Abstract: [Objective] To compare the clinical efficacy of proximal femoral nail anti-rotation II (PFNA-II) fixation of Evans-Jensen typeⅡto type R femoral intertrochanteric fractures in lateral position versus supine counterpart. [Methods] A retrospectve research was conducted on 306 patients who had Evans-Jensen type II to type R femoral intertrochanteric fractures fixed with PFNA-Ⅱ in Ruikang Hospital from January 2017 to December 2022. According to the preoperative doctor-patient communication, 166 patients had PFNA performed in lateral position (LP), while the remaining 140 patients were in supine position (SP). The documents regarding perioperative period, follow-up and images were compared between the two groups. [Results] All patients in both groups had PFNA performed smoothly without intraoperative complications. The LP group proved significantly superior to the SP group in terms of operation time [(88.4±19.4) min vs (97.9±22.4) min, P＜0.001], total incision length [(6.9±2.0) cm vs (7.5±1.9) cm, P=0.004], intraoperative blood loss [(107.4±40.1) mL vs (121.3±41.9) mL, P=0.003], and intraoperative fluoroscopy times [(13.5±0.8) vs (15.0±1.2), P＜0.001], despite of the fact that there were no significant differences in incision healing grade, hospital stay and ambulation time between the two groups (P＞0.05). The follow-up period lasted for (15.2±1.6) months in a mean, and there was no a significant difference in the time to resume full weight-bearing activity between the two groups (P＞0.05). Compared with those 6 months after surgery, the VAS, Harris scores, as well as hip flexion-extension range of motion (ROM) and hip internal-external rotation ROM were significantly improved in both groups 12 months after surgery (P＜0.05). At 6 and 12 months after operation, the LP group achieved significantly greater flexion-extension ROM [(99.0±7.4)° vs (96.5±8.9)°, P=0.010; (114.2±9.1)° vs (111.4±9.3)°, P=0.010] and internal-external rotation ROM [(49.9±7.9)° vs (47.0±8.4)°, P=0.020; (56.0±7.9)° vs (52.7±8.3)°, P＜ 0.001] than the SP group. Regarding imaging, there was no any statistically significant differences in terms of Baumgaertner's fracture reduction grade, and femoral neck-shaft angle (FNSA), tip apex distance (TAD) and fracture healing time between the two groups (P＞0.05). [Conclusion] The lateral position takes the advantages of convenient operation, shorter operation time and less bleeding for PFNA-Ⅱ fixation of femoral intertrochanteric fractures over the supine position

Abstract: [Objective] To compare the clinical consequence of intramedullary nail combined with plate (INP) versus minimally invasive percutaneous plate osteosynthesis (MIPPO) for fixation of tibial shaft spiral fractures complicated with posterior malleolus fractures. [Methods] A retrospective research was performed on 52 patients who had tibial shaft spiral fractures complicated with posterior malleolar fractures treated surgically from February 2019 to February 2024. According to the preoperative doctor-patient communication, 27 patients were treated with INP, while the other 27 patietns were with MIPPO. The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had corresponding surgical procedures performed successfully without serious complications. The INP proved significantly inferior to the MIPPO in terms of operative time [(79.3±7.1) min vs (70.6±6.8) min, P＜0.001], intraoperative blood loss [(137.2±8.1) mL vs (120.6±8.8) mL, P＜0.001] and intraoperative fluoroscopy times [(10.2±3.2) vs (6.4±1.9), P＜0.001], whereas the former was significantly superior to the latter in terms of incision length [(7.0±1.3) cm vs (11.8±1.9) cm, P＜0.001], incision healing scale [A/B/C, (27/0/0) vs (21/4/0), P=0.032] and hospital stay [(12.8±1.5) days vs (16.4±1.9) days, P＜0.001], and there was no a statistical significance in walking time between the two groups (P＞0.05). The mean follow-up time was of (16.0±2.1) months, and there was no significant difference in time to regain full weight-bearing activity between the two groups (P＞0.05). Compared with those 3 months after surgery,the VAS, AOFAS score and ankle ROM in both groups were significantly improved at the last follow-up (P＜0.05). The INP group was poorer than the MIPPO group regarding the HSS score [(72.1±3.5) vs (90.3±4.0), P＜0.001] and knee ROM [(118.6±4.3)° vs (130.6±3.3)°, P＜ 0.001] 3 months postoperatively, whereas which became not statistically significant between the two groups at the last follow-up (P＞0.05). Radiographically, bilateral tibial length discrepancy, distal lateral tibial angle (LDTA), anterior distal tibial angle (ADTA) and the joint congruency were significantly improved at the last followup compared with those preoperatively in both groups (P＜0.05), whereas which proved not statistically significant between the two groups at any time points accordingly (P＞0.05). All patients got fracture osseous union without a statistical significance in the fracture healing time between the two groups (P＞0.05). [Conclusion] Both minimally invasive techniques do effectively treat tibial shaft spiral fractures complicated with posterior malleolar fractures. In contrast, the INP can be operated as early as possible and has advantages in incision length and incision healing, while MIPPO has significant advantages in terms of operation time, intraoperative blood loss, fluoroscopy times, and avoiding knee affected.

Abstract: [Objective] To compare the clinical consequence of external fixator with or without intramedullary bending pin (BP) in the treatment of middle and distal tibial shaft fractures in adults. [Methods] A retrospective research was performed on 46 adult patients who had middle and distal tibial fractures treated with external fixator from January 2020 to March 2024. According to preoperative doctor-patient communication, 23 patients were treated by external fixator with intramedullary BP, while the remaining 23 patients were by the conventional external fixator. The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had operation successfully completed without serious complications. The BP group consumed significantly more operative time [(82.1±8.0) min vs (71.4±7.8) min, P＜0.001] and intraoperative fluoroscopy times [(18.8±2.1) vs (16.7±2.1), P＜0.001] than the conventional group. However, the former regained ambulation significantly earlier than the latter [(3.5±1.1) days vs (5.9±1.4) days, P＜0.001]. The followup period lasted for (21.4±2.3) months in a mean, and the BP group proved significantly superior to the conventional group in terms of the partial weight bearing time [(3.5±1.1) weeks vs (5.9±1.4) weeks, P＜0.001], frame bearing time [(15.0±2.0) weeks vs (18.2±2.6) weeks, P＜ 0.001] and full weight-bearing time [(13.0±2.0) weeks vs (16.2±2.6) weeks, P＜0.001]. The pain VAS and AOFAS scores, as well as knee range of motion (ROM) and ankle ROM were significantly improved in both groups over time postoperatively (P＜0.05). The BP group was also proved significantly superior to the conventional group in terms of the pain VAS [(2.0±0.8) vs (3.5±1.1), P＜0.001], AOFAS score [(75.1± 3.0) vs (66.0±4.1), P＜0.001], knee ROM [(105.4±6.3)° vs (92.7±5.3)°, P＜0.001] and ankle ROM [(45.0±3.2)° vs (34.4±3.2)°, P＜0.001] 3 months postoperatively, despite of the fact that the differences between the two groups in abovementioned items became not statistically significant at the latest follow-up. Furthermore, the BP group was significantly better than the conventional group regarding the excellent and good rate based on the Johner-Wruhs criteria at the last interview [excellent/good/medium/poor, (18/4/1/0) vs (10/8/5/0), P=0.043]. As for imaging, the bilateral tibial length discrepancy, distal lateral tibial angle (LDTA) and anterior distal tibial angle (ADTA) were significantly improved in both groups at the last follow-up compared with those preoperatively (P＜0.05). There was no significant change in tibial alignment in both groups at the last followup compared with that immediately postoperatively (P＞0.05). However, the BP group got fracture healed in imaging significantly early than the conventional group (P＜0.05). [Conclusion] The adding intramedullary bending pin does accelerate the weight-bearing recovery of external fixator for middle and distal tibial shaft fractures in adult, while more active weight-bearing exercise improve the clinical outcome.

Abstract:[Objective] To compare the clinical consequence of robot-assisted percutaneous channel screw versus conventional open reduction and internal fixation (ORIF) of Tile type C1~2 pelvic fractures. [Methods] A retrospective research was conducted on 185 patients who had Tile type C1~2 pelvic fractures fixed surgically in our department from June 2020 to August 2023. According to doctor-patient communication, 93 patients received robot-assisted percutaneous channel screw placement (the robot group), while the other 92 patients received the conventional ORIF (the conventional group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] The robot group proved significantly superior to the conventional group in terms of operation time [(92.5±10.3) min vs (138.7±12.7) min, P＜0.001], screw placement time [(14.3±2.7) min vs (15.4±3.1) min, P=0.011], incision length [(1.4±0.4) cm vs (1.6±0.5) cm, P=0.003], intraoperative fluoroscopy times [(2.5±0.8) vs (2.8±0.9), P=0.018], intraoperative blood loss [(31.7±4.2) mL vs (52.9±6.7) mL, P＜0.001), hospital stay [(9.3±2.1) days vs (10.2±2.4) days, P=0.007], the total incidence of complications (7.6% vs 18.4%, P=0.027), first screw placement success rate (95.7% vs 81.5%, P=0.002), incision healing grade [A/B/C, (42/37/14) vs (27/40/25), P=0.039]. All patients in both groups were followed up for more than 12 months, and the robot group regained ambulation [(13.7±4.6) days vs (18.8±5.2) days, P＜0.001] and full weightbearing activity [(36.4±12.1) days vs (41.0±13.7) days, P=0.016] significantly earlier than the conventional group. The VAS and Majeed scores were significantly improved in both groups over time (P＜0.05). Although there were no statistical significances in VAS and Majeed scores between the two groups before surgery (P＞0.05), the robot group was significantly superior to the conventional group in terms of VAS score [(3.1±1.0) vs (3.7±1.2), P＜0.001; (2.2±0.7) vs (2.8±0.9), P＜0.001] and Majeed score [(85.3±3.2) vs (80.4±4.1), P＜0.001; (90.1±1.8) vs (89.2±2.0), P=0.002] 3 months postoperatively and at the latest follow-up. Radiographically, the robot group was also significantly better than the conventional group in terms of Matta grade and fracture healing rate at all time points postoperatively (P＜0.05). [Conclusion] For Tile type C1~2 pelvic fractures, the Tianji orthopedic robot assisted minimally invasive percutaneous channel screw fixation does shorten the hospital stay, effectively relieve pain, promote rapid fracture healing, reduce postoperative complications with high safety.

Abstract:[Objective] To compare the clinical efficacy of closed retrograde intramedullary nail (CRIN) versus open plate (OP) fixation for distal femoral shaft fractures. [Methods] From January 2020 to July 2024, 97 patients with distal femoral shaft fracture were included in the study. According to doctor-patient communication, 38 patients were treated with CRIN, while other 59 patients were treated with OP. The perioperative, follow-up and imaging data of the two groups were compared. [Results] Both groups successfully completed the operation, with no statistical significance in the operation time and hospitalization days between the two groups (P＞0.05). The CRIN group proved significantly superior to the OP in terms of total incision length [(8.9±1.5) cm vs (19.7±4.2) cm, P＜0.001], intraoperative blood loss [(48.2±13.1) mL vs (244.7±77.6) mL, P＜0.001] and postoperative ambulation [(34.7±4.9) days vs (48.4±10.8) days, P＜0.001], whereas the former consumed significantly greater intraoperative fluoroscopy times than the latter [(21.4±7.9) vs (11.3±4.2), P＜0.001]. The followup period lasted for (17.4±4.7) months in a mean, and the CRIN group resumed full weight-bearing activity significantly earlier than the OP group [(94.3±5.4) days vs (98.1±9.0) days, P=0.021]. Compared with those 3 months after surgery, the VAS score, HSS score and knee extension-flexion ROM were significantly improved in both groups at the last followup (P＜0.05). The CRIN group was significantly better than the OP group in terms of the VAS score [(1.7±1.9) vs (4.6±2.0), P＜0.001] 3 months after surgery, as well as the HSS score [(82.8±4.8) vs(80.4±4.9), P=0.020; (91.1±2.8) vs (87.2±4.0), P＜0.001], knee flexion-extension ROM [(121.8±7.5)° vs (110.8±14.5)°, P＜0.001; (127.2±5.9)° vs (119.4±11.)°, P＜ 0.001] 3 months postoperatively and at the last follow-up. As for imaging, the CRIN group was also proved significantly superior to the OP group in terms of bilateral femur length discrepancy [(6.2±2.4) mm vs (8.7±3.7) mm, P＜0.001] and mechnical axis deviation (MAD) [(4.4±3.4) mm vs (5.8±3.2) mm, P=0.043], regardless of the fact that there was no statistical significance in HKA between the two groups (P＞0.05). Moreover, the CRIN group got fractures healed significantly earlier than the OP group (P＜0.05). [Conclusion] The closed retrograde intramedullary nail fixation does achieve considerably better clinical consequence for distal femoral shaft fractures over the open plate fixation. Closed reduction with biplanar temporary stopper pins and lever is a preferred technique in the retrograde nail.

Abstract: [Objective] To compare the clinical outcome of two kinds of cross Kirschner wires for internal fixation of Gartland type Ⅲ and Ⅳ humerus supracondylar fractures through a mini incision at anterior elbow transverse crease for open reduction. [Methods] A retrospective study was done on 41 children who had Gartland type Ⅲ and Ⅳ humeral supracondylar fractures treated surgically after closed reduction failure from June 2018 to July 2023. According to the doctor-patient communication, 21 children had the fractures fixed with the three Kirschner wires with 2 laterally and 1 medially (the TKW group), while the other 20 patients were with four Kirschner wires with 2 laterally and 2 medially (the FKW group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All the children in both groups had operation performed successfully. The TKW group proved significantly superior to the FKW group in terms of operative time [(37.8±7.3) min vs (47.8±8.2) min, P＜0.001], intraoperative blood loss [(26.7±5.8) mL vs (44.5±6.9) mL, P＜0.001] and the number of fluoroscopy [(9.6±1.8) times vs (12.9±1.9) times, P＜0.001]. All the children in both groups were followed up for an average of (21.3±6.1) months, and there was no a significant difference in the time to resume full weight-bearing activities between the two groups (P＞0.05). The MEPS score, elbow-extension-flexion ROM and forearm pronation-supination ROM were significantly improved over time in both groups (P＜0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P＞0.05). In addition, at the last follow-up there was no significant difference in the Flynn's elbow grade between the two groups (P＞0.05). Regarding imaging, there was no significant difference in the quality of fracture reduction and healing time between the two groups (P＞0.05). The carrying angle, shaft condylar angle and Baumann angle in both groups were significantly improved at the last follow-up compared with those preoperatively (P＜0.05), which were not statistically significant between the two groups at any corresponding time points (P＞0.05). [Conclusion] Both triple pins and quadruple pins for internal fixation for Gartland type Ⅲand type Ⅳ humeral supracondylar fractures achieve satisfactory consequences after closed reduction failure. By comparison, the triple pins takes advantages of shorter operation time, less intraoperative blood loss and less fluoroscopy over the quadruple pins.

Abstract:[Objective] To explore the clinical efficacy of cannulated screws combined with mini plates in the treatment of comminuted radial head fractures. [Methods] A retrospective analysis was conducted on the 100 patients who had comminuted radial head fractures treated surgically in our hospital from February 2022 to February 2024. The patients were divided into two groups based on doctor-patient communication, with 50 cases in each group. The combined group was treated with cannulated screws combined with mini-plate, while the simple group was treated only with mini plate. The perioperative, follow-up and imaging documents of the two groups were compared. [Results] All patients in both groups were operated on successfully. The combined group proved significantly superior to the simple group in terms of operation time [(55.3±5.0) min vs (58.2±5.2) min, P=0.040] and intraoperative fluoroscopy times [(5.2±1.1) vs (8.7±1.3), P＜0.001]. All patients were followed up for 12 to 16 months. There was no statistically significant difference in the time to regain full weight-bearing activity between the two groups (P＞0.05). The VAS, Broderg-Morrey scores, as well as elbow extension-flexion range of motion (ROM) and forarm pronation-supination ROM in both groups were significantly improved over time (P＜0.05). The combined group proved significantly better than the simple group in terms of Broderg-Morrey score [(92.4±8.3) vs (87.2±7.8), P=0.021], elbow extension-flexion ROM [(118.6± 6.7)° vs (111.6±6.0)°, P＜0.001] and forarm pronation-supination ROM [(142.6±7.9)° vs (135.2±7.2)°, P＜0.001] one month after the operation, whereas which became not statistically significant between the two groups at the latest follow-up (P＞0.05). As for imaging, the combined group was marked significant better fracture reduction quality than the simple group [excellent/good/poor, (22/24/4) vs (14/23/13), P= 0.037]. However, there was no statistically significant difference in the proportion of fracture healing, the carrying angle, condylar angle and Baumann angle at the corresponding time points between the two groups (P＞0.05). [Conclusion] The cannulated screws combined with mini plate does improve the clinical outcome in the treatment of comminuted radial head fractures, shorten the operation time, reduce the number of intraoperative fluoroscopy, enhance the quality of fracture reduction, and promote the recovery of elbow function.

Abstract:[Objective] To compare the clinical efficacy of buttress plate combined with cannulated screws through direct anterior approach (DAA) versus conventional cannulated screws for refractory Garden type Ⅳ femoral neck fractures in young and middleaged adults. [Methods] A retrospective study was conducted on 60 patients who had refractory Garden type Ⅳ femoral neck fractures treated surgically from January 2021 to December 2023. Based on the preoperative doctor-patient communication, 30 patients received buttress plate combined with cannulated screws through DAA (the combined group), while other 30 patients underwent conventional cannulated screws (the conventional group). The perioperative period, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had corresponding surgical procedures performed successfully without serious complications during operation. Although the combined group consumed signficantly longer operation time [(60.8±10.5) min vs (50.7±18.1) min, P=0.011] and signficantly more total incision length [(7.3±1.6) cm vs (5.9±1.3) cm, P＜0.001] than the conventional group, the former proved significantly superior to the latter in terms of intraoperative fluoroscopy times [(4.5±1.2) vs (8.1±1.7), P＜0.001] and ambulation time [(8.5±0.4) days vs (11.5±0.6) days, P＜0.001]. The average follow-up time was of (20.5±1.2) months, and the combined group resumed full weight-bearing activities significantly earlier than that of the conventional group [(7.8±1.9) weeks vs (10.9±2.7) weeks, P＜0.001]. The VAS and Harris scores, as well as extension-flexion range of motion (ROM) and internalexternal rotation ROM were significantly improved in both groups over time (P＜ 0.05). At the last follow-up, the combined group was significantly better than the conventional group in terms of Harris score [(94.6±4.1) vs (92.5±3.4), P=0.035], extension-flexion ROM [(137.8±8.2)° vs (130.9±6.7)°, P＜0.001] and internal-external rotation ROM [(37.3±6.4)° vs (33.7±5.7)°, P=0.024]. As for imaging, there was no statistically significant difference in the Garden index between the two groups of patients after surgery (P＞0.05). However, the combined group proved significantly better than the conventional group regarding fracture healing time, the length of femoral neck shortening and the incidence of postoperative complications on imaging at the last follow-up (P＜0.05). [Conclusion] The buttress plate combined with cannulated screws through direct anterior approach does improve the fracture healing rate and effectively avoid the occurrence of postoperative complications of fractures, providing an excellent option for hip-preserving treatment of refractory Garden type Ⅳ femoral neck fractures.

Abstract:[Objective] To evaluate the clinical consequence of modified small incision Ma-Griffith suture (MGS-SI) for acute achilles tendon rupture (AATR). [Methods] A retrospective research was done on 83 patients who had AATR treated surgically from March 2020 to June 2023. According to preoperative doctor-patient communication, 40 patients underwent MGS-SI, while other 43 patients underwent conventional open repair. The perioperative period and followup data of the two groups were compared. [Results] The MGSSI group proved significantly superior to the conventional group in terms of total incision length [(3.8±1.1) cm vs (7.8±1.3) cm, P＜0.001], intraoperative blood loss [(16.5±5.7) mL vs (26.0±5.2) mL, P＜0.001] and ambulation time [(4.3±1.0) days vs (6.5±1.5) days, P＜0.001]. The follow-up period lasted for (16.0±3.5) months in a mean, and the MGS-SI group resumed full weight-bearing activity significantly earlier than the conventional group [(60.5±5.3) days vs (85.4±6.8) days, P＜0.001]. The VAS, AOFAS, ATRS scores, as well as plantar flexion-dorsal extension ROM and heel raise with one foot were significantly improved in both groups over time postoperatively (P＜0.05). The MGS-SI group was significantly better than the conventional group in terms of VAS score [(2.0±0.6) vs (3.4±1.0), P＜0.001; (1.1±0.4) vs (1.8±0.6), P= 0.028], AOFAS [(82.5±4.3) vs (78.0±4.7), P＜0.001; (95.0±3.7) vs (92.6± 4.0), P=0.006], and ATRS score [(86.3±4.8) vs (82.0±5.3), P＜ 0.001; (96.2±3.7) vs (93.6±4.1), P=0.003] 1 and 6 months after surgery, additionally ROM [(38.3±4.0)° vs (36.0±3.5)°, P=0.007] and heel raise time with one foot [(9.4±2.0) times/min vs (8.0±1) times/min, P＜0.001] 1 month after surgery. However, there were no statistically significant differences in VAS, AOFAS and ATRS scores, as well as ROM and heel raise with one foot between the two groups at the latest follow-up (P＞0.05). On MRI images, there were no statistically significant differences in broken end space between the two groups at any time points accordingly (P＞0.05). [Conclusion] Compared with the conventional open repair, MGSSI has the advantages of smaller incision, less blood loss and better early postoperative functional recovery for AATR .

Abstract:Anterior cruciate ligament reconstruction (ACLR) is the gold standard for the treatment of anterior cruciate ligament rupture, but the traditional bone tunnel positioning method relies on the doctor's experience, with low accuracy and repeatability, resulting in a high revision rate. In recent years, the application of navigation technology in bone tunnel positioning in ACLR surgery has made significant progress. Navigation technology has continuously developed from active optical navigation to CT, MRI and multi-modal image fusion, which has significantly improved the positioning accuracy of femoral and tibial tunnels in anatomy. However, its short-term clinical consequence is not significantly different from the traditional method, and the long-term outcome still needs to be further verified. Navigation improves surgical reliability and safety by reducing personal equation, whereas its high cost, operational complexity and increased invasiveness limit its widespread application. This article reviewed the domestic and international technical development, clinical application progress and possible future development direction of bone tunnel navigation for anterior cruciate ligament reconstruction.

Abstract:The fracture of the anteroinferior glenoid, even complicated with labrum and the anterior bundle of the inferior glenohumeral ligament avulsion by trauma is known as bony Bankart lesion. If the area of bone defect more than 20%~25% in the glenoid surface, it is termed as severe bony Bankart lesion with extreme challenges in diagnosis and treatment. Improper treatment leads poor consequence, which increase the patient's suffering. Therefore, the ideal surgical methods for severe bony Bankart injuries deserve further study. In this paper, a case of severe bony Bankart injury was reported involving the clinical characteristics, such as diagnosis and treatment process, as well as clinical followup outcome. In addition, the recent literatures regarding the treatment methods for severe bony Bankart injury at home and abroad were reviewed, especially to explores the efficacy of the modified double-pulley double-row suture combined with Revo knot technique under arthroscopy in the treatment of severe bony Bankart injury.

Abstract:[Objective] By measuring the CT data of normal human pelvises, an adjustable guide device for quickly and effectively inserting posterior column screw was designed and its effectiveness was verified. [Methods] A total of 40 cases of normal adult pelvic CT data were collected, including 20 males and 20 females. The pelvic models were reconstructed using Mimics 19.0 software. The right pelvis was selected as the measurement object, and a 2.5 mm virtual guide pin was inserted towards the ischial tuberosity from the standard posterior column screw insertion point. Relevant parameters were measured. Based on the measurement results, a adjustable guide device for posterior screw guide pin insertion was designed and fabricated. The guide pin placement was compared between that under navigation with the guide device and the conventional manual technique in 6 cadaveric pelvic specimens. [Results] There were no statistically significant differences between the male and female in terms of the sagittal angle of the posterior column screw [(8.0±1.1)° vs (7.7±1.3)°, P=0.096], the coronal angle of the posterior column screw [(14.4±2.3)° vs (14.2±2.9)°, P=0.883], the semi-cone angle [(26.9±4.2)° vs (25.9±4.6)°, P=0.529], the swinging angle in iliac oblique view [(10.1±1.4)° vs (10.7±1.3)°, P=0.634], and the swinging angle in obturator oblique view [(11.2± 1.4)° vs (11.9±1.3)°, P=0.712]. As results of the verification of acetabular posterior column guide pin insertion in cadaveric pelvic specimens, the guide pin insertion guided by the device was significantly superior to the conventional manual technique in terms of the successful pin placement time [(5.2±1.1) min vs (33.5±8.6) min, P=0.021], the number of fluoroscopy [(8.3±2.3) times vs (36.2±6.2) times, P= 0.015], and the adjustment times [(1.3±0.2) times vs (10.3±3.2) times, P=0.019]. [Conclusion] There are no significant differences in the anatomical parameters of posterior column screw insertion between males and females. The adjustable guide device designed and made this study can effectively adjust the posterior column screw to enter the correct bony channel.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of closed reduction and intramedullary nailing for tibiofibular fractures assisted by traction device combined with external support frame. [Methods] Fifteen patients underwent this surgical treatment for tibiofibular fractures. After anesthesia, the patient was placed in supine position. Two Steinmann pins 4.0 in diameter were inserted parallel 1cm to the articular surface at the proximal and distal ends of the tibia respectively. Among them, the proximal pin was placed in the middle and posterior part of the tibial platform to avoid the intramedullary nail channel. Afer triangular fracture traction device was connected through the traction arch, and an axial pulling force was applied to correct the shortening and displacement of the fractures to achieve initial fracture reduction. Two carbon fiber rods and four universal clamps were used to fix the lateral and medial sides of the proximal and distal pins respectively to form a rectangular frame external fixation. The external fixation frame was adjusted to further reduce the fracture. The fibular fracture was fixed with retrograde intramedullary Kirchner wire placed from the lateral malleolus, or a plate through a small incision. After removing the traction device, the affected knee was bend at 100 degrees of flexion, and tibial intramedullary nailing was conventionally conducted through the subpatellar approach in the tibial fracture reduced condition. After the intramedullary nail locking was completed, the temporary external fixator was removed. [Results] All the 15 patients underwent successful surgeries with operation time of (55.2±12.0) min, the intraoperative blood loss of (15.8±7.8) mL, and the fluoroscopy time of (22±2.5) s. No reduction loss or incision infection occurred in anyone of them during the follow-up. The AOFAS score at the last follow-up was of (95.2±2.4), and the clinical healing time of fractures was of (12.1±1.5) weeks. [Conclusion] The combination of a traction device and an external support frame to assist in the closed reduction and intramedullary nailing for tibiofibular fractures can achieve rapid closed reduction and stabilization of the fractures, significantly reduce the operational difficulty during the operation with less iatrogenic trauma. It is particularly suitable for the treatment of complex tibiofibular fractures.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of preoperative 3D printing pre-shaped phalangeal plates for fixation of the ulnar coronoid process fractures. [Methods] This surgical treatment was performed on 20 patients with ulnar coronoid process fractures. Before the operation, the proximal ulnar model was made by 3D printing. Quadrilateral or "T" -shaped phalangeal mini-plates were selected for shaping according to the model and the screw distribution was determined. During the real operation, the ulnar coronoid process was reduced under direct vision. The pre-shaped plate was placed and fixed according to the preoperative plan, and the anterior capsule was sutured in an 8-shape and suspended on the plate to increase stability. After good reduction and fixation of the fractures and stability of the elbow were confirmed by fluoroscopy, adrainage tube was placed and the wound was sutured in layers. If combined with radial head fractures and lateral ulnar collateral ligament injuries, conservative or corresponding surgical treatments were conducted based on intraoperative stress tests. [Results] All patients were operated on successfully, and followed up for (15.5±3.9) months in a mean. At the last follow-up, the VAS score was of 0 to 2, elbow extension of 0° to 10° in extension, elbow flexion of 120° to 145°, pronation of 75°~90°, supination of 75°~90° and Mayo score ranged from 85 to 100 points. All patients achieved clinical healing of the fractures. [Conclusion] The pre-shaped phalangeal plates based on preoperative 3D printed model make the plates adhere more closely, reduce the occurrence of postoperative complications, are conducive to the early functional exercise of the joint, and achieve good clinical consequence for O'Driscoll type Ⅱ ulnar coronoid process fractures.

Abstract: [Objective] To compare the clinical consequence of laryngeal mask airway (LMA) general anesthesia combined with ultrasound- guided fascia iliaca compartment block (FICB) (LMA- FB) versus conventional general anesthesia with endotracheal intubation (GAEI) for hip fracture surgery with abnormal blood coagulation in elderly. [Methods] A retrospective study was conducted on 100 elderly patients who received surgical treatment for hip fractures complicated with abnormal blood coagulation in our hospital from January 2020 to June 2025. According to preoperative doctor-patient communication, 50 patients received the LMA-FB, while the other 50 patients were treated with GAEI. The intraoperative dosage of general anesthetic drugs, the number of fluctuations in hemodynamic parameters, and the incidence of postoperative new complications were compared between the two groups. [Results] The LMA-FB group proved significantly better than the GAEI group in terms of dosage of sufentanil consumed [10.0 (10.0, 15.0) μg vs 15.0 (10.0, 20.0) μg, P＜0.001], dosage of the cisatracurium [6.0 (4.0, 8.0) mg vs 10.0 (8.0, 12.0) mg, P＜0.001], the number of fluctuations in hemodynamic parameters during the operation [3.0 (2.0, 4.0) times vs 5.0 (3.8, 8.0) times, P＜0.001], chance of ICU stay after surgery (6.0% vs 40.0%, P＜0.001), the incidence of new cardiovascular complications (8.0% vs 22.0%, P=0.050), and the incidence of pulmonary complications (6.0% vs 20.0%, P=0.037), whereas there was no statistically significant difference in the incidence of new cerebrovascular complications between the two groups (4.0% vs 6.0%, P＞0.999). All patients in the LMA-FB group had FICB performed successfully under ultrasound guidance with no hematoma, nerve injury or infection-related complications. [Conclusion] The LMA-FB does effectively reduce the dosage of general anesthetic drugs during surgery, maintain hemodynamic stability, and reduce the risk of postoperative cardiovascular and pulmonary complications, providing a safe and effective anesthesia method for hip fractures complicated with abnormal blood coagulation in the elderly.

Abstract:[Objective] To investigate the effect of combined intervention and caring on delirium and unplanned extubation after hip hemiarthroplasty (HHA) for hip fractures in the elderly. [Methods] A total of 84 patients with femoral neck fracture who were undgoing HHA with drainage tube placement were included in this study in our department from January to December 2022, and all of them were conscious before surgery. Patients were divided into two groups using random number table method, including 42 patients given combined intervention on the basis of routine postoperative care, and 42 patients given routine postoperative care only. The incidence of postoperative delirium and unplanned extubation were compared between the two groups. [Results] All patients in both groups had operation performed successfully. The VAS scores of both groups decreased significantly over time postoperatively (P＜0.05), which was not statistically significant between groups at any corresponding time points (P＞0.05). The combined group proved significantly superior to the routine group in terms of incidence of delirium events (19.0% vs 83.3%, P＜0.001), and the duration of delirium [(2.8±1.4) days vs (6.2±1.4) days, P＜0.001]. In addition, the combined group had significantly lower incidence of unplanned extubation than the routine group (0 vs 19.0%, P=0.003). Furthermore, the former had lower incidence of low extremity venous thrombosis and pulmonary infection than the latter, despite of the fact that the difference was not statistically significant (P＞0.05). [Conclusion] Combined intervention and caring does significantly reduce the incidence of postoperative delirium, shorten the duration of delirium, and reduce the risk of unplanned extubation due to delirium.