to the literature and the instructions of various cephalomedullary nails, this paper summarized and analyzed the history, types, clinical application and use disputes of inner locking screws, so as to obtain a consensus on the use of inner locking screws and provide reference for improving the fixation effect of femoral intertrochanteric fractures.

Abstract:Choke vessels serves as bridges connecting adjacent vascular territories in perforator flaps and play a significant role in improving the survival rate of perforator flaps. Currently, research on how to enhance the survival rate of perforator flaps focuses on increasing the blood supply of choke vessels by various measures. By reviewing the research progress of choke vessels in perforator flaps, we analyzes the impact of different intervention measures on choke vessels, and aims to provide reference directions for future research on improving the survival rate of perforator flaps.

Abstract:[Objective] To introduce the surgical techniques and preliminary clinical results of fixation of complex acetabular fractures through the pararectus approach. [Methods] From July 2019 to June 2022, a total of 14 patients received infra-acetabular screw fixation of complex acetabular fractures through the pararectus approach. Through the pararectus approach, the anterior column fracture was reduced and fixed by a reconstructive plate along the upper boundary of the pelvis, with the quadrilateral body fixed by iliac plate or comb screws. In addition, an infra-acetabular screw 3.5mm or 4.5mm in diameter was inserted at the medial end of the iliopectineal eminence towards the ischiatic tubercle through the third window of the para-rectus approach. [Results] All the patients had operation performed successfully without vascular or nerve injury, whereas with an average operation time of (153.5±45.6) min, and an average intraoperative blood loss of (465.7±249.5) ml. Based on Matta criteria, the quality of fracture reduction was excellent in 12 cases and good in 2 cases. The Merled'Aubigne-Postel score ranged from 14 to 18 at the last follow-up lasted for (14.5±4.7) months in a mean, accordingly, 9 cases were excellent, 4 cases were good and 1 case was fair. [Conclusion] Fixation of complex acetabular fractures by a single para-rectus approach, in which the anterior and posterior columns are fixed with infra-acetabular screw to enhance the overall stability of the internal fixation, does achieve satisfactory clinical results.

Abstract:[Objective] To investigate the clinical outcomes of interlocking intramedullary nail combined with tibiofibular screw for fixation of distal fibular fracture complicated with inferior syndesmosis injury. [Methods] A retrospective study was conducted on 29 patients who had distal fibular fracture fixed with interlocking intramedullary nail, and tibiofibular syndesmosis fixed by tricortical screw in our hospital from January 2019 to February 2022. The clinical and imaging data were evaluated. [Results] All patients were operated successfully with operation time of (51.8±10.3) min, the intraoperative blood loss of (68.3±14.3) ml, the total incision length of (42.5±3.6) mm, and followed up for (13.7±2.4) months. The VAS score, AOFAS score and ankle ROM were significantly improved over time (P＜0.05). In terms of imaging, compared with those preoperatively, the inferior tibiofibular overlap (TFO) [(2.1±0.7) mm, (8.1±1.3) mm, (8.0±1.1) mm, P＜0.001] and talocrural angle (TCA) [(73.9±4.2), (83.1±3.0), (82.4±2.9), P＜0.001] increased significantly 6 months after surgery and at the latest follow-up, while the tibiofibular clear space (TFCS) decreased significantly [(8.3±1.3) mm, (4.3±0.5) mm, (4.4±0.5) mm, P＜0.001]. [Conclusion] The interlocking intramedullary nail combined with tibiofibular screw does effectively treat distal fibular fracture complicated with inferior tibiofibular syndesmosis injury, with advantages of small incision, less bleeding, anti-rotation and reliable fixation of the syndesmosis.

Abstract:[Objective] To compare the early clinical outcomes of primary total knee arthroplasty (TKA) with or without patellar resurfacing. [Methods] A retrospective study was conducted on of 45 patients (52 knees) who received primary TKA for knee osteoarthritis in our departments from February 2018 to December 2020. According to doctor-patient discussion, 24 patients (28 knees) had patellar resurfacing replacement, while other 21 patients (24 knees) had not patellar resurfacing replacement in TKA. The perioperative and follow-up results were compared between the two groups. [Results] The operation was successfully completed in both groups, and there were no significant differences in operation time, intraoperative blood loss, incision length and postoperative ambulation between the two groups (P＞0.05). All patients in both groups were followed up for more than 3 months, and got significant improvement in terms of VAS and KSS scores at the last followup compared with those before surgery. However, there were no significant differences between the two groups in VAS score [(1.6±1.0) vs (1.8±0.9), P=0.781] and KSS score [(86.3±7.9) vs (84.6±7.9), P=0.865] at the latest follow-up. [Conclusion] There is no significant difference in term of the early consequence of primary TKA with or without patellar resurfacing replacement.

Abstract:[Objective] To observe the clinical effect of double-layer artificial dermis in repairing wound with exposed Achilles tendon insertion. [Methods] From April 2015 to August 2020, 7 patients received debridement and VSD in the first stage for wound with exposed Achilles tendon insertion, and then had the wound covered with double layer artificial dermis in the second stage as the wounds became fresh and clean. Open the gauze 2~3 days after surgery to observe the wound conditions, and then change the dressing every 3~4 days. Two to three weeks after surgery, pink dermal tissue covered the exposed bone and Achilles tendon, and the wound was naturally epithelialized by regular dressing changes. [Results] All the wounds in the 7 patients completely healed after natural epithelialization in 18~34 days, and no autologous skin grafting was performed in anyone of them. After 6~18 months of follow-up, the repaired wound skin was full and elastic, without obvious scar contracture and pigmentation, and wear-resistant texture without rupture. At the last follow-up, the AOFAS score was (90.6±4.6) and the VSS score was (5.1±1.8). [Conclusion] The application of double-layer artificial dermis is simple, less damaging and effective to repair the wound with exposed Achilles tendon insertion.

Abstract:[Objective] To compare the surgical efficacy of distal locking screw placement among conventional mechanical guide (CMG), two pin fluoroscopy (TPF) and domestic visual electromagnetic navigation system (EMN). [Methods] A retrospective study was performed on 45 adult patients who received interlocking intramedullary nailing for femoral shaft fractures from January 2018 to July 2022. According to the doctor-patient communication, the patients were divided into a CMG, TPF and EMN groups, with 15 cases in each group. The operative efficacy of the three groups was compared. [Results] All patients in the 3 groups had operation performed successfully. The CMG, TPF and EMC group were recorded in terms of operation time [(150.5±39.5) min vs (118.3±31.4) min vs (113.3±29.5) min, P=0.008], total length of the distal incision [(5.2±0.3) cm vs (4.0±0.3) cm vs (4.1±0.2) cm, P＜0.001], distal locking time [(39.3±12.3) min vs (32.1±7.7) min vs (30.1±6.1) min, P=0.020], fluoroscopy times for distal locking [(8.1±2.6) times vs (10.3±2.4) times vs (4.3±1.0) times, P＜0.001], and the success rate of the first screw placement of the distal hole (66.7% vs 80.0% vs 100%, P=0.042). The VAS scores for pain of the CMG, TPF and EMC groups were [(4.8±0.7) vs (3.7±0.7) vs (3.5±0.6), P＜0.001] one week after surgery, while which became not statistically significant among the three groups at the latest follow-up (P＞0.05). [Conclusion] Compared with the conventional mechanical guide, both two pin fluoroscopy and visual electromagnetic navigation system do improve operation efficacy in shortening the time of distal screw placement and shortening the total operation time.

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