Objective To compare 2 mini-invasive surgical treatments,Achillon versus sponge forceps,for acute Achilles tendon rupture.Methods Between December 2010 and January 2015,35 patients with acute Achilles tendon rupture were treated at our department.They were 32 males and 3 females,with an average age of 36.4 years (range,21 to 64 years).The interval between injury and operation was 1 to 13 days (average,3.2 days).Sixteen of them were treated by Achillon while 19 by sponge forceps.The 2 groups were compatible with no significant differences in general clinical data (P ＞ 0.05).Rehabilitation was carried out 4 weeks after immobilization with brace.American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scoring system was used to evaluate the function of the affected foot at the last follow-up.The 2 groups were compared in terms of surgery time,hospital stay,AOFAS score,decrease in leg circumference,complications and rerupture rate.Results All the patients were followed up for an average of 9.6 months (from 6 to 19 months).There were no significant differences between the Achillon and sponge forceps groups regarding average AOFAS score (91.8 ± 4.4 versus 93.2 ± 5.8),surgery time (38.3 ± 13.2 min versus 42.5 ± 9.8 min),hospital stay (3.9 ± 1.5 d versus 4.1 ± 1.6 d),or decrease in leg circumference (2.1 ±0.5 cm versus 2.3 ± 0.3 cm) (P ＞ 0.05).No re-ruptures or sural nerve lesion was observed in either group.One case of delayed wound healing occurred in each group.Conclusions Both Achillon and sponge forceps can lead to limited complications and a very low rate of re-rupture in surgical treatment of acute Achilles tendon rupture.Compared with the Achillon technique,sponge forceps may have the advantages of simplicity and lower cost.

Objective To analyze the varus deformity of caput humeri and its correlation with fuuctional outcome of unstable proximal humeral fracture managed with locking plate.Methods The study involved 62 patients (24 males and 38 females,at age range of 32-83 years,mean 63.7 years)with proximal humeral fracture who were treated by open reduction and locking plate internal fixation from May 2008 to June 2010 and had full follow-up data.According to Neer classification,there were 11 patients with two parts fractures,41 with three parts fractures,five with four parts fractures and five with dislocation.Their clinical results were evaluated with Constant-Murley scores.ResultsThe mean duration of follow-up was 20.3 months (range,14-37 months),which showed fracture healing in all the patients.There were 11 patients with varus deformity of the caput humeri. The significant difference was found in Constant-Murley score of shoulder function ( P =0.045 ),forward elevation ( P =0.006 ) and abduction (P =0.022) between the varus and non-varus groups.But there was no significant difference in shoulder external rotation( P =0.08 ).The fracture types ( P =0.037 ) and varus deformity of caput humeri ( P =0.006) were closely correlated with the shoulder function between two groups.ConclusionsThe varus deformity of caput humeri mav be predictive factor for poor outcome of the unstable proximal humeral fracture. Restoration of humeral head-shaft alignment and sound reduction should be done as possible during operation.

ObjectiveTo analyze the obvious and hidden preoperative and intraoperative blood loss during treatment of the intertrochanter fracture with proximal femoral nail anti-rotation (PFNA) so as to provide necessary data support for clinical perioperative treatment.MethodsThe clinical data of 216 patients with intertrochanteric fractured treated with PFNA between December 2005 and September 2010 were analyzed retrospectively.An analysis was done on preoperative and postoperative blood routine, perioperative and postoperative blood loss and transfusion, perioperative obvious and hidden blood loss and perioperative and postoperative blood transfusion.ResultsThe average blood loss was 48.9ml during operation, with no blood transfusion.Obvious hemochrome decrease (＜9 g/L) was found in 42 patients at 2-4 days after operation and the patients received blood transfusion for mean 300 ml.The mean obvious blood loss was 62.3 ml, while the mean hidden blood loss was 385 ml in all the patients.There was no obvious difference between males and females.ConclusionThe intertrochanter fracture is mostly seen in the elder patients.Compared with the minimal invasive operation, PFNA has more hidden blood loss, as indicates that much attention should be paid to the vital signs of the patients after surgery for prevention of the complications.

Objective:To investigate the characteristics of complications after internal fixation with hallo nails for femoral neck fractures according to OTA/AO classification and analyze the reasons for differences in complications of different classifications based on the current theories and lever-fulcrum balance theory.Methods:A retrospective case series analysis was made on clinical data of 113 patients with femoral neck fractures treated in Peking University People's Hospital from January 2014 to June 2020. There were 49 males and 64 females, with the age of 21-89 years [61(52, 72)years]. According to OTA/AO classification, there were 5 patients with type B1.1 fractures, 18 with type B1.2, 16 with type B1.3, 44 with type B2.1, 5 with type B2.2, 12 with type B2.3 and 13 with type B3. All patients were treated by percutaneous internal fixation with hallo nails. Complications were recorded during follow-up including femoral head necrosis, nonunion, screw back-sliding and screw cut-out. Causes of internal fixation complications were analyzed based on the lever-fulcrum balance theory, taking the location of fulcrum, screw stress (F1), force arm of pressure (L1), resistance of screw (F2) and resistance side (L2) into consideration.Results:All patients were followed up for 1.1-77.5 months [8.2(3.6, 16.6)months]. In all, 24 patients had complications, including femoral head necrosis in 7 patients, nonunion in 3, screw back-sliding in 12 and screw cut-out in 2. The rate of femoral head necrosis of type B1, B2 and B3 was 15%(6/39), 2% (1/61) and 0%, respectively. The rate of femoral head necrosis of type B1 was higher than type B2 ( P<0.05). The nonunion rate was 3%(1/39) in type B1, 3%(2/61) in type B2, and 0% in type B3 ( P>0.05). The rate of screw back-sliding of type B1, B2 and B3 was 3%(1/39), 2%(1/61) and 0%, respectively. The rate of screw back-sliding of type B2.3 and B3 were higher than that of type B1 ( P<0.05). A trend toward a higher rate of screw back-sliding of type B2.3 and B3 was found when compared to type B2.1/2.2, but there was no significant difference ( P>0.05). Moreover, the rate of screw back-sliding showed no significant difference between type B2.3 and B3 ( P>0.05). The rate of screw cut-out was 3%(1/39) in type B1, 2%(1/61) in type B2, and 0% in type B3, which showed no significant difference between type B1 and B2 ( P>0.05). According to the lever-fulcrum balance theory, the extent of pathologic fulcrum of type B1, B2 and B3 gradually increased, resulting in increased L1 and decreased L2. The L1 of type B1, B2 and B3 was (2.2±0.5)cm, (2.8±0.4)cm and (4.7±0.5)cm, respectively ( P<0.01). The L2 of type B1, B2 and B3 was (5.1±0.5)cm, (4.7±0.5)cm, and (3.6±0.4)cm, respectively ( P<0.01). Therefore, the F1 of type B1, B2 and B3 increased progressively. Conclusions:After internal fixation, the rate of femoral head necrosis of type B1 is significantly higher than that of type B2, and the rate of screw back-sliding of type B1 is significantly lower than that of type B3. The lever-fulcrum balance theory can deepen our knowledge of reasons for complications after operation for femoral neck fractures.

Objective: To study the molecular-epidemiological characteristics of Brucella species isolated from different countries, using the multiple locus tandem-repeat (MLVA) analysis. Methods: Eleven variable-number tandem-repeat (VNTR) loci were selected. VNTR strains of Brucella isolated from 48 different countries in 1953-2013, were analyzed by using the BioNumerics software. Unweighted Paired Arithmetic Average method was used to cluster and draw phylogenetic tree as well as the minimum spannin. Results: The evolutionary relationship of Brucella phylogenetic tree was consistent with the classical biological typing method. However, the Brucella suis biovar 5 strains were different from the other Brucella suis biovars 1, 2, 3 and 4. Brucella ceti strains were divided into two parts and different from each other. Worldwide epidemics of brucellosis were emerged from 2005 to 2008 under the MLVA11 Orsay analysis. China has been a brucellosis-prone regions, with Brucella melitensis as the main epidemic Brucella species, followed by Brucella abortus. Brucella suis was mainly identified in the southern provinces, but Brucella canis was mainly found in dogs. No human cases were found. Conclusion Molecular-epidemiological characteristics of the Brucella strains were related to factors as time, region and hosts of isolation, which are important to setting up prevention and control programs on brucellosis.

Objective To establish a preoperative risk scoring system for elderly patients with hip fracture on the basis of investigation into the factors influencing their mortality during hospitalization. Methods The data were collected from the database of hospitalization summary reports ( HSR ) of Beijing Public Health Commission concerning the 14, 577 patients who had been 55 years old or older and hospitalized for hip fracture from January 1, 2006 throughout December 31, 2010 at the 35 top-rank hospitals in Beijing. They were divided into a surgery group and a non-surgery group. Two multivariable risk-adjustment models were established for the 2 groups on the basis of an investigation into the factors influencing their mor-tality during hospitalization. Finally a preoperative risk scoring system for elderly patients with hip frac-ture was formulated according to the valuation of the least common multiples of β coefficients of the risk factors.Results Besides senior age and male gender, 10 different comorbidities were independently associated with in-hospital mortality, particularly pulmonary embolism, respiratory failure, renal failure and diabetes. The risk for inpatient mortality associated with a specific comorbidity was relatively higher in the surgery group than in the non-surgery group. The risk-adjustment models based on the variables had better accuracy in predicting in-hospital mortality ( ROC＝0.91 in surgery group versus ROC＝0.85 in non-surgery group ). In our preoperative risk scoring system for elderly patients with hip fracture, 10 points were for an age of 65 to 74 years old, 14 points for an age of 75 to 84 years old, 18 points for an age beyond 85 years old, 4 points for male gender, 20 points for pulmonary embolism, 18 points for respiratory failure, 10 points for renal insufficiency, 8 points for diabetes, 8 points for heart failure, 7 points for malignant tumor, 7 points for lung infection, 7 points for disturbance of water, electrolyte and acid-base balance, 6 points for arrhythmia, and 6 points for cerebral infarction, totaling 119 points. Conclusions The primary risk factors for in-hospital mortality in the elderly patients with hip fracture seem to be senior age, male gender and 10 different comorbidi-ties. A preoperative risk scoring system has been successfully established for elderly patients with hip fracture.

Objective To observe operative outcomes of suture-button technique for acute Lisfranc injury.Methods A retrospective observation was conducted of the 11 patients who had been operatively treated with suture-button technique and plate fixation for acute Lisfranc injury from January 2015 to December 2016.They were 8 men and 3 women,aged from 22 to 54 years(mean,32.1 years).By the Myerson classification for the injury,there were 9 cases of type B2 and 2 cases of type Cl;by the Chiodo classification,there were 7 cases of middle column injury,2 cases of injury to middle and lateral columns and 2 cases of injury to medial and middle columns.Their scores on the visual analogue scale(VAS),mid-foot scores of American Orthopedic Foot and Ankle Society(AOFAS),bone union and complications were observed post-operatively.Results Follow-ups for this cohort lasted for 14 to 34 months(mean,20.5 months).Follow-ups revealed that their VAS scores for the affected foot averaged 0.6(from 0 to 2),significantly higher than those for the nomal foot(Z=2.070,P=0.038).Their AOFAS scores averaged 95.2(from 87 to 100),significantly lowerer than those for the nomal foot(Z=2.121,P=0.034).All fractures were united well.Conclusion Suture-button technique can lead to satisfactory outcomes for acute Lisfranc injury.

Objective To observe operative results of 2 posteromedial approaches in the treatment of posterior pilon fractures of Klammer type Ⅲ.Methods From January 2015 to December 2016,19 patients with posterior pilon fracture (Klammer type Ⅲ) were treated via the posteromedial approach.They were 12 men and 7 women,aged from 21 to 61 years (mean,37.4 years).Straight posteromedial incision was used in 11 cases and curved posteromedial incision in the other 8 cases.The 2 groups were compared in terms of postoperative wound complication,infection,bone union,visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) scores.Results Follow-up ranged from 6 to 29 months (mean,11.8 months).All the fractures united after 6 to 15 months (mean,10.7 months).In the straight incision group,the VAS scores at the final follow-up ranged from 0 to 3 points,averaging 1.1 points;the AOFAS scores ranged from 83 to 100 points,averaging 90.8 points.In the curved incision group,the VAS scores at the final follow-up ranged from 0 to 3 points,averaging 1.3 points;the AOFAS scores ranged from 80 to 100 points,averaging 90.1 points.In one case in the curved incision group,the posteromedial wound failed to heal but scar healing was achieved after dressing change for 4 months.Conclusion The posteromedial approach,whether straight or curved,can provide good exposure for posterior pilon fractures of Klammer type Ⅲ,which is conductive to reduction and fixation of the fracture.

Objective To verify the effectiveness of a self-designed preoperative risk scoring system for elderly patients with hip fracture.Methods A total of 286 elderly patients with hip fracture were included for this prospective study who had been admitted from February 1,2014 to February 1,2016 to Department of Trauma and Orthopedics,Peking University People's Hospital.They were divided into 5 groups according to their scores by our self-designed preoperative risk scoring system for elderly patients with hip fracture:0 to 10 points,11 to 20 points,21 to 30 points,31 to 40 points and above 41 points.Postoperative complications and deaths were recorded.The correlations between their preoperative scores and postoperative medical complications or death were analyzed to verify the effectiveness of the preoperative risk scoring system for elderly patients with hip fracture.Results The 286 patients scored 24.9 ± 11.0 (from 0 to 69) preoperatively.The femoral neck fractures scored 24.0±11.0 and femoral intertrochanteric fractures 26.3±10.8.The incidence of medical complications was 4.00％ (1/25) in the 0 to 10 points group,4.17％ (3/72) in the 11 to 20 points group,14.66％ (17/116) in the 21 to 30 points group,23.53％ (12/51) in the 31 to 40 points group and 50.00％ (11/22) in the above 41 pints group.Conclusion As the incidence of postoperative medical complications in elderly patients with hip fracture is positively correlated with the scores by our self-designed preoperative risk scoring system for elderly patients with hip fracture,the preoperative risk scoring system can provide an effective prediction of surgical risks.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.