Objective To introduce the experience of treating high energy P il on fractures with an articulated external fixator. Methods From March to June 20 01, twelve patients (13 fractures) suffered from high energy Pilon fractures wer e treated with an articulated external fixator (Orthofix, Italy). The fixators w ere placed medially across the ankle joint, if necessary, fixation of fracture w as enhanced with combination of limited internal fixation. The main injury was c aused by traffic accident and high altitude dropping. The distal two pins were i nserted into the neck of the talus and the tuberosity of the calcaneus so that s ubtalar joint was treated as an axis during ankle movement. At approximately pos toperative two weeks, the articular hinge was released and the patient began ank le exercises. The clinical outcomes and complications were investigated and the postoperative of X-ray examination of ankle were also evaluated. Results Twelve patients were followed up with a mean period of 12 months. No infections of woun d and pin sites and no neurovascular complication was found. According to Teeny & Wiss ankle joint scoring system, the symptom and functional evaluation of the ankle was scored from 74 to 94 (average 87). Clinical results demonstrated 2 exc ellent, 7 good, 4 fair. Quality of reduction of the articular surface showed 7 g ood and 6 fair using system of Marsh classification of reduction of the articula r surface of the ankle. Conclusion External fixation with an articulated fixator combined with limited internal fixation is a satisfying technique to treat high energy Pilon fractures. This technique helps to effectively decrease both wound and bone healing complications. With advantage of restoring anatomical articula r surface and enabling early ankle joint motion, this technique also helps to pr event ankle joint stiffness after fixation. The short term result of the above-m entioned fixation is encouraging.

AIM:The limitation of materials' strength results in the external fixation of patients with patellar fracture following absorbable screw fixation.This study was aimed to guide the patients do progressive rehabilitation and observe the recovery of knee joint function.METHODS:Totally 35 patients with patellar fractures were enrolled from the Sixth People's Hospital in Shanghai Jiao Tong University between June 2004 and June 2006,including 27 cases of transverse fractures and 8 cases of comminuted fractures.They were all treated with BIOFIX self-reinforced poly-lactide absorbable screws,which were produced by Finland BIONX Company.Postoperatively isometric contraction training of quadriceps femoris was followed,and then progressive knee joint range of motion was carried out.The curative effect was evaluated by the recovery of knee joint function and radiograph.Normal knee joint function was taken as excellent effect,while nearly normal knee joint function and slightly poor squatting were taken as good effect.RESULTS:All the patients completed the treatment and rehabilitation,followed up for no less than 12 months,with a mean of 22 months.The average healing time was 6 weeks,excellent result cases were seen in 29 patients and good in 6.There was two cases occurred postoperative complications(wound swelling).CONCLUSION:Self-reinforced poly-lactide absorbable screws for treatment of patellar fractures and appropriate postoperative rehabilitation is believed to prevent the second operations.

ObjectiveTo discuss the biomechanical properties of clavicle intramedullarynail in fixing middle fracture of clavicle and compare with the traditional plate and screw and single Kirschner wire,in order to provide scientific evidence for clinical application.MethodsFifteen adult cadaver were collected to make middle fracture of clavicle models.According to the clinical operation methods,the fracture models were divided into three groups with 5 specimens each:clavicle intramedullary nail group,plate and screwfixation group,and Kirschner wire internal fixation group.Biomechanical properties of three groups were tested and compared by experimental stress analysis method.ResultsIn the load 1000 N,the bending strength and bending stiffness of clavicle intramedullary nail group[ (57.41±4.72),( 2.28±0.17) N ] had no significant difference compared with those of plate and screw fixation group[(58.50 ±t4.14),(2.26 ±0.20) N ] (P ＞ 0.05),while had statistical significance compared with Kirschner wire internal fixation group [(51.14±4.32),(1.54±0.16) N] (P ＜ 0.05).The bending strength and bending stiffness had statistical significance between plate and screw fixation group and Kirschner wire internal fixation group (P＜ 0.05).In the torsional mechanical test,torque of clavicle intramedullary nail group had no significant difference compared with plate and screw fixation group (P ＞ 0.05 ),but had statistical significance compared with Kirschner wire internal fixation group (F =14.88,P ＜0.05).In compression test of the clavicle,the compression limit load of clavicle intramedullary nail grotup [ ( 1246±87) N ] had no statistical significance compared with plate and screw fixation group [ ( 1348±121 ) N ] ( P ＞ 0.05 ),and had significant difference compared with Kirschner wire internal fixation group [ ( 870±72 ) N ] (F =14.74,P ＜ 0.05 ).Conclusions Clavicle intramedullary nailing for treating middle fracture of clavicle can provide better biomechanical strength,stiffness and stability.Meanwhile as a minimally invasive operation,this operation method is feasible.Compared to other internal fixation methods,it has certain advantages.

BACKGROUND:Studies have shown that tibial plateau posterolateral fractures can be treated by posterolateral knee approach, however, there is no clear anatomical research to deeply evaluate and analyze this approach. OBJECTIVE:To evaluate the efficacy and safety of posterolateral knee inverted“L”shaped pathway in invloving tibial plateau posterolateral fractures. METHODS:Eight fresh frozen adult corpses, 16 knees side, were al dissected using posterolateral inverted“L”shaped pathway. During the dissection, the exposure range was observed and important parameters of anatomical structure were measured. RESULTS AND CONCLUSION:The pathway may be ful y exposed to the posterolateral aspect of tibial plateau and posterior cruciate ligament tibial insertions. The operations completed by out team did not create any obvious interference to superior tibiofibular joint, fibular head and posterolateral corner structure. The exposed mean length of common peroneal nerve in incision was 56.48 mm, with a mean angle of 14.7° tilt towards the axis of the fibula. The mean distance between the neck of the fibular and fibular head tip was 31.26 mm, an average of 42.18 mm to the joint line. The mean distance between the opening of the interosseous membrane and the articular surface was 48.78 mm. The divergence of the fibular artery from the posterior tibial artery was an average of 76.46 mm from articular surface. These results confirm that posterolateral inverted“L”shaped pathway met the requirements of anatomical reduction and buttress fixation for posterolateral tibial plateau fracture. Exposure of the common peroneal nerve can be minimized or even avoided by modifying the skin incision. Because the popliteal artery branches anterior tibial artery passed through interosseous membrane hole and peroneal artery and then separated from the posterior tibial artery, pathways dissection to distal deep area should be carried out careful y. Placement of a posterior buttressing plate carries a high vascular risk if the plate is implanted beneath these vessels.

Objective To evaluate the effect and potential risks of two types of materials ( taitanum versus polylevolactic acid,PLLA) screws on fixation of distal tibiofibular syndesmosis by a prospective randomized comparative clinical study.Methods From January 2007 to May 2008,48 patients with ankle fractures combined with a verified syndesmotic rupture were randomly allocated to receive either bioabsorbable PLLA (n =28 ) or titanium (n =20) screw fixation.The patients were assessed in aspects of radiography,function recovery and complication during follow-up.Results The total followup rate was 98％.The demographic information of the two groups showed no statistical difference ( P ＞0.05).After 1-2 years of follow-up,the indexes including Baird score,total score,and Baird grade were not statistically different between the two groups ( P ＞ 0.05).At the end of follow-up,there was significant difference in regard of joint motion between the injured and uninjured ankle in both groups ( P ＜0.05).Moderate rejection occurred in two patients and tibiofibular heterotopic ossification in two in PLLA group.Conclusions There is no significant difference between the bioabsorbable and metallic screws with regard to ankle function recovery,but the bioabsorbable screw fixation can avoid a second operation for taking out the screw.However,the complication risk of the bioabsorbable screws should not be ignored,such as rejection reaction,heterotopic ossification.

Objective:To implement an intervention with community-dwelling middle-aged and elderly people through a new science promotion approach, and to evaluate changes in the level of bone health awareness.Methods:From April 2017 to June 2017, 200 community-dwelling middle-aged and elderly people aged 50 years and over were randomly included.They were divided into the intervention group receiving a new science promotion intervention(n=100, with 50 males and 50 females)and the control group(n=100, with 50 males and 50 females). Baseline and follow-up assessments of bone health awareness were performed before and after the one-year intervention.A questionnaire survey on preferences for different types of science promotion articles in WeChat accounts was conducted.Differences in scores for intervention effects before and after intervention were compared between the two groups.Potential influencing factors for the scale score were examined by a multi-factor analysis.Results:After one year of intervention, scores for intervention effects were higher in the intervention group than in the control group( P<0.001). In the intervention group, scores were higher after intervention than before intervention( P<0.001). In the control group, scores after follow-up were slightly higher than those at baseline(29.4±11.4 vs.27.9±10.1, P<0.001). The increase in scores before and after intervention was greater in the intervention group than in the control group( P<0.001). Baseline score, group designation, history of drinking and diabetes impacted the scores in middle-aged and elderly women, while other factors did not.Most middle-aged and older people preferred texts illustrated with pictures, and older people were more receptive to videos. Conclusions:The new science promotion method is beneficial to bone health management, can improve bone health awareness in middle-aged and elderly people.

Objective To investigate the effects of human umbilical cord mesenchymal stem cells (UC-MSCs ) on vascular endothelial growth factor ( VEGF ) and monocyte chemoattractant protein-1 ( MCP-1 ) of acute myocardial ischemia-reperfusion (AMI-R) injury in rats. Methods 24 Sprague-Dawley rats were randomly divided into sham group, AMI-R group and UCMSCs treatment groups on average. The rats were sacrificed on the 10th day after UCMSCs transplantation, and the myocardial tissues below the ligature were taken. The mRNA and protein expressions of MCP-1 of the tissue were detected by RT-PCR and Western Blot respectively, and the expression of VEGF protein was detected by immunohistochemistry. Results The relative expression levels of MCP-1 mRNA and the protein in UCMSCs group were significantly lower than those in sham group and AMI-R group (all P<0.05). The expression of VEGF protein in UCMSCs group was significantly higher than that in sham group and AMI-R group, the differences were statistically significant(all P<0.05). Conclusion UCMSCs transplantation can promote the angiogenesis and decrease the inflammation reaction in the treatment of acute myocardial ischemia-reperfusion injury.

Objective To compare the effectiveness and mechanical differences in the dynamic hip screw (DHS), proximal femoral nail antirotation (PFNA), and proximal femoral internal fixator (PFI) for fixing complex unstable proximal intertrochanteric fractures by biomechanical testing. Methods Eighteen Synbones of the proximal femur were made to simulate complex unstable femoral intertrochanteric fracture models (Evans-Jensen TypeⅢ), which were fixed by DHS, PFNA, and PFI, respectively. The models were tested using a biomechanical testing machine, in order to compare their differences and advantages for fixing fractures. Results Under the compressive loads of 300, 600, and 1 200 N, the fracture displacement of the DHS was the maximum, with a significant difference compared with PFNA and PFI (P<0.05). There were no significant differences between PFNA and PFI (P>0.05). Under torsional loads of 300, 600, and 1 200 N, the torsional displacements of DHS and PFNA at the fracture ends were the maximum, with no significant difference (P>0.05). There were significant differences between PFI and PFNA as well as PFI and DHS (P<0.05). Conclusions For complex unstable proximal intertrochanteric fractures, the stability of the compression resistance of the PFI system is similar to that of the PFNA system. However, the torsional resistance of PFI is stronger than that of PFNA. The DHS system shows the least resistance with respect to compression and torsion.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

Objectives: This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition.The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach. Methods: A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and anti resorptive agents in sequential therapy approaches. Results: The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to anti resorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for in dividuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment. Conclusions This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.