Abstract: [Objective] To compare the clinical efficacy of cement-augmented proximal femoral nail anti-rotation (C-PFNA) versus conventional PFNA for intertrochanteric fractures of the femur. [Methods] A retrospective study was conducted on 159 patients who had the intertrochanteric fractures fixed by PFNAs in our hospital between October 2019 and October 2022. Based on preoperative doctor-patient communication, 79 patients received the C-PFNA, while other 80 patients were treated with only PFNA. The perioperative, follow-up, and radiological data of the two groups were compared. [Results] All patients had corresponding surgical procedures performed smoothly without statistically significant differences in total incisions length, intraoperative blood loss, and wound healing between the two groups (P＞0.05). Although the C-PFNA group consumed significantly longer operative time [min, (44.4±9.4) vs (32.1±10.9), P＜0.001] and more intraoperative fluoroscopic exposures [times, (22.3±3.6) vs (19.1±3.0), P＜0.001] over the PFNA group, the former proved significantly superior to the PFNA group in terms of postoperative hospitalization [days, (7.8±2.1) vs (11.8±3.1), P＜0.001] and ambulation time [days, (1.1±0.8) vs (5.2± 3.1), P＜0.001]. The average follow-up time was (18.7±3.4) months, and the C-PFNA group resumed full weight-bearing activity significantly earlier than the PFNA group [days, (53.0±10.9) vs (64.2±12.9), P＜0.001]. The VAS scores in both groups significantly decreased (P＜ 0.01), while Harris score, hip extension-flexion range of motion (ROM), and internal-external rotation ROM were significantly increased over time (P＜0.05). The C-PFNA group was signficantly better than the PFNA group regarding the VAS score [points, (1.5±0.5) vs (2.1± 0.8), P＜0.001; (0.5±0.2) vs (1.6±0.8), P＜0.001], Harris score [points, (87.1±3.7) vs (85.3±4.5), P=0.006; (90.8±4.2) vs (86.9±7.1), P＜0.001], hip extension-flexion ROM [°, (93.2±8.7) vs (89.5±7.5), P=0.005; (96.9±8.4) vs (92.7±14.6), P=0.028] and internal-external rotation ROM [°, (44.3±6.2) vs (42.0±4.9), P=0.009; (47.3±6.3) vs (44.7±6.3), P=0.011] 6 months and 12 months after the operation. With respect of imaging, there was no statistically significant difference in the quality of fracture reduction between the two groups (P＞0.05). However, the C-PFNA group proved significantly better over the PFNA group in terms of the femoral neck-shaft angle (FNSA) and tip-apex distance (TAD) 6 months and 12 months postoperatively (P＜0.05). [Conclusion] The bone cement-augmented PFNA is obviously superior to the conventional PFNA in the treatment of intertrochanteric fractures of the femur. It has the advantages of less postoperative pain, earlier walking, shortened hospital stay, good functional recovery, and earlier fracture healing.

Abstract:[Objective] To compare the clinical efficacy of distal posterior tibial artery perforator flaps (DPTAPF) versus peroneal neurovascular flap (PNVF) in repairing heel wounds. [Methods] From August 2016 to July 2023, 45 patients with foot heel wounds were admitted to the hospital. Based on the communication between doctors and patients, 24 patients were treated with DPTAPF, while other 21 patients were treated with PNVF. The perioperative and follow-up documents of the two groups were compared. [Results] All patients in both groups had corresponding surgical procedures conducted successfully. The DPTAPF was significantly superior to the PNVF in terms of flap survival area 1 week after surgery [%, (95.0±7.1) vs (89.5±9.9), P=0.036] and the postoperative hospital stay [days, (7.9±2.4) vs (10.1±3.2), P=0.013]. All patients were followed up for an average of (15.8±3.2) months, and the DPTAPF group resumed full weight-bearing activity significantly earlier than the PNVF group [weeks, (13.2±3.3) vs (15.1±2.2), P=0.036]. The VAS score, AOFAS score, ankle dorsiflexion-plantar flexion ROM, two-point discrimination of the flap, appearance score of the donor area, and appearance score of the recipient area were significantly improved in both groups over time postoperatively (P＜0.05). The VAS score in the DPTAPF group proved significantly better than that in the PNVF 1 month after surgery [points, (3.8±1.3) vs (4.7±1.1), P=0.015], whereas which became not statistically significant between the two groups 3 months after surgery and at the last follow-up (P＞0.05). There was no a statistically significant difference in AOFAS score between the two groups at any matching time points after surgery (P＞0.05). However, the DPTAPF was significantly better than the PNVF 1, 3 months postoperatively and at the last follow-up in terms of the two-point discrimination [mm, (23.3±4.9) vs (30.4±5.2), P＜0.001; (19.1±4.2) vs(25.7±5.5), P＜0.001; (14.7±4.0) vs (21.1±5.7), P＜0.001], appearance score of the donor area [points, (6.8±1.4) vs (8.6±2.5), P=0.005; (5.5± 1.3) vs (7.6±2.5), P＜0.001; (4.8±1.2) vs (6.1±2.5), P=0.023], and appearance score of the recipient area [points, (6.5±1.4) vs (8.0±2.3), P= 0.014; (6.2±1.4) vs (7.5±2.1), P＜0.001; (5.3±1.4) vs (6.7±2.3), P=0.011]. [Conclusion] Both the proximal pedicled flaps can be used for repairing heel wounds effectively. Compared with each other, the DPTAPF has a higher survival rate, shorter hospital stay, better appearance of the donor and recipient areas, and less iatrogenic damage.

Abstract: [Objective] To compare the clinical consequence of Masquelet technique (MT) versus bone transportation (BT) in treating 4~ 6 cm tibial infectious bone defects. [Methods] A retrospective study was conducted on 48 patients who had the tibial infectious bone defects treated surgically in our department from January 2020 to January 2023. According to the preoperative doctor-patient communication, the patients were divided into two groups, with 25 cases in the MT group and 23 cases in the BT group. The documents regarding treatment period, follow-up and images were compared between the two groups. [Results] All patients in both groups received corresponding treatment successfully without treatment plan changed. The MT group proved significantly greater over the BT group in terms of surgical times [times, 1/2/ 3/4, (0/22/3/0) vs (18/5/0/0), P=0.011], wound healing time [days, (21.3±3.5) vs (18.6±3.2), P=0.003], hospitalization times [times, 1/2/3/4, (1/23/1/0) vs (19/4/0/0), P=0.012], and total hospitalization time [days, (13.9±2.1) vs (10.4±1.9), P＜0.001], whereas the former consumed significantly less total treatment cost than the latter [10 k yuan, (4.3±0.5) vs (5.0±0.5), P=0.010]. There were no statistically significant differences in the wound closure methods, wound healing grade and the ambulation time with crutches between the two groups (P＞0.05). All patients were followed up for more than 12 months, and there was no statistically significant difference in the time to regain full weight-bearing activity between the two groups (P＞0.05). With time before treatment, 6 months after surgery and the last follow-up, the VAS, HSS, AOFAS scores, as well as knee and ankle ROMs in both groups were significantly improved (P＜0.05). At 6 months after surgery and the last followup, the MT group was significantly superior to the BT group in terms of the HSS and AOFAS scores, as well as knee and ankle ROMs (P＜0.05). At the last follow-up, all patients in both groups achieved clinical bone defect healing without revision surgery required. Regarding to imaging, the alignment of the tibial ends, bilateral tibial length discrepancy, the lateral displacement of the bone end on the coronal plane, and the angulation of the bone end on the coronal plane in both groups significantly improved at the latest follow-up compared with those before treatment (P＜0.05), whereas which proved not statistically significant between the two groups at any time points accordingly (P＞0.05). In addition, there was no statistically significant difference in the healing time of bone defects between the two groups (P＞0.05). [Conclusion] Both Masquelet technique and bone transportation technique are effective treatments for 4~6 cm tibial infectious bone defects. In contrast, the Masquelet technique has the advantages of lower treatment cost and more significant improvement in joint function after surgery, but it requires high soft tissue conditions and a longer hospital stay.

Abstract: [Objective] To explore the gender impact on clinical and imaging outcomes of medial patellofemoral ligament reconstruction (MPFLR) for recurrent patellar dislocation (RPD). [Methods] A retrospective research was done on of 209 patients who received MPFLR for RPD in the Second Hospital of Lanzhou University from January 2020 to December 2023. By using propensity matching method based on age, BMI and other variables, 70 males and 70 females were matched and enrolled into this study. The clinical and imaging documents were compared between the two groups. [Results] All patients were operated on successfully without neurovascular injury. There were no significant differences in perioperative parameters, including operation time, incision length and intraoperative blood loss between the two groups (P＞0.05). All the patients were followed up for (29.9±15.4) months in a mean, the male resumed full weight-bearing activity significantly earlier than the female [days, (83.8±4.5) vs (95.8±2.9), P＜0.001]. Compared with those preoperatively, the VAS score was significantly decreased (P＜0.05), while the Kujala, Lysholm, IKDC and Tegner scores, as well as knee extensive-flexion range of motion (ROM) were significantly increased in both groups at the latest follow-up (P＜0.05). Although there was no statistically significant difference in the above scores between the two groups before surgery (P＞0.05), the male cohort proved significantly superior to the female cohort in terms of VAS score [points, (1.1±0.8) vs (2.0±0.9), P＜0.001], Kujala score [points, (88.4±12.3) vs (84.5±10.1), P=0.003], Lysholm score [points, (88.4±11.5) vs (83.6±9.2), P＜0.001], IKDC score [points, (74.8±8.8) vs (71.2±8.0), P=0.008] and Tegner score [points, (5.6±1.4) vs (4.6±1.5), P＜0.001] at the latest follow-up. As for imaging, the patellar tilt (PT) and patellar shift (PS) were significantly improved in both groups at the last followup compared with those before surgery (P＜0.05), which were not statistically significant between the two groups at any corresponding time points (P＞0.05). [Conclusion] The male achieves considerably better functional scores and pain relief after MPFLR over the female, but there was no significant gender difference in the imaging parameters.

Abstract: [Objective] To compare the clinical efficacy of antegrade intramedullary nailing versus retrograde nailing under assistance of axial distraction devices for the distal 1/3 shaft femur fractures. [Methods] A retrospective research was conducted on 72 patients who received intramedullary nailing for the femoral distal 1/3 shaft fractures in our hospital from June 2014 to November 2023. According to preoperative doctor- patient communication, 33 patients underwent the antegrade nailing (the antegrade group), and the other 39 patients were treated with the retrograde nailing (the retrograde group). The perioperative, follow-up, and imaging data were compared between the two groups. [Results] There were no statistically significant differences between the two groups in terms of operation time, incision length, intraoperative blood loss, intraoperative fluoroscopy times, time to return ambulation, incision healing grade, and hospital stay (P＞0.05). The average follow-up time was of (54.7±27.2) months, and there was no a statistically significant difference in the time to regain full weight-bearing activity between the two groups after surgery (P＞0.05). Compared with those 3 months postoperatively, the pain VAS, KSS, Harris scores, and knee flexion-extension ROM in both groups were significantly improved at the last follow-up (P＜0.05), and there were no statistically significant differences in the abovesaid indicators between the two groups at any corresponding time points (P＞0.05). Radiographically, there were no statistically significant differences in the bilateral femoral length discrepancy, anatomic lateral distal femoral angle (aLDFA), posterior distal femoral angle (PDFA), and fracture alignment grade between the two groups before surgery and at the last follow-up (P＞0.05). However, the antegrade group proved significantly inferior to the retrograde group in the modified radiographic union score for tibial (mRUST)[score, (10.9±2.0) vs (12.5±1.0), P＜0.001; (14.4±1.9) vs (15.6±1.0), P＜0.001] 3 months postoperatively and at the latest follow-up. [Conclusion] Compared with the antegrade intramedullary nailing, the retrograde intramedullary nailing can better control the distal stability of femoral fractures, and is more conducive to fracture healing.

Abstract:[Objective] To compare the clinical outcomes of titanium cable (TC) versus steel wire (SW) in tension band fixation in the treatment of transverse patellar fractures. [Methods] A retrospective study was conducted on 125 patients who had transverse patellar fractures treated surgically in our hospital from March 2019 to September 2023. According to the preoperative doctor-patient communication, 63 patients received tension bands with Kirschner's wire and TC , while other 62 patients underwent tesion bands of the Kirschner's wire and SW. The perioperative, follow-up and imaging documents of the two groups were compared. [Results] The TC group proved significantly superior to the SW group in terms of the operation time [min, (74.6±19.6) vs (91.1±31.2), P＜0.001] and intraoperative blood loss [mL, (69.2± 18.8) vs (79.1±20.4), P=0.006], the ambulation time [days, (6.7±3.4) vs (10.0±4.9), P＜0.001], and the time to regain full weight bearing activity [days, (40.1±14.2) vs (45.7±15.9), P=0.035]. Over time during follow-up period lasted for (21.1±4.9) months in a mean, the VAS, Kujala and Bostman scores, as well as knee extension-flexion ROM were significantly improved in both groups (P＜0.05). The TC group was significantly better than the SW group regarding VAS score [(2.4±0.8) vs (3.1±1.0), P＜0.001; (1.6±0.4) vs (2.1±0.8), P＜0.001], Kujala score [(66.5± 2.9) vs (64.3±1.6), P＜0.001; (78.9±3.6) vs (73.6±3.2), P＜0.001], B?stman score [(21.9±2.6) vs (20.3±2.9), P=0.002; (24.6±3.2) vs (23.4±3.1), P=0.033] and knee extesion-flexion ROM [°, (35.1±14.9) vs (18.6±8.5), P＜0.001; (80.3±12.2) vs (57.6±9.6), P＜0.001] 1 and 3 months after the operation. As for imaging, there were no statistically significant differences in the quality of articular surface reduction, Insall-Salvati index, and fracture healing time on images between the two groups at any corresponding time points (P＞0.05). [Conclusion] The titanium cable applied in tension band fixation has considerably better consequence in the treatment of transverse patellar fractures, with advantages of more effectively relieving pain, promoting fracture healing and the recovery of knee joint function with better safety over the conventional steel wire tension band.

Abstract:[Objective] To compare the clinical consequences of three types of locking plates for fixation of lateral tibial plateau fractures (LTPFs). [Methods] A retrospective research was conducted on 57 patients who had LTPFs treated with open reduction and internal fixation (ORIF) in our department from February 2019 to February 2024. Of them, 36 patients who received ORIF before June 2021 were with traditional anterolateral locking titanium plates (the traditional group); while the 6 patients who suffered from LTPFs involving the posterolateral quadrant without posterolateral wall fractures were treated with the new-type four-screw locking titanium plate (the four-screw group), 15 patients who had LTPFs involving the posterolateral quadrant with posterolateral wall fractures were treated with the new-type five-screw locking titanium plate (the five-screw group). The perioperative, follow-up and imaging data of the three groups were compared. [Results] All patients in the three groups had corresponding ORIF performed successfully without serious complications, such as nerve and vascular injury during the operation. There were no statistically significant differences in terms of operation time, incision length, intraoperative fluoroscopy times, intraoperative blood loss and hospital stay among the three groups (P＞0.05). All patients in the three groups were followed up for an average of (30.8±14.6) months. The VAS score was significantly reduced in the three groups (P＜0.05), while the Rasmussen clinical score and knee flexion-extension range of motion (ROM) were significantly increased at the last follow-up compared with those 3 months postoperatively (P＜0.05). However, there were no statistically significant differences in the abovesaid items among the three groups at any corresponding time points (P＞0.05). Regarding imaging, the arc of the most anterior screw in the five-screw group was smaller than that in the traditional plate group and the four-screw group [°, (44.5±5.9) vs (51.6±7.0) vs (58.3±8.0), P＜0.001]; the arc of the most posterior screw in the four-screw group and the five-screw group was significantly larger than that in the traditional plate group [°, (112.2±5.1) vs (115.8±13.9) vs (96.1±7.6), P＜ 0.001]. The arc of screw coverage in the five-screw group was larger than that in the four-screw group and the traditional plate group [°, (71.3±12.3) vs (54.0±10.3) vs (44.5±6.0), P＜0.001]. The Rasmussen imaging score immediately after surgery in the five-screw group was lower than that in the traditional plate group and the four-screw group [score, (13.8±1.4) vs (15.1±1.8) vs (17.7±0.8), P＜0.001], while which in the fourscrew group was significantly better than that in the traditional plate group at the last follow-up [score, (17.3±1.0) vs (15.5±1.8), P＜0.001]. [Conclusion] This new-type locking titanium plate through the fibular head approach with larger fixation rangeis more reliable than the traditional anterolateral locking titanium plate, without increasing the operation difficulty. However, when placing the plate, passive anterior displacement of the titanium plate should be avoided, and five screws should be fixed at the top as much as possible.

Abstract: [Objective] To compare the clinical efficacy of total hip arthroplasty (THA) and proximal femoral nail anti-rotation (PFNA) for unstable intertrochanteric femoral fractures in the elderly. [Methods] A retrospective analysis was conducted on 80 elderly patients who had unstable intertrochanteric femoral fractures treated surgically in our hospital from January 2020 to June 2023. According to the communication between doctors and patients, 40 patients underwent THA, while the remaining 40 patients underwent PFNA. The perioperative and follow-up data of the two groups were compared, and the comparisons were stratified according to the AO/OTA classification. [Results] The THA group was significantly greater than the PFNA group in terms of operation time [min, (78.6±10.7) vs (58.3±8.4), P＜0.001], intraoperative blood loss [mL, (220.5±41.3) vs (92.4±25.1), P＜0.001], and hospital cost [10k yuan, (3.0±0.5) vs (1.2±0.2), P＜0.001], whereas the former was significantly less than the latter regarding the number of intraoperative fluoroscopy [times, (1.9±1.0) vs (16.8±4.1), P＜0.001], the postoperative bed rest time [days, (1.5±0.5) vs (5.5±0.9), P＜0.001] and the time to regain full weight-bearing activity [weeks, (0.3±0.1) vs (7.5±1.5), P＜0.001]. The THA group was significantly better than the PFNA group in Harris score 3 and 6 months postoperatively (P＞0.05), but there were no statistically significant differences in Harris score and SF-36 score between the two groups 12 months after surgery (P＞0.05). According to the fracture classification, THA group was marked significantly higher Harris score than the PFNA group 3 months after surgery for the type A2 type fractures (P＜0.001), and there was no statistically significant difference in the complication rate between the two groups (P＞0.05); however, there were no statistically significant differences in Harris score and complication rate between the two groups for the type A3 fractures (P＞0.05). [Conclusion] Both surgical methods have their own advantages. The THA can shorten the bed rest and the time to resume full weight-bearing activity, and promote early functional recovery. On other hand, the PFNA has less surgical trauma and lower cost, and its mid-to-long-term efficacy similar to that of THA.

Abstract: [Objective] To compare the clinical outcomes of robot-assisted femoral neck system fixation versus freehand counterpart in the treatment of femoral neck fracture by a metaanalysis. [Methods] The databases, including CNKI, VIP, Wanfang, PubMed, EMBASE, Cochrane Library and Web of Science, were searched from establishing the databases to September 2024. A meta-analysis was performed using RevMan 5.4 software. [Results] A total of 5 articles were enrolled into this study, involving 286 patients including 135 patients in the robot group and 151 patients in the freehand group. As results of the meta analysis, the robot group proved significantly superior to the freehand group in terms of the operation time (MD=-4.70, 95%CI: -6.56~-2.84, P＜0.001), invasive procedure time (MD=-14.44, 95%CI: -22.68~-6.20, P＜0.001), incision length (MD=-2.17, 95%CI:-2.87~-1.47, P＜0.001), fluoroscopy frequency (MD=-6.48, 95% CI: -7.77~-5.19, P＜0.001), blood loss (MD=-13.31, 95%CI: -24.10~-2.53, P=0.02), frequency of the main guide pin placement drilling (MD=-1.97, 95%CI: -2.31~-1.64, P＜0.001) and Harris score (MD=1.70, 95%CI: 0.79~2.61, P＜0.001). However, there was no significant differences in the postoperative complications and fracture healing time between the two groups (P＞0.05). [Conclusion] Compared with the freehand femoral neck system placement, the robotic-assisted technique has advantages of shortening operative time, reducing intraoperative bleeding, smaller incision, precise implant placement and less fluoroscopy, which facilitates the patient's postoperative recovery of hip function, whereas there is no difference in fracture healing time and postoperative complications.

Abstract:Hamatometacarpal fractures and dislocations are a complex hand injury, including hamate fractures and the 4th and 5th carpo metacarpal dislocations, which significantly affect hand function. In recent years, advancements in imaging and hand surgery techniques have driven innovations in its classification and treatment concepts. This review systematically summarizes the anatomical basis, injury mechanism, classification, treatment principles, and technical progress of hamatometacarpal fractures and dislocations, and focuses on analyzing the impact of classification on treatment principles, as well as discussing postoperative rehabilitation and strategies for preventing complications. By integrating clinical research data, the aim is to provide evidence-based guidance for clinical decision-making and to explore future development directions.

Abstract:[Objective] To explore the relationship between the mechanical-electrical properties and the microstructure of the femoral bone tissue. [Methods] Six right femurs of rabbits were selected as samples. The micro-structural parameters of the bones in six volume of interest (VOI) were obtained by micro computed tomography (Micro-CT) on the samples. Then, a concentrated force load was applied to the samples, and electrodes were attached to the surface of the diaphysis to measure the potential curves. The potential curves were fitted using the known expansion index law, and the fitting parameters of each curve were obtained. The potentials among the six VOIs were compared, and the relationship between the fitting parameters of each potential curve and the microstructural parameters was analyzed. [Results] The differences in bone volume (BV) among VOI1 to VOI6 [mm3 , (21.40±3.35) vs (22.81±1.77) vs (23.71±4.94) vs (15.87±3.65) vs (22.60±5.61) vs (21.65±3.89), P=0.031], the average thickness of cortical bone (Ct.Th) [mm, (0.81±0.09) vs (0.82±0.05) vs (0.91±0.19) vs (0.63±0.20) vs (0.94±0.20) vs (0.87±0.25), P=0.047], and the relative bone surface/bone volume (BS/BV) [(3.60±0.43) vs (3.51±0.13) vs (3.49±0.58) vs (5.47±2.42) vs (3.64±0.78) vs (3.52±0.52), P=0.025] were statistically significant. When subjected to vertical load, the potentials among VOI1 to VOI6 [mV, (2.53±1.05) vs (2.14±1.51) vs (1.99±0.87) vs (-2.75±1.52) vs (0.56±2.32) vs (-0.57±1.31), P＜0.001] and the normal stress [MPa, (3.72±0.47) vs (4.28±0.28) vs (3.18±0.49) vs (-5.96±0.54) vs (-6.76±0.48) vs (-6.20±0.35), P＜0.001] were statistically significant. According to the different signs of normal stress, VOI1 to VOI3 and VOI4 to VOI6 were divided into two groups for Pearson correlation analysis of fitting parameters and microstructural parameters. It was found that Ka was significantly positively correlated with BV and Ct. Th (r=0.75, r=0.59, P＜0.05), and Ka was significantly negatively correlated with BS/BV (r=-0.71, P＜0.05), additionally the τc was significantly positively correlated with bone mineral density (BMD) (r=0.52, P＜0.05). [Conclusion] Measuring the surface potential of bone under load can predict the microstructure of different parts of the bone.

Abstract:[Objective] To introduce the surgical techniques and preliminary clinical outcome of externally placed pelvic internal fixation frame (INFIX) combined with channel screw fixation for unstable pelvic fractures in children. [Method] After successful anesthesia, the child was placed in a supine position, with the surgical area disinfected and draped. Bilateral anterior inferior iliac spine incisions were made approximately 1 cm in length. After the skin, subcutaneous tissue, and fascia layer were successively incised, and the area was slightly released to both sides to expose the anterior inferior iliac spine. An INFIX universal screw was placed each side along the anterior inferior iliac spine bone channel, and then the connecting rod in arch shape was attached with the screw ends on both sides respectively outside the skin. Under longitudinal traction over the pelvis with a lower limb distraction device, the pelvic fractures were reduced with distraction device and rod clamp, finally, the INFIX screw-rod system was fastened. In addition, under fluoroscopy a guide wire was inserted along the bone channel, and then a cannulated screw in proper length and diameter was placed over the guide wire. After satisfactory reduction and implants in good position confirmed by fluoroscopy, the guide wire removed, the incisions were closed in layers. [Results] The successful closed reduction of fractures was achieved in all children, marked as excellent in 3 cases and good in 3 cases based on Matta's criteria with an excellent and good rate of 100%, with the average operation time of (45.4±14.8) min and the average intraoperative blood loss of (18.8± 8.6) mL. The patients were followed up for (12.5±1.7) months in a mean, and regained sensory and motor functions of the lower extremities to normal level. All of them had fractures healed with the average healing time of (6.5±0.6) weeks. [Conclusion] The externally placed INFIX combined with channel screw fixation for the treatment of unstable pelvic fractures in children achieves satisfactory reduction, with advantages of short operation time, small trauma, stable fracture fixation, fast healing, and satisfactory recovery of lower extremity function.

Abstract: [Objective] To introduce the surgical technique and clinical outcomes of reverse-flow revascularized free anterolateral thigh flap for anterior tibial soft tissue defects. [Methods] A total of 10 patients received abovesaid surgical procedures. After a thorough debridement of the wound, the distal end of the injured anterior tibial vessels was exposed for later anastomosis. The flap was designed along the iliopatellar line based on the shape and size of the defect, with the flap margins typically extending 1 cm beyond the wound edges to prevent retraction and a small "muscle cuff" preserved around the vascular pedicle. The donor area was directly sutured or repaired with mediumthickness skin grafting. The free flap was transplanted to the recipient area with the arterial and venous pedicles of the skin flap respectively anastomosed end-to-end with the distal tibial anterior artery and vein of the defect area. [Results] All the patients had operation performed successfully without serious complications such as nerve or blood vessel injuries, and got flaps survived well. The follow-up period ranged from 8 to 26 months. At the last follow-up, all patients had normal appearance and color of the flaps with soft texture, despite of the fact that 5 patients showed obvious corpulent flaps, which was trimmed 6 months after the primary operation. [Conclusion] For cases of severe lower leg injuries resulting in complex anterior tibial soft tissue defects combined with anterior tibial vascular injuries, this reverse-flow revascularized free anterolateral thigh flap is a reliable surgical method if the conventional anterograde blood supply transplantation is difficult.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical results of 3D print-assisted iliac bone autografting for repairing foot bone defects. [Methods] The operation was carried out in two stages. In the first-stage, debridement to remove the necrotic tissues and bone cement filling were performed. After that, 3D CT reconstruction, image processing and model printing were conducted. On the ilium model, simulated bone harvesting was carried out based on the bone defect on the printed foot model. In the second-stage surgery, according to the simulated surgery, a bone block was harvested from the ipsilateral iliac for future use. After the bone cement filled the bone defect was removed, and the bone graft was trimmed and placed into the bone defect, and then internal fixation or surrounding joint fusion were performed. [Results] All the patients were successfully operated on. The visual analogue scale (VAS) for pain significantly improved from (6.9±1.2) before the operation to (2.1±0.9) 6 months after the operation, while the ankle and hind foot score of the American Orthopaedic Foot and Ankle Society (AOFAS) significantly improved from (40.9±4.9) before operation to (86.8±3.7) 6 months after the operation. [Conclusion] This 3D print-assisted iliac bone autografting for repairing foot bone defects is precise and has a good preliminary clinical efficacy.

Abstract: [Objective] To compare the clinical efficacy of ilioischial plate versus buttress screw fixation in the treatment of acetabular fractures involving quadrilateral surface. [Methods] A retrospective study was done on 18 patients who had acetabular fractures involving quadrilateral surface fixed surgically in our hospital from December 2022 to April 2024. According to preoperative doctor-patient communication, 11 patients were fixed with ilioischial plate (the IIP group), while other 7 patients were fixed with buttress screws (the BS group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups were successfully operated on without serious complications. There were no significant differences in operation time, intraoperative blood loss, incision length, hospitalization days, walking time and incision healing grade between the two groups (P＞0.05). Compared with those 3 months after surgery, the VAS scores [(1.6±0.7), (1.2±0.4), P＜0.001; (1.7±0.5), (1.1±0.4), P＜0.001] and Merle D'Aubigne-Postel score [(16.3±0.8), (17.7±0.5), P＜0.001; (16.3±0.9), (17.8±0.4), P＜0.001] both in the IIP group and BS group were significantly improved at the last follow-up, whereas which proved not significantly different between the two groups at any corresponding time points (P＞0.05). Radiographically, the Matta grade for acetabular alignment was signficantly improved (P＜0.05), whereas the Tonnis grade for hip degeneration was significantly deteriorated over time in both groups (P＜0.05). At any corresponding time points, there were no significant differences in Matta and Tonnis grades between the two groups (P＞0.05). [Conclusion] Both ilioischial plate and buttress screw fixation for acetabular fractures involving the quadrilateral surface have good fixation quality and achieve satisfactory clinical consequence.

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