Abstract: [Objective] To search the factors related to clinical outcomes of open reduction and internal fixation (ORIF) combined with arthroscopic repair for distal radius fracture complicated with triangular fibrocartilage complex (TFCC) tear. [Methods] A retrospective research was done on 152 patients who had distal radius fractures complicated with triangular fibrocartilage complex (TFCC) tear treated by ORIF and arthroscopic repair in Dezhou Branch Qilu Hospital, Shandong University from 2021 to December 2023. Based on GartlandWerley wrist score at the last follow-up, the patients were divided into good group and poor group. Univariate comparison and logistic multivariate regression analysis were conducted to analyze the factors related to the clinical outcome. [Results] The 152 patients were comprehensively marked in term of clinical results at the latest follow-up, 120 (79.0%) patients fall into the good group, while the remaining 32 (21.0%) were into the poor group. The good group proved significantly younger than the poor group in term of age [(58.8±10.2) years vs (65.3±9.8) years, P=0.002]. In addition, the former had significantly less complexity in term of Palmar classification than the latter group [IA/IB/IC/ID/compound, (17/53/1/39/10) vs (3/6/1/5/17), P＜0.001]. Moreover, the good group was significantly greater than the poor group regarding the preoperative ulnar inclination [(19.4±2.0)° vs (15.0±1.9)°, P＜0.001] and volar tilt [(-10.6±2.6)° vs (-13.2±2.5)°, P＜0.001]. However, there were no significant differences in terms of gender, BMI and ASA scale, as well as smoking, drinking, hypertension, diabetes, liver disease, kidney disease history, and interval from injury to operation, radial styloid height, operation time, TFCC repair method, and postoperative fixation time between the two groups (P＞0.05). As results of multiple logistic regression, the advanced age (OR=9.219, P= 0.002) and complex Palmar classification (OR=2.024, P＜0.001) were risk factors for poor clinical outcomes, while greater ulnar inclination (OR=0.302, P＜0.001) and greater volar tilt (OR=0.665, P＜0.001) were protective factors for poor outcomes. [Conclusion] Age, Palmar clas-sification, preoperative ulnar inclination and volar tilt are the main factors affecting surgical outcome of distal radius fracture complicated with TFCC tear, and targeted intervention aiming the abovesaid factors is needed to improve the therapeutic consequece and promote functional recovery. distal radius fracture, triangular fibrocartilage complex injury, open reduction and internal fixation, wrist arthroscopy, influencing factors

Abstract:[Objective] To search the risk factors for deep venous thrombosis (DVT) in perioperative period of femoral intertrochanteric fractures in the elderly, and establish a prediction model. [Methods] A total of 200 elderly patients who had femoral intertrochanteric fractures treated surgically in our hospital from January 2021 to December 2023 were included in this study, and were divided into DVT group and non-DVT group. Univariate comparison and multiple logistic regression analysis were used to explore the risk factors of DVT, and then a prediction model was built according to the selected risk factors. [Results] DVT occurred in 24 of the 200 patients during perioperative period, with DVT incidence of 12.0%. Regarding univariate comparison, the DVT groups proved significantly greater than the non-DVT group in terms of age [(77.3±1.0) years vs (71.1±0.5) years, P＜0.001], diabetes mellitus [yes/no, (11/13) vs (35/141), P=0.005], monocyte [(0.7±0.1)×109 /L vs (0.6±0.1)×109 /L, P=0.035], D-dimer [(1 581.5±156.3) ng/mL vs (1 193.2±54.0 ng/mL, P=0.011], proportion of general anesthesia in anesthesia method [general anesthesia /CSEA, (15/9) vs (72/104), P=0.045], intraoperative blood loss [(275.0±21.3) mL vs (167.0±7.5) mL, P＜0.001], operation time [(2.1±0.) hours vs (1.6±0.1) hours, P＜0.001], whereas the former was significantly less than the latter in terms of proportion of males [male/female, (3/21) vs (60/116), P=0.033] and postoperative use of anticoagulant drugs [yes/no, (8/16) vs (110/66), P=0.006]. As results of logistic multivariate analysis, the longer operation time (OR=3.056, P=0.015), advanced age (OR= 1.174, P＜0.001) and large amount of blood loss (OR=1.007, P=0.006) were independent risk factors for DVT, while the male (OR=0.204, P= 0.035) and postoperative anticoagulant use (OR=0.233, P=0.012) were the protective factors. The prediction model constructed based on the above indicators had the area under curve (AUC) of 0.895, and fitted well. Decision curve analysis showed that the model could achieve clinical benefits in a wide range of thresholds. [Conclusion] This constructed prediction model might be used as a useful tool for predicting DVT risk in perioperative period of femoral intertrochanteric fractures in the elderly.

Abstract: [Objective] To evaluate the advantages and disadvantages of intramedullary nail (IMN) fixation of middle and distal tibial fractures through the lateral parapatellar approach (LPPA) versus middle-line infrapatellar approach (MIPA). [Methods] A retrospective research was conducted on 57 patients who had middle and distal tibial fractures fixed with IMN in our hospital from July 2020 to August 2022. According to the preoperative doctor-patient communication, 27 patients had IMN placed through the LPPA, while other 30 patients were through the MIPA. The documents regarding perioperative period, follow-up and imaging were compared between the two groups. [Results] All patients in both groups had IMN for middle and distal tibial shaft fractures conduced successfully. The LPPA groups proved significantly superior to the MIPA group in terms of operation time [(79.5±13.5) min vs (88.5±16.1) min, P=0.027), incision length [(5.9±1.2) cm vs (6.9±1.3) cm, P=0.004], intraoperative blood loss [(144.4±69.1) mL vs (194.3±79.9) mL, P=0.015] and fluoroscopy times [14.5±4.5) times vs (19.6±5.1) times, P＜0.001]. The VAS, HSS and AOFAS scores, as well as knee flexion-extension range of motion (ROM) and ankle dorsalplantar flexion ROM were significantly improved over time in both groups (P＜0.05). The LPPA group was significantly better than the MIPA group in terms of VAS score [(3.0±0.9) vs (3.7±1.1), P=0.012], HSS score [(74.5±7.1) vs (70.2±5.9), P=0.016], AOFAS score [(67.7±8.2) vs (62.1±5.9), P=0.005], the knee ROM [(119.6±11.8)° vs (113.6±9.3)°, P=0.037] and ankle ROM [(44.5±5.7)° vs (40.2±6.1)°, P=0.008] 3 months postoperatively, although abovesaid parameters became not statistically significant between the two groups at the latest follow-up (P＞ 0.05). Radiographically, the LPPA was also significantly better than the MIPA group regarding lateral distal tibial angle (LDTA) [(89.1±1.3)° vs (87.3±1.9)°, P＜0.001], anterior distal tibial angle (ADTA) [(81.6±2.6)° vs (78.5±2.1)°, P＜0.001] and fracture alignment [excellent/good/ poor, (8/17/2) vs (12/10/8), P=0.048] at the latest follow-up. [Conclusion] IMNs through both approaches are safe and reliable for the fixa-tion of middle and distal tibial shaft fractures. By comparison, the LPPA does optimize the surgical process and has good results in fracture reduction, early pain relief and early motion over the MIPA.

Abstract: [Objective] To compare the clinical consequence of three-dimensional proximal femoral nail (3DPFN) versus proximal proximal femoral nail anti-rotation (PFNA) in the treatment of femoral intertrochanteric fractures (FIF). [Methods] A retrospective study was conducted on 61 patients who had FIF fixed by intramedullary nailing from January 2021 to April 2023. According to preoperative docent-patient communication, 30 patients had FIF fixed by 3DPFN, while the remaining 31 patients were by PFNA. The documents regarding periop- erative period, follow-up and imaging were compared between the two groups. [Results] All the 61 patients had operation performed successfully without vascular, nerve injury and other serious complications. Although the 3DPFN group consumed significantly longer operative time [(95.0±15.0) min vs (86.2±15.4) min, P=0.028] and intraoperative fluoroscopy times [(12.0±2.4) times vs (10.6±2.1) times, P=0.018] than the PFNA group, the former resumed ambulation significantly earlier than the latter [(13.5±3.2) days vs (17.2±4.6) days, P＜0.001]. There were no significant differences in total incision length, intraoperative blood loss, incision healing grade and hospital stay between the two groups (P＞0.05). The mean follow-up time was of (20.0±2.5) months, and the 3DPFN group returned to full weight-bearing activity significantly earlier than the PFNA group [(62.3±6.4) days vs (70.2±10.0) days, P＜0.001]. As time went on, the VAS and Harris scores, as well as hip extension-flexion range of motion (ROM) and internal-external rotation ROM were significantly improved in both groups (P＜0.05), which were not statistically significant between the two groups 6 and 12 months after surgery (P＞0.05). Radiographically, there was no a significant difference in Baumgaertner grade between the two groups (P＞0.05). Compared with those immediately after surgery, there were no significant changes in FNSA and TAD in both groups 6 months after surgery and at the last follow-up (P＞0.05). In addition, there were no significant differences in FNSA and TAD between the two groups at any corresponding time points (P＞0.05), and there were no a statistically significant differences in fracture healing time between the two groups (P＞0.05). [Conclusion] The 3DPFN in the treatment of FIF can pro-mote ambulation and complete weight-bearing activities as soon as possible, which is conducive to functional recovery.

Abstract:[Objective] To compare the clinical outcome of two sequences of blocking screw placement in intramedullary nailing for tibial fractures. [Methods] A retrospective study was done on 60 patients who had tibial fractures treated with intramedullary nailing and blocking screws in our hospital from January 2021 to January 2024. According to the communication between doctors and patients, 30 patients had blocking screws placed before the intramedullary nailing (pre-blocking group), while other 30 patients had blocking screws placed after the intramedullary nailing (post-blocking group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had successful surgeries. The pre- blocking group proved significantly inferior to the post- blocking group in terms of operation time [(131.3±30.6) min vs (96.6±21.4) min, P＜0.001], intraoperative fluoroscopy [(24.3±1.9) times vs (20.6±1.8) times, P＜ 0.001], and adjustment of blocking screws [(3.6±1.3) times vs (1.5±0.6) times, P＜0.001]. The follow-up period lasted for (24.5±3.3) months in a mean, and the pre-blocking group regained full weight-bearing activity significantly later than the post-blocking group [(119.2±16.5) d vs (112.0±10.2) d, P=0.046]. The VAS, HSS and AOFAS scores, as well as knee and ankle range of motions (ROMs) in both groups significantly improved at the last follow-up compared with those 3 months postoperatively (P＜0.05). Although no statistically significant differences were noted in VAS scores, knee ROM and ankle ROM between the two groups at any corresponding time points (P＞0.05), the pre-blocking group was significantly poorer than the post-blocking group in terms the HSS [(73.7±9.2) score vs (77.8±6.2) score, P=0.045] and AO- FAS [(82.0±8.7) score vs (86.4±7.1) score, P=0.035] 3 months after surgery. However, there were no statistically significant differences in HSS, AOFAS scores and Johner-Wruhs grade between the two groups at the latest follow-up (P＞0.05). Regarding imaging, the pre-blocking group were significantly inferior to the post-blocking group in terms of fracture alignment [n, excellent/good/poor, (19/11/0) vs (24/6/0), P= 0.036], lateral displacement in the coronal plane [(4.6±1.5) mm vs (1.4±1.3) mm, P＜0.001], and angulation in the coronal plane [(2.6±2.1)° vs (1.2±1.4)°, P=0.004] at the last follow-up, and the fracture healing rate in 16~20 weeks [n (%), 12 (40.0) vs 20 (66.7), P=0.038], despite of the fact that the bilateral tibia length discrepancy between the two groups was not statistically significant (P＞0.05). [Conclusion] The placing blocking screws later is more convenient to operate, has stronger repeatability, while fewer fluoroscopy times, shorter operation time, and better fracture reduction over the placing blocking screws first.

Abstract:[Objective] To compare the clinical consequence open reduction and internal fixation (ORIF) with or without deltoid ligament repair (DLR) for ankle fractures complicated with deltoid ligament injury. [Methods] A retrospective study was conducted on 102 patients who underwent ORIF for ankle fractures complicated with deltoid ligament injury from June 2020 to May 2023. According to preoperative doctor-patient communication, 54 patients received DLR during the ORIF, while other 48 patients had ORIF only without DLR. The perioperative period, follow-up and imaging data were compared between the two groups. [Results] All the 102 patients were operated on successfully. Although the DLR group consumed significantly longer operative time [(110.0±12.7) min vs (104.2±12.0) min, P=0.020] and incision length [(8.5±2.3) cm vs (6.8±1.9) cm, P＜0.001] than the non-DLR group, the former proved significantly superior to the latter in terms of intraoperative X-ray fluoroscopy times [(8.0±2.0) vs (12.0±4.0) times, P＜0.001], hospital stay [(13.5±3.1) days vs (17.2±2.8) days, P＜0.001] and ambulation time [(14.7±4.2) days vs (20.5±4.7) days, P＜0.001]. The average follow-up time was of (19.5±3.8) months, and the DLR group resumed full weight-bearing activity significantly earlier than the non-DLR group [(78.6±16.0) days vs (92.0±20.5) days, P＜ 0.001]. In addition, the DLR group was also significantly better than the non-DLR group in terms of AOFAS score [(93.5±5.0) vs (91.4± 5.3), P=0.042], dorsal- plantar flexion ROM [(16.0±2.5)° vs (14.5±2.4)°, P=0.003] and inversion-eversion ROM [(17.5±2.7)° vs (16.0± 2.3)°, P=0.003] at the latest follow-up. As for imaging, the DLR group was further proved significantly superior to the non-DLR group regarding fracture reduction quality, talocrural angle (TCA), medial clear space (MCS) and tibiofibular clear space (TFCS) (P＜0.05). [Conclusion] Deltoid ligament repair does enhance the efficacy of ORIF and improve ankle joint function recovery for ankle fractures complicated with torn deltoid ligament.

Abstract:[Objective] To compare the clinical efficacy of intramedullary nail versus locking plate in fixation of four-part proximal humeral fractures. [Methods] A retrospective study was conducted on 25 patients who had four-part proximal humeral fractures surgically treated from January 2021 to June 2023. According to the preoperative doctor-patient communication, 13 patients received intramedullary nail (the IN group), while other 12 patients underwent locking plate (the LP group). The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups were operated on successfully, with no serious complications occurred during the operation. The IN group proved significantly superior to the LP group in terms of operation time [(89.2±9.3) min vs (120.0±12.5) min, P＜0.001], the total incision length [(7.3±1.0) cm vs 13.5±1.1) cm, P＜0.001], intraoperative blood loss [(225.2±13.6) mL vs (300.1±15.0) mL, P＜0.001], postoperative drainage [(37.3±14.9) mL vs (53.0±15.7) mL, P=0.017] and active activity time [(2.3±0.7) days vs (3.0±0.8) days, P=0.042]. All patients in both groups were followed up for more than 12 months, and the IN group resumed full weight-bearing activity significantly earlier than the LP group [(11.5±1.2) weeks vs (13.6±1.7) weeks, P=0.002]. The VAS, ASES and Constant-Murley scores, as well as shoulder flexion-elevation and abduction-elevation ROMs in both groups were significantly improved over time (P＜0.05). The IN group was significantly better than the LP group in terms of VAS score [(6.0±1.1) vs (7.5±1.2), P=0.003] 1 day after operation, ASES score [(71.1±4.5) vs (66.9± 3.6), P=0.017], Constant-Murley score [(68.4±5.2) vs (61.0±3.5), P＜0.001], forward flexion- elevation ROM [(118.9±17.5)° vs (105.2± 12.2)°, P=0.034), and the abduction-elevation ROM [(115.8±16.5)° vs (102.4±13.2)°, P=0.036] 3 months postoperatively. Regarding imaging, there was no significant difference in fracture reduction quality between the two groups (P＞0.05). At the last follow-up, the IN group had significantly greater humeral neck-shaft angle (HNSA) than the LP group [(131.9±2.3)° vs (129.6±2.9)°, P=0.038], additionally, the former got fracture healing on images significantly earlier than the latter (P＜0.005). [Conclusion] Intramedullary nail fixation of four- part proximal humerus fractures has the advantages of less surgical trauma, stable fixation, rapid fracture healing and early rehabilitation over the locking plate.

Abstract:Biomaterials play important roles in the treatment of orthopedic diseases. Common implant materials include stainless steel, titanium alloy, bioceramics, and ultra-high molecular weight polyethylene and others. Among them, titanium alloy has become one of the most common materials in orthopedic clinic due to its good mechanical properties and osteogenic ability, especially in the fields of internal fixation implants, joint prosthesis, and so on. However, titanium alloys also have drawbacks, such as metal inertness and metal ion release at the surface. At present, with advancements of material science, new titanium alloys have been optimized for their physical and chemical characteristics, as well as their biological properties. In this paper, we review the research progress in application of titanium alloys in orthopedic field to provide a reference for further studies on titanium alloy materials in this aspect.

Abstract:Pectoralis major tendon tear is common in sports and military training, and it mostly occurs in young men. For the young patients with sports requirements, surgical treatment is the first choice. Although postoperative rehabilitation is crucial for restoring sports ability after pectoralis major tendon injury, few studies have focused on postoperative rehabilitation training. For this reason, this article reviews the research progress on the diagnosis and treatment of pectoralis major muscle tears, as well as the design of postoperative rehabilitation programs.

Abstract:Cauda equina syndrome (CES) is a series of neurological dysfunction caused by absolute or relative stenosis of lumbar spinal canal and compression of cauda equina due to various congenital or acquired reasons. The type IIIB CES is characterized by long-term low back pain and discomfort with gradual progression, which is proposed by Tandon's classification and Gleave's classification. Its characteristic clinical manifestations mainly presents intestinal or bladder dysfunction. As type IIIB CES complicated with urinary system diseases and intestinal system diseases, it is difficult to make differential diagnosis. Our team treated a patient who suffered from type IIIB CES complicated with urinary and intestinal system diseases, with clinical manifestations of low back pain accompanied by difficulty in defecation and abnormal erectile function. In this paper, the case was reported in detail and the recent literature was reviewed. We hope that our treatment experience can provide some reference for physicians who are committed to studying this complex disease.

Abstract:[Objective] To design a reduction forceps of distal tibiofibular syndesmosis with the anatomical characteristics of Chinese people through digital orthopedics, and verify its superiority by a cadaveric comparative study, so as to provide theoretical basis for clinical application. [Methods] CT data of 60 normal Chinese ankle joints were imported into Mimics software. The center point of tibiofibula was marked on the horizontal plane 1.5 cm above the ankle point, and the line of tibiofibular center point was the central force line. Then the medial side of the tibia was divided into three equal parts, and the intersection point of the middle and front 1/3 was marked as point P. The relationship between the projection point O and point P was analyzed statistically. A circle 1cm in diameter centered on the O point was drawn, the curvature of the circle on the tibial surface was calculated, and a circular chuck was printed by 3D printing to make the reduction forceps. Ten fresh cadavers were divided into normal group, injured group and reduced group to compare the effect of the reduction forceps. [Results] The OP value was (0.7±0.4) mm, point O was regarded as point P, and the tibial surface curvature of point P was (1.722±0.025)°, so the reduction forceps was made based on the anatomy around point P. Compared with the normal group, the tibiofibular overlap (TFO) in the injured group decreased significantly, while compared with the injured group, the TFO increased significantly in the reduced group [(7.3±0.5) mm vs (4.8±0.4) mm vs (7.1±0.4) mm, P=0.019]. Compared with the normal group, the tibiofibular clear space (TFCS) increased significantly in the injured group, whereas compared with the injured group, TFCS decreased significantly in reduced group [(5.3±0.4) mm vs (7.9±0.4) mm vs (5.0±0.6) mm, P=0.003]. Compared with the normal group, the medial clear space (MCS) in the injured group significantly increased, while compared with the injured group, the MCS in the reduced group decreased significantly [(3.4±0.4) mm vs (5.7±0.3) mm vs (3.6±0.3) mm, P=0.032]. Compared with the normal group, the tibiofibular distance (TFD) in the injured group was significantly increased, while compared with the injured group the TFD in the reduced group was significantly decreased [(3.4±0.3) mm vs (7.1±0.5) mm vs (3.1±0.2) mm, P=0.016]. Compared with the injured group, the fibular rotation angle was significantly declined in the reduced group [(5.8±0.5)° vs (3.8±0.8)°, P= 0.026]. However, there were no significant differences in TFO, TFCS, MCS and TFD between normal group and reduced group (P＞0.05). [Conclusion] The tibiofibular central force point in the horizontal plane 1.5 cm above the ankle point was located at the intersection of the anterior-middle third of the medial tibia.The new type of syndesmotic reduction forceps conforms to the anatomical characteristics of Chinese people, and has good clamping effect.

Abstract: [Objective] To introduce the surgical technique and preliminary clinical outcome of image processing-assisted bone harvesting for arthroscopic bone grafting in treatment of glenoid bone defect. [Methods] The preoperative 3D CT images were processed, and a bone graft was designed in the scapular spine crest on the affected side. After general anesthesia, the patient was placed in lateral position with the affected arm abducted and flexed under traction. The acromion, scapular spine crest and coracoid process, as well as the posterior, anterior and anterolateral portals were marked. A transverse incision was made on the spine crest 5 cm to the posterolateral edge of the acromion. As the soft tissue and periosteum of the scapular were distracted, a bone block for grafting were cut based on the preoperative design, with two holes drilled for later use. Through the working tube at the anterior portal, the anterior labrum-capsule complex was released to expose the anterior glenoid, and two anchors were inserted. The bone block was introduced into the joint cavity from the anterior working tube, and placed on the anteroinferior edge of the glenoid. Finally, the scapular glenoid, bone block and labrum-capsule complex were fixed using the double-pulley anchor sutures. [Results] All patients had the surgical procedures performed successfully. Numbness occurred at the fingertip of the affected side after the operation in 4 patients, which all disappeared within 3 days. No serious complications, such as hematoma, infection, joint stiffness, postoperative re-dislocation or subluxation, fixation failure and revision surgery happened in anyone of them after the operation. The ASES score was marked as (81.8±11.9), and the Constant score was of (85.8±10.4) at the last follow-up. In addition, the healing rate of the grafted bone block was of 100%, and daily exercise capacity was regained in most patients. [Conclusion] This image processingassisted bone harvesting for arthroscopic bone grafting does effectively shortens the recovery time and reduces postoperative complications in the treatment of recurrent anterior shoulder dislocation, achieve satisfactory preliminary clinical consequence.

Abstract: [Objective] To introduce the surgical technique and preliminary clinical results of arthroscopic reduction and fixation of Pipkin type I and II femoral head fractures. [Methods] A total of 14 patients underwent arthroscopic reduction and internal fixation of Pipkin type I and II femoral head fractures. After general anesthesia, the patient was placed in the supine position and placed on the traction table. The affected limb was placed at the hip flexion of 10° and internal rotation of 15° with longitudinal traction applied, until proper vacuum sign confirmed under fluoroscopy. As arthroscope was inserted through the anterolateral portal, the joint cavity was washed until the vision field became clear gradually, and then the anterior portal was established. After the capsule was cut in T shape with the hook knife, the joint cavity was debrided from the anterior portal, and then the injury extent and fracture type were evaluated. During the reduction of the fracture, the traction of the affected limb was relaxed with the knee flexion of 90° and the hip flexion about 30°, and the hip extremely external rotation, so that the femoral head fractures were close to the anterior portal. The fracture reduction could be assisted by prying with a Kirschner wire or nucleus pulposus forceps. After successful reduction, the fracture fragments were temporarily fixed with Kirschner wires. Finally, the fractures were fixed with cannulated Herbert screws through the anterior auxiliary portal. [Results] All patients were successfully operated on, without serious complications during operation, and followed up for 12 to 36 months. At the latest interview, all the patients had fractures healed well, with no ectopic ossification, no traumatic arthritis, and no necrosis of the femoral head. At the last follow-up, the Harris score ranged from 90 to 96, and the clinical outcome were marked as excellent in 9 cases and good in 5 cases. [Conclusion] The arthroscopic reduction and fixation of Pipkin type I and II femoral head fractures are safe, feasible, minimally invasive techniques, with few complications, and achieve satisfactory short-term initial clinical outcome.

Abstract:[Objective] To evaluate the clinical outcome of locking plate combined with Nice knot for fixation of midclavicular comminuted fractures. [Methods] A retrospective study was conducted on 67 patients who had midclavicular comminuted fractures treated surgically in our hospitals from October 2020 to January 2023. According to doctor-patient communication, 33 patients had fractures fixed by locking plate combined with Nice knot (the NK group), while other 34 patients were by locking plate combined with lag screw (the LS group). Clinical and imaging data were compared between the two groups. [Results] All patients in both groups had open reduction and internal fixation of midclavicular comminuted fractures performed successfully. The NK group proved significantly superior to the LS group in terms of operating time [(57.4±6.6) min vs (61.3±6.4) min, P=0.019], length of incision [(5.1±0.6) cm vs (7.8±0.9) cm, P＜0.001] and intraoperative blood loss [(66.9±12.7) mL vs (77.2±13.0) mL, P=0.020]. The VAS and Constant-Murley scores as well as forward flexion-elevation ROM were significantly improved in both groups at the latest follow-up lasted for more than 12 months compared with those 1 month after surgery (P＜0.05), whereas which were not statistically significant between the two groups at any corresponding time points (P＞0.05). As for imaging, clavicular alignment and callus formation in both groups were significantly improved over time (P＜0.05), which were not statistically significant between the two groups at time points accordingly (P＞0.05). [Conclusion] Locking plate combined with Nice knot has reliable clinical consequence for midclavicular comminuted fracture, with obvious advantages for treatment of small free bone fragment and removing internal fixation.

Abstract:[Objective] To investigate the clinical outcome of robot-assisted rehabilitation after internal fixation of intertrochanteric femoral fractures in elderly. [Methods] A retrospective study was done on 86 patients who had femoral intertrochanteric fracture treated with proximal femoral intramedullary nail from January 2021 to December 2022. According to doctor- patient communication, 43 patients received the robot-assisted rehabilitation training (the robot group), while other 43 patients received traditional rehabilitation training (routine group). Clinical consequence and complications were evaluated. [Results] There were no significant differences in operation time and intraoperative blood loss between the two groups (P＞0.05). All patients successfully completed rehabilitation and followup. Compared with 1 day after surgery, VAS scores in both groups were significantly decreased at 12 weeks after surgery (P＜0.05). The robot group proved significantly superior to the routine group in terms of VAS [(2.3±0.8) vs (2.7±0.7), P=0.016], Harris [(88.6±9.0) vs (76.3±8.1), P＜0.001], BBS [(48.6±8.0) vs (39.3±6.1), P＜0.001] and MBI scores [(69.7±12.2) vs (58.1±11.0), P＜0.001] 12 weeks after operation. In addition, the former was also significantly better than the latter in terms of step length [(37.2±4.9) cm vs (34.6±4.4) cm, P=0.011], step speed [(36.7±3.2) m/min vs (32.2±3.2) m/min, P＜0.001] and step width [(11.1±1.) cm vs (9.7±1.3) cm, P＜0.001] 12 weeks postoperatively. [Conclusion] Robot assisted rehabilitation after internal fixation of femoral intertrochanteric fractures in elderly does improve hip function, improve movement ability and quality of life, and reduce complications.

Abstract: [Objective] To compare the early postoperative analgesic effects of cocktail analgesic drugs-loaded gelatin sponge and nondrug-loaded gelatin sponge in open reduction and internal fixation (ORIF) of humeral shaft fracture. [Methods] A total of 40 patients who were undergoing ORIF for closed humeral shaft fractures were enrolled into this prospective study from August 2022 to January 2024. According to the random number table method, the patients were divided into a drug-loaded group and a non-drug-loaded group, with 20 cases in each group. The clinical and laboratory data of the two groups were compared. [Results] All patients in both groups had ORIF performed smoothly. The drug-loaded group proved significantly superior to the non-drug-loaded group in terms of VAS score [(3.2±0.9) vs (6.0±1.1), P＜0.001; (3.5±1.2) vs (5.1±1.8), P=0.002; (2.4±0.7) vs (3.7±0.9), P＜0.001], elbow ROM [(49.0±4.0)° vs (42.1±3.4)°, P＜0.001; (58.4±2.7)° vs (48.8±5.2)°, P＜0.001; (69.8±2.6)° vs (56.2±3.2)°, P＜0.001] and Constant-Murley score [(43.5±3.2) vs (29.0±4.0), P＜0.001; (46.2±2.9) vs (33.2±1.9), P=0.002; (46.8±2.3) vs (36.6±4.3), P＜0.001] 1, 3 and 5 days postoperatively. In addition, the drug-loaded group was significantly better than the non-drug-loaded group in the number of additional analgesics used and the length of hospital stay (P＜0.05). Regarding laboratory tests, there was no statistically significant difference in CRP between the two groups 1 day after the operation (P＞0.05), whereas which proved significantly lower in the drug-loaded group than that in the non-drug-loaded group 3 and 5 days postoperatively (P＜0.05). Moreover, IL-6 in the drug-loaded group was significantly lower than that in the non-drug-loaded group at all the corresponding time points (P＜0.05). [Conclusion] The use of gelatin sponge containing cocktail analgesic drugs in ORIF of humeral shaft fracture has a significant analgesic effect in the early postoperative period, which can accelerate the recovery of shoulder and elbow functions and reduce the hospital stay.

Abstract: [Objective] To evaluate the clinical consequence of open reduction and internal fixation (ORIF) of acetabular fractures in elderly. [Methods] A retrospective study was done on 18 elderly patients who underwent surgical treatment for acetabular fractures in our hospital from January 2017 to December 2021, including 10 males and 8 females, aged 65~89 years, with an average age of (72.5±5.6) years. According to Letournel classification, there were 6 posterior wall fractures, 4 double-column fractures, 3 transverse with posterior wall fractures, 2 posterior column with posterior wall fractures, and 3 T-shaped fractures. The ORIF was conducted through ilioinguinal approach in 8 cases, K-L approach in 6 cases and combined anterior and posterior approaches in 4 cases. All acetabular fractures were fixed with reconstruction plates and 3.5 mm screws. [Results] All the patients were operated on successfully, with no serious complications such as death and massive bleeding during the operation, while with operation time of (106.0±23.8) min, intraoperative blood loss of (300.0±63.8) mL and intraoperative fluoroscopy of (18.0 ± 3.6) times. Sciatic nerve stretching injury occurred in 1 case, while lateral femoral cutaneous nerve stretching injury was in 2 cases, whereas the symptoms of nerve stretching injury in the 3 cases were recovered half a year later. All patients were followed up for 12~63 months, and the time to return to full weight-bearing activities was ranged from 1.5 to 3.2 months after surgery, with an average of (1.8±0.9) months. At the last follow-up, among 18 patients, 15 patients recovered pre-injury motion capacity, while 3 patients did not recover to pre-injury activity level. According to the modified Merle D 'Aubigne- Postel criteria, the clinical results were marked as excellent in 11 cases, good in 3 cases, fair in 3 cases and poor in 1 case, with excellent and good rate 77.8%. In terms of images, reduction quality evaluated according to the Matta criteria was excellent in 12 cases, good in 3, fair in 2, and poor in 1, with an excellent and good rate of 83.3% among the 18 patients. At the last follow-up, 3 patients had osteoarthritis imaging changes. [Conclusion] ORIF for acetabular fractures in elderly should be performed through a single surgical approach if possible, which does achieve satisfactory clinical efficacy.