Abstract: [Objective] To explore the risk factors of traumatic coagulopathy (TIC) secondary to multiple fractures. [Methods] A retrospective analysis was conducted on 240 patients who had multiple fractures treated in our department from February 2022 to January 2025. Based on the 2016 European TIC diagnostic guidelines, the patients were divided into the TIC group and the non-TIC group. Univariate comparison and multivariate logistic regression analysis were used to search the factors related to TIC. [Results] Among the 240 patients with multiple fractures, 32 patients developed TIC, with a prevalence of 13.3%. Regarding to univariate comparison, the TIC group proved significant greater than the non-TIC group in terms of age [year, (46.9±8.3) vs (38.7±6.0), P＜0.001], the injury severity score (ISS) [points, (30.3± 4.2) vs (24.6±3.7), P＜0.001], complicated shock [n (%), 6 (18.8) vs 10 (4.8), P=0.003], open fractures [n (%), 16 (50.0) vs 46 (22.1), P＜ 0.001], time span from injury to admission [hour, (3.2±0.7) vs (2.5±0.6), P＜0.001], major vascular injury [n (%), 15 (46.9) vs 44 (21.2), P＜ 0.001], pulse [bpm, (113.4±9.3) vs (108.6±7.9), P=0.006], respiration [bpm, (21.3±2.3) vs (20.0±1.9), P＜0.001], PCO2 [mmHg, (47.4±3.4) vs (45.5±3.0), P＜0.001]. In contrast, the TIC group was significantly less than the non-TIC group in terms of mean arterial pressure [mmHg, (79.1±5.3) vs (82.4±5.7), P=0.002], core body temperature [℃, (35.4±1.2) vs (36.8±1.5), P＜0.001], PO2 [mmHg, (76.5±5.7) vs (80.6±6.5), P＜ 0.001], RBC [1012/L, (3.8±0.3) vs (4.0±0.3), P＜0.001], PLT [109 /L, (178.5±10.8) vs (198.4±10.9), P=0.001], Hb [g/L, (106.1±9.4) vs (118.6± 10.6), P＜0.001] and TAT/PIC1 [(1.4±0.3) vs (1.8±0.3), P＜0.001]. As consequence of multivariate logistic regression, the ISS score (OR= 1.569, P＜0.001), age (OR=1.210, P=0.021), and the presence of shock (OR=2.024, P＜0.001) were independent risk factors for TIC, while the core body temperature (OR=0.400, P＜0.001), Hb (OR=0.451, P＜0.001), and TAT/PIC (OR=0.539, P＜0.001) were the protective factors.[Conclusion] The incidence of TIC in this group of patients with multiple fractures is of 13.3%. Higher ISS score, older age, and concurrent shock are independent risk factors for TIC, while higher core body temperature, Hb, and TAT/PIC ratio are protective factors for TIC.

Abstract:[Objective] To compare the clinical outcomes of arthroscopic treatment of Schatzker type Ⅱ~Ⅳ tibial plateau fractures with or without robot assistance. [Methods] A retrospective study was conducted on 53 patients who underwent arthroscopic treatment for Schatzker type Ⅱ~Ⅳ tibial plateau fractures in our hospital from April 2020 to April 2023. Based on preoperative doctor-patient communication, 28 patients were treated with robot-assisted arthroscopic reduction and fixation, while the remaining 25 patients received conventional arthroscopic reduction and fixation without robot assistance. The perioperative, follow-up, and imaging data of the two groups were compared. [Results] All patients successfully completed the surgery. The robot group consumed significantly longer operation time than the conventional group [min, (148.4±58.8) vs (103.6±33.5), P=0.005], but the robot-assisted group proved significantly superior to the conventional group in terms of incision length [cm, (5.4±1.7) vs (8.2±2.7), P＜0.001], intraoperative fluoroscopy [times, (5.6±1.4) vs (9.1±1.9), P＜0.001], and intraoperative blood loss [mL, (43.4±26.4) vs (70.0±30.6), P=0.001]. In addition, the robot-assisted group resumed ambulation [d, (27.9±1.7) vs (30.4±3.3), P＜0.001] and full weight-bearing activity [d, (74.8±11.6) vs (85.5±7.7), P＜0.001] significantly earlier than the conventional group. At 6 months postoperatively, the robot-assisted group was significantly better than the conventional group in terms of VAS score [points, (0.4±0.6) vs (1.0±0.9), P=0.011], Rasmussen clinical score [points, (19.2±1.3) vs (18.3±1.1), P=0.017], and knee flexion-extension ROM [°, (114.2±6.2) vs (109.9±6.7), P=0.016], although the differences in VAS and ROM between the two groups became not statistically significant at the last follow-up (P＞0.05). As for imaging, the robot group was significantly better than the conventional group regarding fracture healing time on images and K-L grade of joint degeneration at the last follow-up (P＜0.05). However, there were no statistically significant differences in Rasmussen radiographic scores between the two groups immediately postoperatively and at the last follow-up (P＞0.05).[Conclusion] The robot-assisted arthroscopic reduction and internal fixation take significant advantages of minimally invasive surgery, pain reduction, accelerated fracture healing, and postoperative recovery over the conventional counterpart for Schatzker type Ⅱ~Ⅳ tibial plateau fractures.

Abstract: [Objective] To explore the factors related to the prognosis of open reduction and internal fixation (ORIF) for Neer type 2~4 proximal humeral fractures. [Methods] From January 2021 to December 2024, a total of 100 patients who received ORIF for Neer type 2~4 proximal humeral fractures at Rizhao Central Hospital and the First Affiliated Hospital of Jinzhou Medical University were included in this study. According to the Neer score and postoperative complications, the patients were divided into the poor outcome (PO) group and the good outcome (GO) group. Univariate comparison and multivariate logistic regression analysis were used to explore the factors related to the poor outcome, and a nomogram prediction model was constructed and validated. [Results] The PO group proved significantly greater than the GO group in terms of age [years, (67.9±10.9) vs (50.3±11.5), P＜0.001], chronic diseases [n, yes/no, (7/15) vs (6/72), P=0.003], interval from injury to surgery [days, 4.00 (2.00, 4.00) vs 2.00 (1.00, 3.00), P＜0.001], proportion of plate fixation [n, plate/intramedullary nail, (12/10) vs (18/ 60), P=0.004], time to start exercise after surgery [days, (6.2±1.2) vs (4.8±1.1), P＜0.001], postoperative complications [n, yes/no, (5/17) vs (3/ 75), P=0.004], and VAS score at the last follow-up [points, (1.8±0.3) vs (1.6±0.4), P=0.032]. However, the former was significantly less than the latter in terms of the preoperative and last follow-up humeral neck-shaft angle [°, (108.2±9.3) vs (118.4±9.6), P＜0.001; (126.1±7.9) vs (132.5±8.4), P=0.002]. As results of logistic regression, the late start of exercise after surgery (OR=32.213, P=0.012), postoperative complications (OR=7.353, P=0.010), presence of chronic diseases (OR=5.600, P=0.006), plate fixation (OR=3.816, P=0.022), time from injury to surgery (OR=2.236, P=0.032), and age (OR=1.144, P=0.001) were independent risk factors for poor clinical outcome, while a larger neck shaft angle (OR=0.651, P=0.014) was a protective factor. The area under the curve (AUC) of ROC for constructed nomogram prediction model was 0.990 (95%CI: 0.977~1.000). [Conclusion] Older age, presence of chronic diseases, long time from injury to surgery, plate fixation, late start of exercise after surgery, and postoperative complications are independent risk factors for poor clinical prognosis, while a larger neck-shaft angle is a protective factor.

Abstract: [Objective] To explore the risk factors for leg length discrepancy (LLD) after elastic stable intramedullary nailing (ESIN) of femoral fractures in children. [Methods] A retrospective study was conducted on 139 children who had femoral fractures treated with ESIN in the Department of Pediatric Orthopedics of the Women and Children's Hospital Affiliated to Qingdao University from January 2017 to March 2024. Univariate comparison and multivariate logistic regression analysis were used to explore the risk factors for LLD after ESIN treatment of femoral fractures in children. [Results] Among the 139 patients, 40 children developed LLD 1.5 years after surgery, accounting for 28.8%. As results of univariate comparison, the LLD group had significantly higher proportions of unstable fractures [n, unstable/stable, (23/17) vs (18/81), P<0.001], nail-canal diameter (NCD) ratio <0.8 [n, <0.8/≥0.8, (29/11) vs (28/71), P<0.001], and LLD measurement values [(cm, (1.3±0.3) vs (0.5±0.2), P<0.001] compared with the non-LLD group. However, there were no statistically significant differences in age, gender, weight, time from injury to surgery, side, injury energy, craniocerebral injury, fracture location, ESIN fixation method, residual displacement at the fracture end, residual angulation at the fracture end, and time of nail removal between the two groups (P>0.05). Regarding multivariate logistic regression analysis, the NCD ratio <0.8 (OR=5.107, P<0.001) and fracture instability (OR=4.103, P<0.001) were independent risk factors for LLD. [Conclusion] The low NCD ratio and fracture instability are independent risk factors for LLD after ESIN of femoral fractures in children.

Abstract: [Objective] To explore the influencing factors of poor functional recovery after arthroscopic treatment of femoroacetabular impingement (FAI) and establish a predictive model. [Methods] A retrospective study was conducted on 166 patients who underwent arthroscopic treatment for FAI from January 2018 to January 2022. According to the modified Harris Hip Score (mHHS) 1 year postoperatively, patients were classified into the poor group if the score was ＜74, and the satisfactory group if it was ≥74. Univariate comparisons and binary logistic regression analysis were used to explore the factors related to poor clinical outcomes. A predictive model was established based on these factors and a nomogram was drawn. The model's performance was evaluated using the ROC curve, calibration curve, and decision curve analysis (DCA). [Results] At 1 year postoperatively, 41 patients were classified into the poor group (24.7%), and 125 patients were classified into the satisfactory group (75.3%). As results of univariate comparisons, the poor group proved significantly greater than the satisfactory group in terms of age [years, (40.9±11.7) vs (31.7±9.8), P＜0.001], BMI [kg/m² , (26.6±3.2) vs (22.9±2.4), P＜0.001], and disease duration [months, (31.8±4.8) vs (24.4±6.8), P＜0.001], as well as VAS pain score during FADDIR and FABER tests, α angle, and MRI cartilage injury grade (P＜0.05). Conversely, the poor group was significantly less than the satisfactory group regarding preoperative mHHS, iHOT12, HOS-ADL, HOS-SSS scores, hip ROM in all directions, head-neck offset, and the rate of labral repair [n, suture/ resection, (29/12) vs (121/ 4), P＜0.001], and rate of normal labral morphology after surgery [n, absent/ectopic/normal, (12/9/20) vs (4/19/102), P＜0.001]. With respect of logistic regression analysis, the BMI (OR=1.679, P＜0.001), disease duration (OR=1.283, P=0.002), and age (OR=1.102, P=0.002) were the independent risk factors for poor clinical outcomes. In contrast, intraoperative labral repair (OR=0.071, P=0.004) was identified as a signifi-cant protective factor for poor clinical outcomes. The nomogram model established based on these factors had an AUC of 0.947 (95% CI: 0.914~0.980) in ROC analysis. After internal validation, the C-index was of 0.928, while the DCA confirmed that the model had significant clinical net benefit across a wide range of threshold probabilities. [Conclusion] Advanced age, obesity, and prolonged disease duration constitute risk factors for poor prognosis in FAI arthroscopy. Conversely, meticulous acetabular labrum repair during surgery represents a factor improving prognosis. The nomogram model developed in this study demonstrates high accuracy, providing valuable clinical guidance.

Abstract:[Objective] To evaluate the efficacy of mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) in the repair of cra-niomaxillofacial bone defects. [Methods] The literature data that met the criteria were retrieved in PubMed, Embase, Cochrane, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, VIP and the Chinese Biomedical Literature Database from the establishment until May 2025. The SYRCLE tool was applied to assess the risk of bias. Data were extracted and analyzed using Revman 5.4.1 software and Getdata Graph Digitizer software. [Results] A total of 12 literature met the inclusion criteria, and all of them involved animal experiment. As results of the meta-analysis, the MSC-EVs group proved significantly superior to the control group in terms of the ratio of bone volume to total volume (SMD=3.97, 95%CI 2.50~5.43, P＜0.00001), bone mineral density (SMD=5.89, 95%CI 3.50~8.29, P＜0.00001), trabecular bone number (SMD=3.01, 95%CI 0.42~5.60, P=0.02), trabecular separation (SMD=-3.48, 95%CI -5.84~-1.12, P=0.004) and vessel volume (SMD=4.69, 95%CI 3.03~6.36, P＜0.00001).However, there was no significant difference between the unpretreated MSC-EVs group and the pretreated MSC-EVs group in abovesaid parameters. [Conclusion] MSC-EVs therapy has a significant effect in accelerating the healing of craniomaxillofacial bone defects. There was no significant difference between the unpretreated MSC-EVs group and the pretreated MSC-EVs group.

Abstract:The meniscus plays a pivotal role in weight bearing, maintaining coordination of knee motor function, stabilizing the knee and absorbing shock. However, accelerated cartilage degeneration caused by increasing meniscal herniation has drawn attention, and studies have found it to be associated with early osteoarthritis (OA) of the knee. Therefore, the knee arthroscopic meniscus centralization technique has been proposed to reduce cartilage wear in the articular space of the knee. In this procedure, the meniscus that has been pushed out of the joint space is sutured to the edge of the tibial plateau using suture anchors to fix the protruding meniscus back to its original position in order to alleviate the degenerative deformation of the cartilage.

Abstract:The deltoid ligament of the ankle is the core composite structure that maintains the medial stability of the ankle joint, while the rehabilitation treatment after injury is crucial for functional recovery. In recent years, with the advancement of rehabilitation concepts and surgical techniques, the rehabilitation strategies for deltoid ligament injuries have become increasingly systematic and individualized. This article focuses on the three core sections of injury classification, clinical treatment, and rehabilitation system, reviews the latest research results at home and abroad, analyzes the current diagnostic, treatment, and rehabilitation controversies, and clarifies the core development direction of standardized staging combined with individualized intervention, minimally invasive treatment combined with intelligent rehabilitation, in order to provide reference for clinical practice.

Abstract:[Objective] To investigate the effects of aspirin/α-calcium sulfate hemihydrate (α-CSH) composite scaffolds on the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) in rats. [Methods] BMSCs from SD rat were extracted and cultured, and randomly divided into the composite group (aspirin/α-CSH composite scaffold), the α-CSH group (α-CSH scaffold), and the blank control group (without any intervention). The proliferation, osteogenic differentiation, migration of BMSCs and related indicators were measured and compared among the 3 groups. [Results] The OD values of CCK-8 assay were significantly increased in the composite group and the α-CSH group 7 days compared with that 3 day of culture (P＜0.05), which in the composite group and the α-CSH group were significantly higher than those in the blank control group 3 days and 7 days [OD values, (1.4±0.3) vs (0.9±0.2) vs (0.2±0.1), P＜0.001; (2.0± 0.4) vs (1.4±0.3) vs (0.2±0.1), P＜0.001]. The scratch test healing rate were significantly increased at 3 days and 7 days in the composite group and the α-CSH group compared with that at 1 day (P＜0.05), which in the composite group and the α-CSH group was significantly higher than that in the blank control group at 1 day and 3 days [% (72.3±2.7) vs (60.2±2.5) vs (6.3±1.0), P＜0.001; (92.5±2.8) vs (83.2±3.0) vs (7.0±1.2), P＜0.001]. In addition, the area of calcified nodules in the composite group and the α-CSH group was significantly larger than that in the blank control group at 14 days [%, (43.2±4.3) vs (31.3±4.0) vs (20.4±2.8), P＜0.001]. After 7 days of culture, the IL-1β, IL-6, and TNF-α in the culture medium of the composite group and the α-CSH group were significantly lower than those of the blank control group (P＜ 0.05), while the relative expression levels of BMP-2, OPN, ALP, RUNX2, Wnt 3a, LRP5, and β-catenin proteins in the composite group and the α-CSH group at 7 days of osteoinduction culture were significantly higher than those in the blank control group (P＜0.05), whereas the GSK-3β protein in the composite group and the α-CSH group was significantly lower than that in the blank control group (P＜0.05). [Conclusion] Aspirin/α-CSH composite scaffolds does promote the proliferation and osteogenic differentiation of rat BMSCs, while inhibit the expression of inflammatory factors. The mechanism may be related to the regulation of the Wnt/β-catenin signaling pathway.

Abstract:[Objective] To compare the endogenous BMP-2 content and in vitro osteoinductive capacity of four human bone allografting materials, including cortical bone, cancellous bone, demineralized cortical bone, and demineralized cancellous bone. [Methods] The aboves-aid four human bone allografting materials were provided by Beijing Weidafeng Medical Biotechnology Co., Ltd. and prepared in the form of 5 mm×5 mm×5 mm bone particles. The protein content of endogenous BMP-2 in each material was quantitatively detected by ELISA; and the osteoinductive capacity of each material was systematically evaluated using MC3T3-E1 pre-osteoblast cells, including cell adhesion, proliferation, alkaline phosphatase (ALP) staining, and alizarin red S (ARS) mineralization staining. [Results] The BMP- 2 content was ranked up-down as demineralized cancellous bone ＞ demineralized cortical bone ＞ cancellous bone ＞ cortical bone [ng/g, (20.1±1.3) vs (3.1± 0.8) vs (1.8±0.1) vs (0.4±0.1), P＜0.001]. In the in vitro trails, cell adhesion was arranged as demineralized cancellous bone ＞ cancellous bone ＞ demineralized cortical bone ＞ cortical bone [% (68.1±2.1) vs (52.1±2.0) vs (42.5±1.9) vs (36.0±2.1), P＜0.001]. In addition, both ALP staining and ARS staining of in vitro osteogenic induction showed the following order from high to low, demineralized cancellous bone ＞ demineralized cortical bone ＞ cancellous bone ＞ cortical bone. [Conclusion] The BMP-2 content of the human bone allografting materials is significantly related to the bone source type and demineralization treatment. Among them, the BMP-2 content in the demineralized cancellous bone is the highest, with the strongest osteoinductive capacity.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcomes of arthroscopy-assisted reduction and internal fixation for anterolateral compression fractures of the tibial plateau via the anteroinferior meniscal portal. [Methods] From January 2020 to January 2024, 11 patients had the anterolateral compression fractures of the tibial plateau treated by abovementioned surgical techniques. The standard anterolateral and anteromedial portals were established for joint examination and debridement. Based on the lesion location, the additional anteroinferior meniscal portal for lateral or medial meniscus was created. The anteroinferior meniscal portal and conventional arthroscopic portals were used alternately to visualize and manage the fracture site. The fracture center was located using an ACL reconstruction guide, followed by reduction via the tunnel impaction method or direct prying. Fixation was achieved with Kirschner wires or screws under arthroscopic and C-arm fluoroscopic guidance, and bone grafting was performed for bone defects. [Results] All 11 patients underwent operations successfully without vascular or nerve injuries. All patients were followed up for (16.8±2.4) months after the operation, and got fractures reduced well with good recovery of the knee flexion-extension, as well as walking functions. At the latest follow-up, the clinical consequence was marked as excellent in 9 cases and good in 2 cases based on the Rasmussen's criteria. [Conclusion] The an-teroinferior meniscal portal used in arthroscopy-assisted minimally invasive treatment of tibial plateau anterolateral compression fractures offers significant advantages, including elimination of arthroscopic blind spots, direct visualization of the fracture site, precise and convenient reduction, bone grafting, and fixation. The preliminary surgical outcomes are highly satisfactory.

Abstract: [Objective] To introduce the surgical technique and preliminary clinical results of high-frequency color Doppler ultrasound assisted bilateral dorsal palmar artery perforator flap to repair hand wounds. [Methods] From June 2016 to December 2023, high-frequency color Doppler ultrasound assisted bilateral dorsal palmar artery perforator flap was used to treat hand large skin and soft tissue defects in 18 patients. Preoperative high-frequency color Doppler ultrasound was used to label the palmar dorsal cutaneous nerve and perforating branches of the palmar dorsal artery around the wound. After debridement, the dorsal palmar cutaneous nerve and dorsal palmar artery perforating branches near the axis and rotation point were located with preserving approximately 1.0 cm wide fascial tissue on both sides of the axis. The wound was covered with open tunnel flap transposition with the dorsal palmar cutaneous nerve carried by the skin flap anastomosed end-toend with the nerve stump in the donor area without tension under the microscope. The donor area was closed by direct suture or full-thickness skin grafting harvesting from the inner side of the forearm on the same side. [Results] All the 18 patients had the flap and shin graft in the donor site survived well, with the donor closed in one stage. The follow-up period lasted for (17.3±4.0) months in a mean. All patients got the flap appearance well, with texture and color similar to the recipient skin. At the latest follow-up, the static two-point discrimination of the skin flap ranged from 8 to 17 mm, with an average of (11.9 ± 3.3) mm. According to the Michigan Hand Function Questionnaire evaluation criteria, 13 patients were marked 5 in term of skin flap appearance score, and other 5 patients were of 4, with an average of (4.4±0.9). According to the Vancouver Scar Assessment Scale, the donor site was marked as 2~5, with an average of (3.3±1.2). [Conclusion] The high frequency color Doppler ultrasound assisted bilateral dorsal palmar artery perforator flap for treating large skin and soft tissue defects in the hand has advantages of simple operation and good results.

Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcome of distractor assisted reduction and retrograde intramedullary nailing for middle and lower femoral fractures. [Method] A total of 15 patients had middle and lower femoral fractures treated with distractor assisted reduction and retrograde intramedullary nailing. The patient was placed in supine position with the distal femur elevated and knee flexed at 60 degrees. Tibial tubercle transosseous traction was performed, and the distractor was installed to apply longitudinal distraction on the femoral fracture ends to achieve closed reduction of the fracture. Under C-arm fluoroscopy, the reduction of the fracture was evaluated. A 2.5 cm longitudinal incision was made in front of the patellar ligament, the patellar ligament and joint capsule were longitudinally incised to expose the intercondylar fossa of the femur. As a guide pin was inserted along the anterior edge of the center of the intercondylar fossa into the femoral medullary cavity, the medullary cavity was reamed along the guide pin, and a retrograde intramedullary nail was placed to promote reduction. Locking screws were inserted at the proximal and distal ends for locking, and the incision was closed in layers. [Results] All patients in this group had operation performed successfully with an average operation time of (45.2±11.3) min, an average intraoperative blood loss of (92.5±18.3) mL, and a fracture reduction time of (2.5±1.5) min. Except 1 patient who had delayed healing of the fractures, all patients got satisfactory clinical consequence with Lysholm of (92.4±4.2) points at the latest follow-up lasted for more than 1 years. [Conclusion] The distractor assisted reduction and retrograde intramedullary nailing for middle and lower femoral fractures take advantages of short surgical time, minimal trauma, reduced intraoperative reduction time, stable fracture fixation, fast healing, and satisfactory recovery of knee function.

Abstract:[Objective] To explore the method for locating the S1 percutaneous iliosacral screw placement point for fixation of posterior pelvic ring injury. [Methods] A retrospective study was done on 41 patients who underwent percutaneous iliosacral screw fixation of posterior pelvic ring injury under the guidance of image planning in our center from April 2023 to June 2024. The sagittal CT image of the pelvis was reconstructed using Mimics software, and the pin insertion point was planned as the midpoint of the line connecting the anterosuperior corner and posteroinferior corner of the S1 vertebral body. Virtual surgery was simulated for screw insertion, which was used to guide the real surgery and evaluate the clinical and imaging consequences. [Results] The 41 patients had a total of 41 iliosacral screws at S1 placed successfully with the average operation time for each screw of (19.6±5.8) min, and the average number of fluoroscopy of (13.1±6.9) times. With time preoperatively, 3 months after surgery and the last follow-up, the VAS [points, (7.8±0.9), (4.7±1.6), (2.9±1.3), P＜0.001], hip flexionextension ROM [°, (71.2±13.7), (108.2±13.8), (140.4±7.9), P＜0.001], hip internal-external rotation ROM [°, (37.4±11.5), (70.4±8.4), (88.1± 6.5), P＜0.001], and Majeed score [points, (30.6±14.4), (60.9±14.0), (83.2±6.7), P＜0.001] were significantly improved. In term of imaging, 36 screws (87.8%) were rated as grade 1, and 5 screws (12.2%) as grade 2. The average fracture healing time was (14.1±2.6) weeks and no non-union of fractures or loss of reduction was noted in anyone of them. [Conclusion] In lateral fluoroscopy during the operation, the midpoint of the line connecting the anterosuperior corner and posteroinferior corner of the S1 vertebral body is a reliable mark for insertion of il- iosacral screws.

Abstract:[Objective] To explore the clinical efficacy of 3D printing assisted correction of posterior malleolar fractures (PMF) malunion by osteotomy and reconstruction through the distal fibula osteotomy approach. [Methods] A retrospective research was conducted on 20 patients who had PMF malunion treated with the abovesaid technique from January 2018 to December 2023. Before the operation, personalized 3D printed fracture models were prepared for surgical planning. During the operation, the distal fibula was osteotomized to expose the talotibial joint surface, and PMF was osteotomized and repositioned to restore the original articular curvature, and then fixed with a plate. The clinical and radiological data were evaluated. [Results] All the 20 patients had the surgical procedures performed successfully without serious complications during the operation. As time went before surgery, 3 months after surgery, and the last follow-up lasted for an average of (23.6±9.8) months, the VAS [points, (6.5±1.7), (2.1±1.5), (1.9±1.8), P＜0.001], AOFAS [points, (41.6±5.7), (81.3±5.5), (82.8±5.9), P＜ 0.001], and SF-36 [points, (37.5±7.1), (82.1±6.2), (83.1±4.9), P＜0.001] were significantly improved, despite of unchanges in ankle plantarflexion-dorsiflexion range of motion (ROM), and foot inversion-eversion ROM (P＞0.05). In terms of imaging, the joint surface step [mm, (5.5±2.7), (0.2±0.2), (0.2±0.2), P＜0.001], ankle coronal angle (α angle) [°, (8.2±2.3), (4.1±1.6), (4.1±1.6), P＜0.001], and ankle sagittal angle (β angle) [°, (13.6±5.6), (15.1±4.3), (15.1±4.3), P=0.013] were significantly improved over this period. [Conclusion] The 3D printing-assisted osteotomy and reconstruction for treatment of PMF malunion do improve the accuracy of articular surface reduction, promote functional recovery, and effectively control complications, and have a good clinical application prospect.

Abstract: [Objective] To explore the application value of shear wave elastography in evaluating the status of the medial collateral ligament (MCL) in unicompartmental knee arthroplasty (UKA). [Methods] A retrospective study was conducted on 40 patients who underwent UKA. The elastic modulus (EM) and shear wave velocity (SWV) of the MCL were measured at different time points before and after surgery. In addition, the HSS and WOMAC scores and the bilateral difference of KT-1000 were recorded, and correlation analysis was performed. [Results] As time went preoperatively, 3 months and 6 months postoperatively, the HSS score significantly increased [points, (65.3±7.2), (82.1±5.5), (88.6±5.0), P＜0.001], while the WOMAC score [points, (45.6±6.4), (28.4±5.0), (20.1±3.8), P＜0.001], EM [kPa, (45.2±5.1), (38.6±4.8), (32.2±4.3), P＜0.001], and SWV [m/s, (3.1±0.4), (2.8±0.4), (2.4 0.3), P＜0.001] significantly decreased. At the time points preoperatively, 3 months postoperative, and 6 months postoperative, EM was significantly negatively correlated with the HSS score (P＜0.05), whereas significantly positively correlated with the WOMAC score and the side to side difference of KT-1000 (P＜0.05). Moreover, SWV was significantly negatively correlated with the HSS score (P＜0.05), and significantly positively correlated with the WOMAC score and the side to side difference of KT-1000 (P＜0.05). [Conclusion] The parameters of shear wave elastography are closely related to the function and stability of the knee after UKA, and can dynamically and objectively reflect the biomechanical changes of the collateral ligament, providing a reliable quantitative basis for the rehabilitation and efficacy evaluation after UKA.

Abstract:[Objective] To compare the efficacy of three analgesic approaches after anterior cruciate ligament (ACL) reconstruction. [Methods] A retrospective analysis was conducted on 90 patients who underwent unilateral arthroscopic ACL reconstruction between February 2022 and December 2023. Based on preoperative consultations, patients were divided into three groups, including 30 patients in the only adductor canal nerve block (the ACNB group), 30 in the ACNB combined with a hydrogen-oxygen gas mixture (the hydrogen-rich group), and 30 received ACNB combined with both a hydrogen-oxygen gas mixture and pregabalin (the combined group). Clinical outcomes and laboratory data were compared among the groups. [Results] All patients successfully completed the surgery with no significant differences in surgery duration and intraoperative blood loss among the 3 groups (P＞0.05). The ACNB group and the hydrogen-rich group resumed active activity significantly later than the combined group [day, (2.4±0.6) vs (2.3±0.5) vs (2.0±0.7), P＜0.001]. Compared with those before operation, the SAS, VAS, Lysholm and IKDC scores significantly improved in the three groups after the operation (P＜0.05). Before the operation there was no statistically significant difference in the above indicators among the three groups (P＞0.05), the ACNB group and the hydrogen-rich group were significantly inferior to the combined group in terms of SAS and VAS scores at corresponding time points postoperatively (P＜0.05). The knee ROM, Lysholm and IKDC scores were ranked as the ACNB group ＜ the hydrogen-rich group ＜ the combined group postoperatively with statistically significant differences (P＜0.05). In term of ketamine-amidocaproic acid consumed postoperatively, the ACNB group and the hydrogen-rich group were significantly greater than the combined group [times, (2.2±0.5) vs (1.0±0.8) vs (0.8±0.6), P＜0.001] . In terms of lab test, the ACNB group and the hydrogen-rich group were significantly greater than the combined group regarding C-reactive protein (CRP), interleukin-6 (IL6), and serotonin (5-HT) at all corresponding time points after the operation (P＜0.05). [Conclusion] ACNB combined with hydrogen-oxygen mixture and pregabalin do effectively alleviate knee pain after ACL reconstruction, relieve anxiety, and improve knee function.