Abstract:[Objective] To compare the clinical outcomes of the fully threaded headless compression screws (FTCS) versus intramedul-lary nails (IMN) used as internal fixations in tibiotalocalcaneal arthrodesis (TTCA) for end-stage ankle and subtalar arthropathy. [Methods]A retrospective study was conducted on 52 patients (52 feet) who received TTCA for end-stage ankle and subtalar osteoarthritis in our hospi-tal from 2018 to 2022. Based on the preoperative patient-doctor discussion, 28 patients had tibiotalocalcaneal joints fixed with multiple FTC-Ss, while the remaining 24 patients were fixed with IMN. The documents regarding to perioperative period, follow-up and images were com-pared between the two groups. [Results] All the patients in both cohorts had TTCA performed successfully, without statistically significantdifferences between the two groups in terms of operation time, total length of incision, intraoperative blood loss, number of intraoperative fluo-roscopy, ambulation time, incision healing grade, ratio of percutaneous nerve injury, and hospital stay (P＞0.05). The follow-up period lastedfor more than 12 months, and the FTCS group resumed full weight-bearing activity significantly earlier than the IMN group [(125.7±38.9)days vs (149.2±23.6) days, P=0.013]. The VAS scores significantly decreased at the last follow-up compared with that preoperatively (P＜0.05), while the AOFAS scores significantly increased at the last follow-up compared with that 3 months postoperatively in both groups (P＜0.05). The FTCS group proved significantly superior to the IMN group in term of AOFAS score 3 month postoperatively and at the latest fol-low-up [(61.5±4.8) vs (57.3±7.0), P=0.015; (75.2±6.7) vs (70.7±8.5), P=0.036]. As for imaging, the tibiocalcaneal angle (TCA), calcaneal off-set (CO) and internal arch angle (IAA) significantly improved in both groups at the latest follow-up compared with those preoperatively (P＜0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P＞0.05). However, the FTCSgroup got bony fusion on images significantly earlier than the IMN group (P＜0.05). [Conclusion] The FTCS achieved considerably betteroutcome in terms of AOFAS scores, time to regain full weight bearing activity, and bony fusion time on images over the IMN for end-stage an-kle and subtalar arthropathy in this paper.

Abstract:[Objective] To compare the clinical efficacy of open reduction and internal fixation (ORIF) based on comprehensive classi-fication versus ORIF based on AO classification for pilon fractures, and to provide a reference for the surgical plan making. [Methods] Aretrospective study was conducted on 90 patients who received ORIF for pilon fractures from June 2017 to October 2019. According to thepreoperative doctor-patient communication, the patients were divided into two groups. Of them, 45 patients had ORIF performed based oncomprehensive classification (the comprehensive group), while other 45 patients had operation conducted based on the traditional AO classi-fication (the AO group). The documents of perioperative period, follow-up and images were compared between the two groups. [Results]The comprehensive group proved significantly superior to the AO group in terms of incision length [(13.2±1.5) cm vs (13.8±1.0) cm, P=0.018], intraoperative blood loss [(50.9±18.4) ml vs (63.8±17.6) ml, P＜0.001] and hospital stay [(13.4±3.6) days vs (16.2±5.6) days, P=0.006]. The average follow-up time was of (18.5±4.6) months, and the comprehensive group resumed full weight-bearing activity signifi-cantly earlier than the AO group [(84.4±6.1) days vs (87.3±7.4) days, P=0.046]. The ROM, VAS scores and AOFAS scores in both groupswere significantly improved over time (P＜0.05), which in the comprehensive group were significantly better than those in the AO group atall corresponding time points after surgery (P＜0.05). With respect of imaging, fracture reduction quality in the comprehensive group was sig-nificantly better than that in the AO group [excellent/good/poor, (17/22/6) vs (12/16/17), P=0.029]. Compared with those preoperatively, theheight, width, coronal angle and sagittal angle of ankle mortise in both groups were significantly improved at the last follow-up (P＜0.05). Atthe last follow-up, the comprehensive group proved significantly better than the AO group regarding to the height [(23.2±2.5) mm vs (24.3±2.5) mm, P=0.044], width [(39.9±2.3) mm vs (41.8±2.9) mm, P＜0.001], coronary angle [(6.4±1.1)° vs (6.9±1.0)°, P=0.044], sagittal angle ofthe ankle mortise [(13.0±1.3)° vs (13.7±1.6)°, P=0.030]. [Conclusion] The clinical consequence of ORIF based on comprehensive classifi-cation are significantly better than the ORIF based on AO classification, suggesting that comprehensive classification has important clinicalsignificance in guiding ORIF.

Abstract:[Objective] To investigate the impact of sarcopenia on the prognosis of hemiarthroplasty for femoral neck fractures. [Methods] A retrospective analysis was performed on 102 patients who underwent hemiarthroplasty due to femoral neck fractures from January2021 to December 2023. According to the Chinese Medical Association's "Consensus on sarcopenia", the patients were divided into twogroups, the sarcopenia group and non-sarcopenia group. The documents regarding perioperative period, follow-up and images were com-pared between the two groups. [Results] Among the 102 patients included in this study, 38 were consistent with sarcopenia, accounting for37.25%, while the remaining 64 were of non-sarcopenia, accounting for 62.75%. All patients in both groups had hemiarthroplasty per-formed successful without serious complications, such as perioperative death. Although there was no significant difference in operativetime, fluoroscopy times, and blood loss between the two groups (P＞0.05), the sarcopenia group proved significantly inferior to the non-sarco-penia group in terms of incision healing quality [A/B, (34/4) vs (64/0), P=0.008], ambulation time [(6.7±0.7) days vs (6.0±0.5) days, P＜0.001], hospital stay [(12.4±2.2) days vs (10.9±2.0) days, P=0.001], incision healing time [(11.5±1.9) days vs (10.4±1.7) days, P=0.003] andtotal complication rate [cases (%), 6 (15.8) vs 2 (3.1), P=0.021]. In addition, the sarcopenia group resumed full weight-bearing activity sig-nificantly later than the non-sarcopenia group [(74.3±8.5) days vs (70.1±7.4) days, P=0.010]. The extension-flexion range of motion (ROM),interal-external rotation ROM and HHS scores significantly increased in both groups over time (P＜0.05). However, the sarcopenia groupwas significantly poorer than the non-sarcopenia group regarding abovesaid itmes at all corresponding time points (P＜0.05). As for imagingat the last follow-up, the sarcopenia group were more serious than the non-sarcopenia group in the limb length discrepancy (LLD), the oc-currence of ectopic ossification, prosthesis loosening and acetabular wear, whereas which were not statistically significant between them (P＞0.05). [Conclusion] The incidence of sarcopenia in patients with femoral neck fracture is high, and it may affect the prognosis of hemiar-throplasty.

Abstract:[Objective] To compare the clinical outcomes of arthroscopic reduction and internal fixation of Hawkins II type talus neckfractures with or without robotic assistance. [Methods] From February 2019 to February 2023, 65 patients with Hawkins II type talus neckfractures were treated by arthroscopic reduction and internal fixation. According to preoperative doctor-patient communication, 33 patientshad fractures fixed by cannulated screws under robotic assistance (robot group), and the other 32 patients were with conventional methods(the conventional group). The perioperative, follow-up and imaging data were compared between the two groups. [Results] Although therewas no significant difference in surgical blood loss, ankle arthroscopic operation time, hospital stay, incision healing quality and complica-tion rate between the two groups (P＞0.05), the robot group proved significantly superior to the conventional group in terms of screw place-ment time [(29.9±5.3) min vs (37.6±6.7) min, P＜0.001], intraoperative fluoroscopy times [(4.6±1.2) times vs (9.7±1.7) times, P＜0.001], andsuccess rate of first screw placement (94.0% vs 56.3%, P＜0.001). There was no significant difference to regain full weight-bearing activitiesbetween the two groups (P＞0.05). As time went on, the VAS scores significantly decreased (P＜0.05), while foot varus-valgus range of mo-tion (ROM), ankle-dorsal-plantar flexion ROM and AOFAS scores significantly increased in both groups (P＜0.05), whereas which were notstatistically significant between the two groups at 3 months postoperatively and the last follow-up (P＞0.05). Regarding imaging, there wereno significant differences in fracture reduction quality, postoperative Takakura degeneration scale and adverse signs between the two groups(P＞0.05). [Conclusion] Robot-assisted arthroscopic reduction and internal fixation of Hawkins II type talus neck fractures does shorten thefixation time, reduce the number of fluoroscopy, and improve the success rate of one time screw placement.

Abstract:[Objective] To compare the clinical outcomes of anterior approach femoral head replacement for femoral neck fracture withor without capsule suture. [Methods] A retrospective study was conducted on 82 elderly patients who received anterior approach femoralhead replacement for femoral neck fractures in our hospital from February 2015 to June 2020. According to preoperative doctor-patientcommunication, 35 patients had capsule sutured, while other 47 patients were unsutured. The documents regarding to perioperative period,follow-up and images were compared between the two groups. [Results] Although the sutured group consumed significantly longer opera-tive time than the unsutured group [(72.3±10.4) min vs (53.6±8.9) min, P＜0.001], the former proved significantly superior to the latter interms of intraoperative blood loss [(172.6±24.6) ml vs (226.3±32.5) ml, P＜0.001], postoperative ambulation time [(4.2±1.0) days vs (5.6±1.7)days, P＜0.001] and hospital stay [(10.3±2.3) days vs (12.5±2.4) days, P＜0.001]. All patients were followed up for more than 12 months, andthe sutured group resume full weight-bearing activity significantly earlier than the unsutured group [(48.3±8.0) days vs (70.4±13.3) days, P＜0.001]. Compared with those 6 months after surgery, the pain VAS score significantly decreased (P＜0.05), while SF-36, Harris scores andhip extension -flexion ROM significantly increased in both groups at the latest follow-up (P＜0.05). At all corresponding time points, VASscore and SF-36 score in sutured group were significantly better than those in unsutured group (P＜0.05). As for imaging, the sutured groupgot significantly less bilateral femur length discrepancy than the unsutured group at the last follow-up (P＜0.05). [Conclusion] Suturing thejoint capsule is significantly better than the non-suturing regarding many factors such as intraoperative blood loss, postoperative recovery,pain relief, quality of life improvement and hip function recovery in hemiarthroplasty for femoral neck fracture.

Abstract:[Objective] To evaluated clinical consequences of closed reduction and percutaneous Kirschner wire fixation of Jacob typeIII lateral humeral condylar fracture (LHCF) in children. [Method] A retrospective research was conducted on 37 children who had Jacobtype III LHCF fixed with Kirschner wires in our hospital from December 2020 to August 2022. Based on preoperative communication be-tween doctors and patients, 19 children received closed reduction and percutaneous Kirschner wire fixation (the CRPF group), while other18 patients were treated by open reduction and internal fixation with Kirschner wire (the ORIF group). The documents regarding to perioper-ative period, follow-up, and images were compared between the two groups. [Result] All patients in both groups had operation performedsuccessfully without any serious complications, such as neurological or vascular damage during the operation. The CRPF group proved sig-nificantly superior to the ORIF group in terms of intraoperative bleeding [(11.3±0.4) ml vs (67.9±2.0) ml, P＜0.001], operation time [(39.2±6.1) min vs (68.4±7.7) min, P＜0.001], and hospital stay [(6.3±0.1) days vs (13.5±0.2) days, P＜0.001], while the CRPF group consumed sig-nificantly greater number of intraoperative fluoroscopy than the ORIF group [(8.6±1.2) times vs (4.0±1.1) times, P＜0.001]. There was no sta-tistically significant difference in time of postoperative external fixation time and incision healing grade between the two groups (P＞0.05).All patients in both groups were followed up for 9~15 months, with an average of (12.3±0.3) months. There were no statistically significantdifferences in time to regain full weight-bearing activity and Flynn scale at the latest follow-up between the two groups of patients (P＞0.05). The VAS score and MEPS score significantly improved in both groups over time (P＜0.05). The CRPF group was significantly betterthan the ORIF group in VAS one day after surgery [(4.6±1.0) vs (6.9±0.9), P＜0.001], despite of the fact that there was no statistically signifi-cant difference in VAS score and MEPS score between the two groups at the remaining time points (P＞0.05). As for radiology, there was nosignificant difference in fracture reduction quality, fracture healing time, carrying angle and SCA between the two groups (P＞0.05), and allchildren in both groups had fractures healed without any loosening or fracture of internal fixation at the latest follow-up. [Conclusion]Closed reduction and percutaneous Kirschner wire fixation of Jacob type III lateral humeral condylar fracture in children has the advantag-es of shortening surgical time, minimizing bleeding, no need for incision, relieveing postoperative pain, and is beneficial for early recoveryof the fracture in children.

Abstract:[Objective] To investigate the predictive value of diffusion weighted imaging (DWI) of MRI in recurrent fractures of thesame vertebra after percutaneous vertebroplasty (PVP). [Methods] From January 2020 to June 2022, 80 patients who received PVP treat-ment in Liaoyou Baoshihua Hospital of Panjin were included in the study, and were divided into the refracture group (the RF group) and thenon-fracture group (the NF group) according to whether there was a refracture of the same vertebra after surgery. The risk factors of recur-rent fracture were analyzed by univariate comparison and multivariate logistic regression, the predictive efficacy of apparent diffusion coeffi-cient (ADC) in recurrent fracture was analyzed by ROC curve, and Pearson analysis was performed for the correlation. [Results] As followupperiod lasted for (18.0±4.0) months in a mean, 24 cases (30.0%) proved refracture at the same vertebral body. As results of univariatecomparison, the RF group had was significantly greater than the NF group in terms of bone mineral density T value [(-3.6±0.8) vs (-3.2±0.6), P=0.016], preoperative IVC ratio [yes/no, (9/15) vs (2/54), P＜0.001], fracture line involved end-plate ratio [yes/no, (13/11) vs (16/40),P=0.029], postoperative fluid accumulation around bone cement ratio [yes/no, (9/15) vs (4/52), P=0.002], vertebral height restoration rate[(10.5±2.5)% vs (6.5±2.2)%, P＜0.001] and ADC values [(1.8±0.5) 10^-3mm²/s vs (1.0±0.3) 10^-3mm²/s, P＜0.001]. As for multivariate logisticanalysis, the preoperative IVC (OR=8.864, P=0.005), ADC value (OR=3.241, P=0.024), vertebral height recovery rate (OR=2.746, P=0.012), postoperative fluid accumulation around bone cement (OR=2.261, P=0.029) were the independent risk factor for recurrent fractureof the same vertebra after surgery. The area under the curve (AUC) predicted by ADC values for recurrent fractures was 0.953. In addition,the ADC values were negatively correlated with bone mineral density (r=-0.335, P＜0.001), whereas positively correlated with vertebralheight recovery (r=0.250, P＜0.001). [Conclusion] MRI-DWI has a certain predictive value for the recurrence of the same vertebral bodyfracture after PVP. By evaluating the risk factors such as DWI-ADC value and IVC value of MRI, it may be beneficial to prevent the recur-rence of fracture after PVP.

Abstract:[Objective] To compare the clinical efficacy of folded repair (FR) and direct repair (DR) of the medial patellofemoral liga-ments (MPFL) with suture anchors for acute patellar dislocation with patellar side injury. [Methods] A retrospective study was conductedon 34 patients who received MPFL repair with suture anchors for acute patellar dislocation from October 2015 to May 202. According to thedoctor-patient discussion, 18 patients underwent FR, while the remaining 16 patients underwent DR. The documents regarding to perioper-ative period, follow-up and imaging were compared between the two groups. [Results] All the patients in both groups got operation per-formed successfully with no statistically significant differences in terms of operation time, incision length, intraoperative blood loss, postop-erative walking time and hospital stay between the two groups (P＞0.05). All of them were followed up for an average of (4.3±1.1) years, andthere was no significant difference in time to resume full weight-bearing activity between the two groups (P＞0.05). The VAS score for anteri-or knee pain, IKDC and Kujala scores, as well as knee flexion extension range of motion (ROM) were significantly improved in both groupsat the last follow-up compared with those preoperatively (P＜0.05), whereas which were not of statistically significant differences betweenthe two groups at any time points accordingly (P＞0.05). During follow-up, no re-dislocation occurred in anyone of the FR group, whereas 2patients (2/16) of re-dislocation happened in the DR group. Radiographically, the patellar tilt (PT) and patellar shift (PS) were significantlyreduced in both groups at the last follow-up compared with pre-operation (P＜0.05), however, there were no statistically significant differ-ences in the abovementioned imaging measurements between the two groups in any matching time points (P＞0.05). [Conclusion] The clini-cal outcomes of the two kinds of suture-anchor repair is satisfactory and comparable for acute patellar dislocation due to patellar side inju-ry. However, the folded repair might take a advantage of preventing patellar re-dislocation over the direct repair.

Abstract:N6-methyladenosine (m6A) is a reversible post-transcriptional modification that plays an important regulatory role in thelife activities of all eukaryotes. In recent years, m6A methylation has been found to regulate bone development and bone homeostasis bymodulating key genes such as RNA stabilization and translation efficiency. In this review, we summarize the current functional roles of m6Amethylation and its related regulators in bone metabolism and osteoporosis, as well as the important advances of m6A methylation-relatedregulators as potential therapeutic targets. These findings will provide new directions and insights into the in-depth study of m6A methyla-tion in osteoporosis, as well as new strategies for the pharmacological treatment of osteoporosis.

Abstract:Nonunion is a more common complication after humeral fracture, defined as no sign of bone healing for at least 9 months af-ter humerus fracture. The incidence of nonunion after humeral fracture is high in elderly patients, resulting in deformity and loss of functionof the affected limb, which seriously affects the daily life, as well as physical and mental health of patients. The etiology, risk factors, treat-ment and prognosis of postoperative nonunion of humerus fracture have been reported many times in the previous literature, however, postoperativenonunion of humerus complicated with a huge cladding formation has rarely been reported in the literature. In this paper, we re-port a case of nonunion complicated with a huge cladding formation after plate fixation of humerus fracture, and analyze its mechanism andtreatment. In addition, this paper reviews the relevant literature.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of anterior and posterior percutaneous Infixfixations of pelvic ring injury. [Methods] From January 2021 to October 2023, 6 patients with anterior and posterior pelvic ring injurieswere treated surgically. The Infix of the posterior pelvic ring was performed in the forward position of prone or floating position, and then theInfix of the anterior pelvic ring was performed in the backward position of supine or floating position. Firstly, an incision was made abovethe posterior superior iliac spine on both sides to expose the iliac bone, and part of the iliac bone was chiseled above the posterior superioriliac spine, followed by an opening between the internal and external plates of the iliac crest. The pedicle screws were placed aiming the an-terior inferior iliac spine, and a transverse connecting rod in appropriate length was placed to tighten the tail cap after reduction of fractureor dislocation. After that, the patient was placed in a supine position or a floating position. Incisions were made centered on both side of theanterior inferior iliac spine to reveal the bone. The screws were inserted in the direction to the posterior superior iliac spine, and the tail ofthe screw was about 2 cm from the anterior inferior iliac spine. A precurved connecting rod was placed under the abdominal wall and lockedthe tail cap after reducing the pelvic fracture or dislocation. [Results] All the 6 patients were successfully operated on without serious com-plications, such as major blood vessel and nerve injury, and were followed up for 6~36 months. According to Majeed function score, 4 pa-tients were excellent, 1 was good and 1 was fair, with the excellent and good rate of 83.3%. Chronic sacroiliac joint pain occurred in a pa-tient who was marked as fair in clinical evaluation. Regarding image evaluation, the reduction quality was excellent in 4 cases and good in 2cases, with the excellent and good rate of 100% based on the Matta's criteria. Bone healing achieved in all of the 6 paitients 3 months afteroperation with no loss of reduction or failure of internal fixation, and the implants were removed 3 months after surgery. [Conclusion] Ante-rior and posterior percutaneous Infix fixations are minimally invasive technique with advantages of simple operation, reliable fixation, few complications, and good clinical outcomes in the treatment of pelvic ring injury.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of free flap and bone transportation withTaylor spatial frame (TSF) for bone and soft tissue defects around the ankle. [Methods] A total of 16 patients were surgically treated forbone and soft tissue defects around the ankle from January 2016 to February 2020. In the first stage, complete debridement was performedto remove infected and necrotic bone and soft tissue, temporary fixation was performed with a simple external fixation frame, and the defectwound was covered with vacuum sealing drainage (VSD). In the second stage, according to the wound site, area, soft tissue defect and vascu-lar condition, the free lat dorsal myocutaneous flap, anterolateral femoral myocutaneous flap and medial gastrocnemius myocutaneous flapwere used to repair the soft tissue defect. After the survival of the flap, the bone transportation or tibiotalars fusion with TSF were performedat the third stage according to the extent of bone defects. During the last operation, TSF was installed and fixed according to the require-ments of treatment with osteotomy. One week after the surgery, an electronic prescription was made according to the deformity, installationand frame parameters measured before surgery. The bone transportation with TSF were adjusted at a rate of 1 mm/d per day, divided intofour times, and finally distraction osteogenesis and tibial talus fusion were completed. [Results] All the 16 patients were followed up for 14~52 months, with external frame wearing time of (17.3±2.4) months, the bone healing of (14.8±1.4) months, and the total treatment time of(17.9±2.2) months. At the last follow-up, total tibial lengthening was of (7.5±1.1) cm. The clinical outcome was marked as excellent in 12cases and good in 4 cases based on AOFAS criteria. [Conclusion] Free flap and bone transportation with Taylor spatial frame can effective-ly repair bone and soft tissue defects around the ankle, with high success rate of tibiotalar fusion, good recovery of alignment and successfulreconstruction of lower limb function.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results for the management of soft tissue complica-tions of in bone transportation for tibial bone defect secondary to osteomyelitis. [Methods] From January 2017 to December 2022, 54 pa-tients with chronic osteomyelitis of tibia were treated with bone transportation, with the soft tissue complication treated accordingly. The lo-cal debridement, skin grafting or skin flap transplantation, and skin stretch device were used for skin infection or necrosis around the junc-tion. Local soft tissue release was used for occlusal soft tissue incarceration, while bone grafting at the joint ends combined with replacementof plate external fixation was conducted for soft tissue incarceration at the joint end complicated with bone nonunion. In addition, local de-bridement and skin stretching were performed for late soft tissue defect with bone exposed again. [Results] The bone lengthened ranged from3 cm to 14 cm, and the external fixation index was of 1.2~2.5 months /cm in the 54 patients. Of them, 30 patients got conjunctional end heal-ing without soft tissue complications, whereas the remaining 24 patients had soft tissue related complications around the conjunctional ends,accounting for 44.4%. However, all the local soft tissue complications were solved effectively after the corresponding treatment as mentionedabove. [Conclusion] The incidence of soft tissue complications of bone transportation with Ilizarov frame for tibial bone defect secondary os-teomyelitis is high, including soft tissue reinfection in the early stage, simple soft tissue incarceration, soft tissue incarceration with bone non-union, and late soft tissue redefect with bone exposure. Although the related complications can eventually be solved through later treatment,the obvious prolongation of the treatment process and increase the burden of patients should be paid great attention to by orthopedic surgeon.

Abstract:[Objective] To investigate the clinical efficacy of posterior column osteotomy (PCO) and long-level pedicle screw fixationin the treatment of stage III Kümmell's disease. [Methods] A retrospective analysis was performed on 12 patients who received PCO andlong-segment pedicle scrwe fixation for stage III Kümmell's disease in our department from December 2019 to December 2022. The clini-cal and imaging data were evaluated. [Results] All the 12 patients were successfully operated on without death or serious complicationssuch as nerve injury aggravation, whereas with operation time of (173.6±37.3) min, the intraoperative blood loss of (335.2±67.8) ml, and theincision length of (25.6±3.2) cm. Among them, 2 patients had delirium and another patient had cerebrospinal fluid leakage after operation,and there were no adverse consequences after corresponding treatment. With the passage of time before surgery, 3 months after surgery, and12 months after surgery, the VAS score [(8.7±1.2), (2.1±1.1), (1.9±0.8), P＜0.001], ODI score [(75.7±5.5), (29.7±4.8), (22.4±3.6), P＜0.001]and ASIA neurological function scale [C/D/E, (2/10/0), (1/5/6), (1/5/6), P＜0.001] were significantly improved. In terms of images, the localkyphotic angle [(35.7±5.5)°, (7.1±3.9)°, (7.1±3.5)°, P＜0.001] and anterior vertebral height [(18.5±1.3) mm, (23.8±.2) mm, (23.7±1.3) mm,P＜0.001] were significantly improved over the time period. [Conclusion] The PCO combined with long-segment pedicle screw fixation isan effective surgical method for the treatment of stage III Kümmell's disease.

Abstract:[Objective] To explore the clinical effect of umbrella-shaped bone grafting combined with vascular pedicle iliac bone trans-fer in the treatment of adult femoral head necrosis. [Methods] A retrospective study was conducted on 21 adults (25 hips) who received hippreservation treatment for femoral head necrosis in our hospital from June 2018 to December 2022. All patients were treated with umbrellashapedbone grafting combined with vascular pedicle iliac bone transfer, and the clinical efficacy and imaging results were evaluated. [Re-sults] All the patients had operation performed smoothly, with no complications, such as nerve and vascular injury, despite of delayedwound healing after operation noted in 2 cases. All patients were followed up for (18.5±4.2) months, and at the final follow-up, all 15 hipsin stage II showed significant improvement, while 6 hips showed improvement and 1 hip remained unchanged in the 7 hips of stage III , and1 hip improved, 1 hip remained unchanged, and 1 hip underwent revision total hip arthroplasty in the 3 hips in stage IV. As time went fromthat preoperatively, 6 months postoperatively and the latest follow-up, the VAS scores significantly decreased [(6.0±1.2), (2.0±0.7), (1.2±0.4), P＜0.001]; whereas Harris score [(66.3±7.4), (87.8±6.1), (90.0±4.5), P＜0.001), hip flexion [(75.8±5.7)°, (90.3±5.6)°, (97.6±2.9)°, P＜0.001], external rotation range of motion (ROM) [(24.6±1.2)°, (29.1±1.5)°, (32.0±1.0)°, P＜0.001] and internal rotation ROM [(25.5±1.2)°,(30.2±2.0)°, (32.2±1.6)°, P＜0.001] significantly increased. Imaging showed that Ficat stage, necrotic area and articular surface collapse offemoral head at the last follow-up were significantly changed compared with those before surgery, with overall significant improvements (P＜0.05). [Conclusion] The umbrella bone grafting combined with vascular pedicle iliac bone transfer for femoral head necrosis does achievesatisfactory clinical consequences, and transported vascularized iliac bone may provide a new blood supply system for femoral head to bebenefit to prevent the collapse of the femoral head.

Abstract:[Objective] To investigate the efficacy and safety of dexamethasone used in perioperative period of femoral intertrochanter-ic fractures in elderly. [Methods] A total of 105 patients who underwent surgical treatments for femoral intertrochanteric fracture in our hos-pital from July 2021 to July 2023 were included and randomly divided into blank group, single-dose group and multiple-dose group by ran-dom number table method, with 35 cases in each group. The patients were given corresponding dexamethasone treatment in each group.The clinical and test data of the three groups were compared. [Results] All patients in the three groups had operation performed successful-ly. The multiple-dose group proved significantly superior to the blank group and single-dose group in terms of consumption of Tramadol[(60.4±13.2) mg vs (90.3±20.3) mg vs (75.4±17.6) mg, P＜0.001] and metoclopramide [(7.7±3.8) mg vs (13.1±5.1) mg vs (10.5±3.1) mg, P＜0.001]. The incidence of perioperative nausea and vomiting was ranked as the multipl-dose group ＜ single-dose group ＜ blank group [cases(%), 3 (8.6) vs 7 (20.0) vs 10 (28.6), P＜0.001]. The ICFS, PSQI and VAS in the three groups were significantly decreased 1 and 3 days aftersurgery compared with those preoperatively (P＜0.05). The multiple-dose group was significantly better than the blank group and singledosegroup regarding PSQI score and VAS score (P＜0.05). In term of blood test, there were no statistically significant differences in WBC,CRP and IL-6 among the three groups before surgery (P＞0.05). However, the multiple-dose group and single-dose group proved significnt-ly superior to the blank group in WBC [(9.7±2.6)×10⁹/L vs (10.5±2.4)×10⁹/L vs (12.8±3.2)×10⁹/L, P＜0.001], CRP [(19.2±6.9) mg/L vs (27.6±8.7) mg/L vs (39.4±10.2) mg/L, P＜0.001] and IL-6 [(32.6±9.6) pg/ml vs (42.8±9.7) pg/ml vs (64.7±11.4) pg/ml, P＜0.001] 3 days postopera-tively. [Conclusion] Multiple administrations of low-dose dexamethasone during perioperative period of femoral intertrochanteric fracturesnot only reduce pain, improve sleep and relieve perioperative fatigue, but also does not increase the risk of hormone-related complications.

Abstract:[Objective] To investigate the clinical efficacy of Lando? double-layer artificial dermis used for repair of finger tip defectcomplicated with bone exposed. [Methods] From January 2020 to December 2022, 30 patients (30 fingers) had double-layer artificial der-mis with pressure dressing used after debridement to repair the finger tip defect complicated with bone exposed. The compression suture kitwas removed 7~10 days after surgery, the sutures were removed 3 weeks after surgery, while the surface silicone film over double layer arti-ficial dermis was removed 4 weeks after surgery to allow the wound to be naturally epithelialized. The appearance of wound healing andfunctional recovery were observed, and the curative effect was evaluated. [Results] Of the 30 patients, 27 patients got wound healing in onestage, 2 patients had a part of the wound remained without bone exposure, and got wound healed after dressing change, whereas one patientremained a part of the tendon exposure after surgery, and had the tendon healed after revision double-layer artificial dermis implantation.All the patients were followed up for more than 6 months, with the mean time of natural epithelialization of (60.1±8.8) days. After the woundhealed, the finger belly was well-stacked with good color and proper skin sensation. Compared with that 3 months after surgery, the averagetwo-point discrimination was significantly improved at 6 months after surgery [(3.8±1.1) mm, (2.5±0.9) mm, P＜0.001]. [Conclusion] Thisdouble-layer artificial dermis used to repair of finger tip defect with bone exposed in one stage is simple and effective technique without do-nor area damage.

Abstract:[Objective] To grasp the characteristics of the spectrum distribution of orthopedic diseases in the peacekeeping level II hos-pital in the Eastern Theater of Mali. [Methods] The patients with orthopedic diseases who received treatment in the level II Hospital of the10th peacekeeping army in Mali East War Zone from September 2022 to August 2023 were selected as the research subjects. The distribu-tion of diseases by category, country and month was summarized by means of outpatient registration, outpatient cases and expert consulta-tion, and describing statistical analysis was conducted. [Results] A total of 3 442 patients were treated in 1 year, and orthopedic diseases ac-counted for 13.3%. A total of 326 persons were included in this study, including 306 males and 20 females, aged 20~61 years with a meanof (35.1±8.4) years. In term of disease category, soft tissue injury accounted for 62.6%, low back pain due to strain for 13.8%, fracture for11.4%, tendon sheath bursal disease for 4.6% and lumbar disc herniation for 3.7%. In term of patient identity, peacekeeping military per-sonnel accounted for the most orthopedic patients (79.1%), while the top five countries were Jordan (13.7%), Egypt (13.0%), Sri Lanka(10.3%), China (9.8%) and Bangladesh (9.4%). In term of season of patient visit, the orthopaedic diereses occurred mainly in rainy seasonand cool season, accounted for 80.1% of the total; with peaks in June and September. In term of disease location, 141 (40.6%) patients in-volved in the lower limbs, 81 (23.3%) in the waist, 79 (22.8%) in the upper extremity, 26 (7.5%) in the shoulder, 13 (3.8%) in the head andneck. [Conclusion] The main orthopedic diseases of peacekeepers in Mali are soft tissue injury, back strain pain and fracture, which in-volve mainly in Jordan, Egypt, Sri Lanka, China, Bangladesh and other countries with a large number of troops, with high incidence of thedisease in the rainy season, cool season and the rotation period of the troop-contributing countries