Objective To explore the clinical outcomes of treating unstable intertrochanteric fractures with proximal femoral locking plate (PFLP) in the elderly patients.Methods From January 2010 to June 2015,380 elderly patients with unstable intertrochanteric fracture were treated with PFLP and successfully followed up at our department.They were 171 men and 209 women,from 60 to 89 years of age (average,68.7 years).By AO classification,there were 58 cases of AO31-A2.2,87 ones of 31-A2.3,130 ones of 31-A3.1,63 ones of 31-A3.2,and 42 ones of 31-A3.3.Operation time,incision length,length of hospital stay,fracture healing time,postoperative complications and hip joint Harris scores were recorded.Results This cohort was followed up for an average of 13.3 months (range,from 8 to 21 months).Their operation time averaged 53.2 min,X-ray exposure 12.2 times,intraoperative blood loss 92.7 mL,incision length 12.6 cm,postoperative drainage volume 54.7 mL,and length of hospital stay 9.2 days.Pulmonary infection was observed in 3 cases,fixation loosening in 8,fixation breakage in 2,hip varus in 9,and fracture nonunion in 4,yielding a total complication rate of 6.8％ (26/380).No operative incision infection was observed.The average fracture healing time was 11.8 weeks (range,from 7 to 48 weeks) after operation.The average Harris score one year postoperation for the 380 patients was 86.3 ± 6.1,significantly higher than the preoperative value (43.6±4.4) (P ＜0.05).There were 96 excellent,231 good,42 fair and 11 poor cases,giving an excellent to good rate of 86.1％.Conclusion Since PFLP has advantages of limited invasion,blood loss and complications,a high rate of fracture healing,and good functional recovery of the hip,it may be a good treatment for unstable intertrochanteric fractures in the elderly patients.

Objective To retrospectively analyze the methods and clinical outcome to treat Crowe type Ⅳ developmental dysplasia of the hip (DDH) in young adults with total hip arthroplasty (THA) after limb-lengthing with external fixator.Methods From October 2007 to January 2012,12 patients with unilateral Crowe type Ⅳ DDH were treated with two-staged surgical method in our department.There were 2 males and 10 females with an average age of 25.7 years (range,18-35 years).In the first stage,the patients underwent soft tissue relaxation and iliofemoral distraction with use of an external fixator for 10-17 days.There were 1-2 cm distraction at the first time and 3-5 mm daily distraction.When the femoral head was distracted to the level of anatomical position,the second stage-THA was performed.All patients underwent uncemented prosthesis with bulk femoral head autograft for acetabular reconstruction.The acetabular cup was placed in the anatomical position in every patient.Shortening femoral osteotomies were not required.Results The mean time of first operation was 35.2±3.6 min,and hospital stay was 13.3±1.6 days.The mean time of second operation was 77.3±12.4 min,and hospital stay was 9.2±2.5 days.The average follow-up was 13.6±3.2 months,limb-length discrepancy was 5.6±1.5 cm on average preoperatively and 0.5±0.2 cm on average postoperatively.The Harris hip score was increased from 45.7±2.6 preoperatively to 92.3±3.3 postoperatively.All of the cases had acquired good hip and knee function.No patient suffered pin-site infection,hip joint infection,prosthesis loosening or deep vein thrombosis in our research.Transient nerve palsy occurred during the leg limb lengthening in 3 cases; calf skin numbness after THA occurred in 5 cases.Conclusion For the Crowe type Ⅳ DDH in young adults,normal limb length can be restored nearly and avoid nerve injury via continuously limb-lengthing with external fixator before THA.This method can get precise results,improve limb function significantly and have fewer complications.

Objective To explore the efficacy of proximal femur locking plate(PFLP) for the treatment of unstable femoral intertrochanteric fractures in elderly patients.Methods Data of 120 cases of patients with unstable femoral intertrochanteric fractures who were treated by PFLP were retrospectively analyzed.There were 56 males and 64 were females,aging from 62 to 78 year-old (average,69.4 year-old).85 cases were left hip,and 35 cases right hip.According to AO fracture classification,there were 12 cases of A2.2,23 A2.3,34 A3.1,29 A3.2,and 22 A3.3.According to Evans intertrochanteric fractures classification:there were 93 cases of type Ⅲ,19 type Ⅳ,and 8 type Ⅴ.Operation time,length of hospital stay,fracture healing time,postoperative complications and hip joint Harris scores were recorded.Results All patients were followed up for 8-14 months (average,12.4 months).Their operating time were 51-80 min (average,63.1 min);X-ray exposure were 8-15 times (average,11.6 times);intraoperative blood loss were 70-120 ml (average,92.7 ml);postoperative drainage volume were 50-100 ml (average,61.7 ml),and length of hospital stay were 7-14 d (average,10.2 days).The healing time ranged from 12 to 32 weeks (20.4 weeks average).14 cases had delayed union,and healing time was 8-10 months.In addition,4 cases had deep vein thrombosis (after thrombolysis therapy the vein was recanalized);2 had internal fixation broken,who were then treated with PFNA Ⅱ,and bone healed after 6 months;5 had hip varus,who were then treated via hip replacement,and no hip prosthesis fracture were found.No other complications occurred in the remaining patients.At the latest follow-up,according to Harris hip score:there were 38 cases with excellent results,71 good,9 fair,and 2 poor,and the rate of excellent and good was 90.8％ (109/120).Conclusion PFLP for the treatment of unstable femoral intertrochanteric fractures has advantages of less invasion,less complication,reliable fixation and high fracture healing rate,thus it is suitable for unstable intertrochanteric fractures in elderly patients.

Objective To analyze the related factors of femoral head necrosis after internal fixation operation of femoral neck fracture.Methods Clinical data of 524 patients with femoral neck fracture who underwent internal fixation surgery between January 2012 and January 2015 were retrospectively analyzed.Taking the femoral head necrosis as an observable indicator,the clinical data of postoperative femoral head necrosis and those other patients who were treated at the same period were compared.Whether the clinical factors (gender,age,surgical reduction type,fracture type,quality of reduction,post-injury operation time,loading time after operation,and whether to withdraw internal fixation) were in correlation with postoperative femoral head necrosis was analyzed by univariate analysis.Then the statistically significant indicators were integrated into logistic regression analysis to determine the related factors of femoral head necrosis.Results According to inclusion and exclusion criteria,the study group consisted of 212 cases,including 94 males and 118 females;the follow-up time was 2-5 years,and the average follow-up time was 3.6±1.6 years.There were 46 cases with femoral head necrosis and 166 cases without femoral head necrosis after operation.The rate of femoral head necrosis was 21.7％ (46/212).The femoral head necrosis group included 46 cases with 21 males and 25 females;20 cases below 60 years old and 26 cases above 60 years old;17 cases using open reduction and 29 cases using closed reduction;6 cases belong to type Ⅰ/Ⅱ and 40 cases belong to type Ⅲ/Ⅳ according to Garden classification;16 cases got satisfactory reduction while 30 cases with unsatisfactory reduction;30 cases below 48 h and 16 cases above 48 h on post-injury operation time;17 cases below 3 months and 29 cases above 3 months on post-operation loading time;22 cases with internal fixation removal and 24 cases without internal fixation removal.The femoral head without necrosis group included 166 cases with 73 males and 93 females;84 cases below 60 years old and 82 cases above 60 years old;69 cases using open reduction and 98 cases using closed reduction;120 cases belong to type Ⅰ/Ⅱ and 46 cases belong to type Ⅲ/Ⅳ according to Garden classification;160 cases got satisfactory reduction while 6 cases with unsatisfactory reduction;119 cases below 48 h and 47 cases above 48 h on post-injury operation time;70 cases below 3 months and 96 cases above 3 months on post-operation loading time;74 cases with internal fixation removal and 92 cases without internal fixation removal.Univariate x2 analysis suggested that fracture type and quality of reduction were associated with postoperative femoral head necrosis.Other clinical factors (gender,age,surgical reduction type,post-injury operation time,loading time after operation and whether to remove internal fixation or not) were not associated with postoperative femoral head necrosis.The multivariate Logistic regression analysis showed fracture type and quality of reduction were significantly related to postoperative femoral head necrosis.Conclusion Femoral head necrosis after internal fixation operation of femoral neck fracture is affected by many factors.The fracture type and quality of reduction are important factors affecting femoral head necrosis after internal fixation operation of femoral neck fracture.

Objective To investigate the advantage and application prospect of 3D printing technology in assisting surgery for complex tibial plateau fractures.Methods The complete clinical data of 41 patients (48 knees) were retrospectively analyzed.And these patients were divided into two groups as 3D printing assisted operation group and traditional operation group,according to whether 3D printing technology was applied.Study was carried out to compare the clinical efficacy of surgery assisted by 3D printing technology and traditional surgery in the treatment of complex tibial plateau fractures.The 3D printing assisted operation group included 18 patients (22 knees,12 males and 6 females),aging from 16 to 68 (mean age 45.5±7.2),and there were 12 cases of Schatzker Ⅴ and 10 Ⅵ.The traditional operation group included 23 patients (26 knees,15 males and 8 females),aging from 19 to 69 (mean age,46.2±6.8),and there were 14 cases of Schatzker Ⅴ and 12 Ⅵ.The operation time,intraoperative blood loss,the Rasmussen score and hospital for special surgery knee score (HSS) at 6 weeks post-operation were analyzed and the difference between the two groups was tested.Results All those patients were followed up for 7 to 20 months (mean 15 months).For 3D printing assisted operation group,the mean operation time was 81.4±6.3 min for Schatzker Ⅴ and 90.6± 15.4 min for Schatzker Ⅵ;the mean intraoperative blood loss was 200.4±72.3 ml for Schatzker Ⅴ and 280.6±101.6 ml for Schatzker Ⅵ;the result of 6-week Rasmussen score was 14 excellent,6 good and 2 fair (excellent and good rate 90.9％);the result of 6-week HSS score was 15 excellent,5 good and 2 fair (excellent and good rate 90.9％).Then for traditional operation group,the mean operation time was 100.4± 15.3 min for Schatzker Ⅴ and 111.5±20.2 min for Schatzker Ⅵ;the mean intraoperative blood loss was 450.4±173.3 ml for Schatzker Ⅴ and 500.5±247.2 ml for Schatzker Ⅵ;the result of 6-week Rasmussen score was 14 excellent,8 good,2 fair and 2 bad (excellent and good rate 84.6％);the result of 6-week HSS score was 13 excellent,8 good,2 fair and 3 bad (excellent and good rate 80.8％).The difference in operation time,intraoperative blood loss had statistical significance between the two groups;but the difference in 6-month post-operation Rasmussen score and HSS score had no statistical significance.Conclusion Compared with traditional surgery,3D printing technology assisted surgery for complex tibial plateau fracture possesses advantage such as shortened operation time,reduced intraoperative blood loss;but there's no evidence for improved knee function at 6 weeks post-operation.

Objective: To evaluate Herbert screwing directly via the anterior approach for femoral head fractures of Pipkin type Ⅱ in the youth. Methods: A retrospective analysis was conducted of the 16 patients who had been treated at Department of Orthopaedics, Union Hospital, Tongji Medical College for femoral head fractures of Pipkin type Ⅱ from August 2016 to June 2018. They were 9 men and 7 women, aged from 18 to 45 years (mean, 25.6 years). Of them, 10 cases who had been complicated with posterior dis-location of the hip received emergency hip reduction(<6 h) before surgical fixation. All the patients underwent Herbert screwing directly via the anterior approach. Their incision length, operation time, intraoperative blood loss, hospitalization time, Harris hip scores, therapeutic efficacy and complications were recorded. Results: In this series, the incision length averaged 10.4 cm, operation time 45.6 min, intraoperative blood loss 46.5 mL, and hospitalization time 4.0 d. All the 16 patients were followed up for 11 to 15 months (average, 12.7 months). Their Harris hip scores at preoperation, 3, 6 and 9 months postoperation and at the last follow-up were, respectively, 14.3±2.2, 64.8±2.4, 81.1±4.9, 88.1±4.6 and 91.9±3.4 points, showing a significant difference between any 2 time points (P<0.05). The therapeutic efficacy at the last follow-up by the Thompson-Epstein clinical evaluation was assessed as excellent in 9 cases, as good in 6 and as fair in one. No osteonecrosis of the femoral head or heterotopic ossification was observed by follow-up. Conclusion For young patients with femoral head fracture of Pipkin type Ⅱ, Herbert screwing directly via the anterior approach provides easy exposure and manipulation, does not aggravate the blood supply to the femoral head, decreases incidence of heterotopic ossification, and leads to shorter operation time and quick functional recovery of the hip.

Objective To investigate the causes and treatment strategy for postoperative complications following trans-articular external fixation in the elder patients with distal radius fracture of type C3.Methods The clinical data were retrospectively studied of the 226 patients with distal radius fracture of type C3 who had been treated by trans-articular external fixation from January 2011 to December 2016 at Department of Orthopaedics,Union Hospital.Of them,42 (18.6％) suffered from postoperative complications.They were 12 men and 30 women,aged from 65 to 83 years (average,68.4 years).Results Of the 42 patients,22 (52.4％) had loss of reduction which was improved by timely adjustment of their external fixators,14 (33.3％) had joint stiffness which was mitigated by physical therapy,5 (11.9％) had traumatic arthritis which was relieved after medication and physical therapy,and one (2.4％) had pin tract infection which was controlled after antibiotic treatment and regular dressing change.Conclusion Although trans-articular external fixation is an effective treatment for elder patients with distal radius fracture of type C3,it is likely to result in a major complication,loss of reduction,which should be treated timely and effectively to avoid serious consequences.

Objective:To evaluate the application of ERAS concept in the treatment of tibial plateau fractures with minimally invasive double reverse tractions (MIDRT).Methods:A retrospective study was conducted of the 39 patients with tibial plateau fracture who had been treated at Department of Orthopedics, Union Hospital from February 2018 to June 2020. They were 20 males and 19 females, aged from 27 to 47 years. All cases were treated with the same MIDRT but with different perioperative management protocols. Of them, 20 received conventional perioperative management (control group) and 19 perioperative ERAS management (ERAS group). The 2 groups was compared in terms of visual analogue scale (VAS) at 24 hours postoperation, drainage volume, time for removal of drainage tube, hospital stay, patient’s satisfaction, incidence of complications, and American Special Surgery Hospital (HSS) scores at discharge and 1, 3, 6 and 9 months postoperation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability between groups ( P>0.05). All cases obtained complete follow-up (mean, 10.9 months). No statistically significant difference was found between the 2 groups in drainage volume, time for removal of drainage tube or HSS scores at discharge or one month after discharge ( P>0.05). The VAS score at 24 hours after operation, hospital stay [(9.4±4.8) d], patient's satisfaction, HSS scores [(90.8±3.8), (93.5±4.3) and (95.6±3.7)] in the ERAS group were significantly better than those in the control group [(13.3±1.9) d, (87.5±5.1), (88.1±4.4) and (88.8±4.4)] ( P<0.05). None of the patients had such serious complications as wound infection, breakage or failure of internal fixation, or fracture nonunion. Conclusion:The perioperative management protocols designed according to the ERAS concept may enhance the clinical efficacy of MIDRT in the treatment of tibial plateau fractures and thus raise the patient’s satisfaction.

As the National Health Commission changes the management of novel corona virus infection, the situation and preventive policies for controlling the epidemic have also entered a new stage in China. Perioperative care strategies for orthopedic trauma such as designated isolation and nucleic acid test screening have also been adjusted in the new stage. Based on the perioperative work experiences in the new stage of epidemic from the frontline anti-epidemic staff of orthopedics in domestic hospitals and combined with the literature and relevant evidence-based medical data in perioperative care of orthopedic trauma patients under the current anti-epidemic policies at home and abroad, Chinese Orthopedic Association and Chinese Society of Traumatology organized relevant experts to formulate the Guideline for clinical perioperative care of orthopedic trauma patients in the new stage of novel corona virus infection ( version 2023). The guideline summarized 16 recommendations from the aspects of preoperative diagnosis and treatment, infection prevention, emergency operation and postoperative management to systematically standardize the perioperative clinical pathways, diagnosis and treatment processes of orthopedic trauma in the new stage of novel corona virus infection, so as to provide a guidance and reference for hospitals at all levels to carry out relevant work in current epidemic control policies.

Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.