Objective To report the clinical results of managing distal tibial fractures with a hybrid external skeletal fixator.Methods From January 2006 to June 2013,39 patients with distal tibia fracture were managed with limited-close or limited-open reduction and a hybrid external skeletal fixator.They were 26 men and 13 women,with an average age of 40.1 years (range,from 23 to 65 years).According to AO classification,15 fractures were of type A3,8 of type B2,10 of type B3,2 of type C2 and 4 of type C3.According to Gustilo classification,of the 12 open fractures,8 were of type Ⅱ,3 of type Ⅲ a and one of type Ⅲ b.According to Tscherne classification of soft tissue injury,4 cases were of grade l,24 of grade 2,and 11 of grade 3.Open fractures were managed first with radical debridement.Those complicated with fibular fracture were managed first with open reduction and internal fixation of distal fibula followed by close or limited-open reduction and minimal internal fixation depending on the position of distal tibial fracture.Next,the hybrid external skeletal fixation was applied.Five cases were immobilized with trans-articular fixators.The data were recorded regarding interval from injury to surgery,operation time,perioperative blood loss,hospital stay,time of external fixation,time of bony union,and complications.The ankle function was evaluated clinically with the Maryland Scale system at the final follow-ups.Results The 39 patients were followed up for 12 to 18 months (average,14.5 months).Primary incision healing was achieved in 37 cases,but the other 2 patients with open fracture suffered delayed wound healing which was cured by dressing changes for 4 weeks.Altogether,38 cases achieved normal fracture union and their average time of external fixation was 13.5 weeks.The time for complete infusion of fracture lines on X-rays averaged 19.7 weeks.Delayed union occurred in one case whose fracture united after removal of the external fixator,internal fixation with a locking plate and autogenous bone grafting.One case was complicated with pin track infection which was healed after debridement,drainage for 8 weeks and removal of the external fixator.No neurovascular complications were observed.According to the Maryland Scale system,the ankle function was excellent in 8 cases,good in 24 and fair in 7,with an excellent and good rate of 82.1％.Conclusions The hybrid external skeletal fixator is good for distal tibial fractures,because it can cffectively protect the skin and minimize invasion to the soft tissues,reducing incidences of skin necrosis and wound infection.Moreover,since it is flexible in screwing and structure formulation,it facilitates wound management,eslpecially in the management of open fractures.

Objective To observe the efficacy and safety of Shenqiwuweizikeli for treating chronic insomnia.Methods One hundred and ninety-six cases of subjects were randomly divided into Shenqiwuweizikeli group (n =98) and Estazolam tablets group (n =98).The pittsburg sleep quality index (PSQI) was adopted to evaluate the clinical effects and records of adverse reactions during the study period.Also the lab routine inspection(blood routine,urine routine,liver and kidney function, electrocardiogram were conducted to evaluate safety.Results The Shenqiwuweizikeli and Estazolam tablets all had significant effects for chronic insomnia.The total effective rate of Shenqiwuweizikeli group was 92.86％ (91/98), of Estazolam tablets group was 93.88％(92/98) ,and there was no significant difference (P＞0.05).There were no abnormalities in terms of each routine inspection index.After stopping take the medicine, The adverse reactions including bounce sex insomnia(60 cases), daytime sleepiness/drowsiness (55 cases), dizziness with lacking of power and light headedness(23 cases) in Estazolam tablets group were all more than Shenqiwuweizikeli group with significant difference(P＜0.01).Conclusion The Shenqiwuweizikeli has definite efficacy and safety for treated with chronic insomnia without withdrawal of recoil and dependence.

Objective:To report our experience in treatment of patients with orthopaedic trauma during COVID-19 epidemic.Methods:We retrospectively analyzed the 67 patients with orthopedic trauma who had been treated at Department of Orthopaedics, Peking Union Medical College Hospital from February 1 to March 31, 2020. After screening for COVID-19 infection was performed under strict protection, the patients were diagnosed and assigned to outpatient emergency treatment or hospitalization according to their specific condition. Twenty-six patients were treated at the outpatient emergency department. They were 8 males and 18 females with an average age of 69.5 years. Of them, 6 with vertebral compression fracture were placed on bed brakes, 14 with limb fracture immobilized after close reduction, 2 with skin laceration treated with debridement and suture, and 4 with hip fracture immobilized in bed. In the 41 hospitalized patients, there were 14 males and 27 females with an average age of 68.5 years. In them, hemiarthroplasty was performed for 7 femoral neck fractures, kyphoplasty for 5 vertebral compression fractures, total elbow arthroplasty for one humeral intercondylar fracture, exploration and suture for one case of Achilles tendon rupture, and internal fixation surgery for the remaining 27 cases.Results:Most of the patients had osteoporotic fractures which accounted for 61.5% (16/26) of the outpatients and 68.3% (28/41) of the inpatients, respectively. The duration from injury to surgery averaged 2.3 days and the length of hospitalization 4.5 days for the 41 hospitalized patients, decreased compared with the corresponding data (3.1 days and 11.5 days) for the similar inpatients in the same period last year. In the 41 inpatients, fever was observed upon hospitalization in 4 cases and after operation in 26 cases, and related to their primary injury or surgical trauma in all. Acute pulmonary embolism happened during operation in one patient with femoral shaft fracture.Conclusions:The prevention and control of COVID-19 should be continued. The awareness and behavior of health care providers are expected to be enhanced by strict screening protocol, protection and supervision. The proportion of elderly patients with osteoporotic fracture increased during the COVID-19 pandemic. Shortage of blood was the major problem affecting the treatment. Timely surgical treatment should be indicated for the patients with orthopedic trauma, especially those with lower extremity fracture.

【Objective】 To compare the macrolide resistance, molecular characteristics and multilocus antigen sequence typing (MAST) of Bordetella pertussis (Bp) collected from Xi’an and Shanghai so as to provide reference for prevention of pertussis and optimize vaccination strategies. 【Methods】 Erythromycin, azithromycin and clarithromycin susceptibility of clinical isolates collected from Xi’an and Shanghai during 2018 and 2019 were determined by E-test. PCR was used to detect the drug-resistant genes and mutation sites. MAST was employed to do molecular typing for the strains. The differences in macrolide resistance and MAST types between Xi’an and Shanghai were compared. 【Results】 Totally 34 strains from Xi’an and 26 strains from Shanghai were isolated. There were differences between Xi’an and Shanghai in the macrolide resistance (χ²=13.650, P<0.001). The composition ratio of MAST types of pertussis strains was also different between Xi’an and Shanghai (χ²=18.642, P<0.001) in that the prn1/ptxP1/ptxA1/fim3-1/fim2-1 strains dominated in Xi’an, while the prn1/ptxP1/ptxA1/fim3-1/fim2-1 and prn2/ptxP3/ptxA1/fim3-1/fim2-1 were almost half and half in Shanghai. A2047G site mutation was detected in all the macrolide-resistant strains, but not in all sensitive strains. Methylase genes ermA and ermB were detected in some macrolide-resistant strains. No other macrolide-resistant genes were found in resistant strains and no mutation or drug resistance gene was found in all the susceptible strains. 【Conclusion】 Differences existed between Xi’an and Shanghai in the macrolide resistance and MAST types of Bordetella pertussis strains. Further monitoring of Bordetella pertussis in China is required to better understand the resistance and evolution of the pathogen.