BACKGROUND:Three-dimensional (3D) printing technology exhibits a broad future in the orthopedics,especially exhibiting good guidance and auxiliary in the treatment of tibial plateau fractures.However,the related researches are few,and there is a lack of evidence-based medicine to confirm its application values.OBJECTIVE:To compare the efficacy of 3D printing-assisted surgery and traditional surgery in the treatment of tibial plateau fractures through a meta-analysis.ME=THODS:MEDLINE,Cochrane library,Embase,CBM,CNKI and WanFang databases were searched by computer and the relevant literatures were retrieved manually,to collect the controlled trials concerning the efficacy of 3D printing-assisted surgery versus traditional surgery for tibial plateau fractures.Methodology quality of the trials was assessed critically and relative data were extracted,followed by analysis on Stata 11.0 (Stata Corporation,College Station,TX) software.RESULTS AND CONCLUSION:(1) Seven controlled trials involving 362 patients were included.(2) Meta-analysis results showed that the 3D printing-assisted surgery had shorter operation time (SMD=-2.411,95％C/=-2.718-2.104,P=-0.00) and less intraoperative blood loss (SMD=-1.579,95％C/=-1.842--1.316,P=-0.00) than those in the traditional surgery.The excellent and good rate in Rasmussen and Hospital for Special Surgery knee scores showed no significant differences between two growps (P ＞ 0.05).(3) To conclude,compared with the traditional surgery,the 3D printing-assisted surgery can significantly shorten the operation time and reduce the intraoperative blood loss in the treatment of tibial plateau fractures.

Objective To investigate the effect of homeopathic reduction technique in treatment of irreducible variant femoral neck fractures.Methods A retrospective case control study was performed for 91 cases of irreducible variant femoral neck fractures surgically treated from January 2011 to January 2014.Forty-seven cases [31 males,16 females;23-61 years,mean 40.6 years] were assigned to homeopathic reduction treatment (study group) and 44 [30 males,14 females;28-63 years,mean 43.1 years] were assigned to closed reduction and open reduction (control group).All fractures were Garden type Ⅳ.All cases were stabilized with three cannulated screws (6.5 mm in diameter).Operation time,intraoperative blood loss,Garden index for reduction quality,bone healing,complications like femoral head necrosis and Harris hip score were evaluated.Results Operation time and blood loss in study group [(41.2 ± 7.5) min,(37.3 ± 9.5) ml] were significantly lower than those in control group [(105.0 ± 15.7) min,(269.6 ± 50.6) ml] (P ＜ 0.05).Garden index was Grade Ⅰ 44 cases and Grade Ⅱ three in study group compared to Grade Ⅰ 20 and Grade Ⅱ three in control group (P ＜ 0.05).Incidence of femoral head necrosis had no significant differences between study group (four cases) and control group (10 cases) (P ＞ 0.05).Nonunion was not observed in study group,while there were eight cases of nonunion in control group (P ＜ 0.05).According to the Harris score,the excellent rate in study group was 91％ (39 excellent,four good,four fair) versus 66％ (21 excellent,eight good,15 fair) in control group (P ＜ 0.05).Conclusion Compared to closed reduction and open reduction,homeopathic reduction technique in treatment of femoral neck fractures is associated with shortened operation time,reduced blood loss,improved reduction quality and lowered incidence of necrosis and nonunion.

Objective To compare the outcomes of homeopathic bidirectional-traction reduction device and traction table in surgical treatment of femoral intertrochanteric fractures.Methods A retrospective case control study was made on 94 cases of femoral intertrochanteric fractures treated from July 2015 to December 2015.There were 26 males and 68 females,aged 60-75 years.According to the Evans classification,the fractures were type Ⅱ in 24 cases,type Ⅲ in 32 and type Ⅳ in 38.Fifty-seven cases sustained chronic diseases.According to the random number table,the subjects were assigned to receive homeopathic bidirectional-traction reduction (homeopathic reduction group,48 cases) and traction table reduction (control group,46 cases).All fractures were fixed with proximal femoral nail antirotation.Operation time,reduction time,tluoroscopy time,blood loss and rate of closed reduced cases were recorded.Fracture union and rotation of the affected femur to the tibia were detected after operation.Functional outcome was evaluated using the Harris score at the final follow-up.Results All fractures were reduced closely in homeopathic reduction group,while 15 fractures in control group were reduced via a small-incision anterior approach.Operation time,reduction time and fluoroscopy time in homeopathic reduction group were (62.9 ± 12.1) min,(6.8 ± 1.5) min and (11.3 ± 5.6) s respectively,significantly less than the corresponding data in control group (all P ＜ 0.05).One month after operation,rotation of the affected femur to the tibia was (2.8 ± 1.2) ° in homeopathic reduction group,significantly less than that in control group [(11.5 ± 4.7) °] (P ＜ 0.05).Bone union was observed in all cases.At the final follow-up,Harris hip score was (92.6 ± 7.6)points in homeopathic reduction group,significantly higher than that in control group [(87.3 ± 6.5) points] (P ＜ 0.05).Conclusion For the elderly patients with intertrochanteric fractures,homeopathic bidirectional-traction device has advantages of high rate of closed reduction,shorter operation time,less radiological exposure and satisfactory function recovery of the affected hip joint.

Objective To investigate the clinical effect of homeopathic reduction with minimally invasive adjustable plate in treatment of sacral fractures.Methods A retrospective case-control study was conducted to assess the data of 89 patients with sacral fractures treated from January 2013 to January 2015.There were 49 males and 40 females,with a mean age of 37.8 years (range,18-70 years).Denis classification was type Ⅰ in 24 patients,type Ⅱ in 48,and type Ⅲ in 17.Patients were divided into three groups according to fixation methods:homeopathic reduction with minimally invasive adjustable plate group (Group A,n =30),sacroiliac screw group (Group B,n =31) and iliolumbar rod group (Group C,n =28).Operation time,blood loss,intraoperative radiographic time,and complications were recorded.Reduction quality was assessed using the Matta criteria.Bone healing was evaluated based on X-ray appearance.Functional outcome was evaluated using the Majeed score at last tollow-up.Results Operation time was significantly lower in Group A [(109.3 ± 14.4) min] and Group B [(114.2 ± 17.7) min] than Group C [(126.8 ± 15.7)min] (P ＜ 0.05),but there was no significant difference between Groups A and B (P ＞ O.05).Blood loss was significantly lower in Group A [(433.3 ± 121.3)ml] and Group B [(461.3 ± 130.8)ml] than Group C [(785.7 ±205.0)ml] (P ＜0.05),but there was no significant difference between Groups A and B (P ＞ 0.05).Radiographic time was (5.6 ± 1.9) s in Group A,(13.4 ± 3.1)s in Group B,and (8.4 ± 2.5)s in Group C,showing significant difference among the three groups (P ＜ 0.05).Excellence rate of Matta score in Group A [70％ (21/30)] and Group C [86％ (24/28)] was higher than that in Group B [32％ (10/31)],but the there was no significant difference between Group A and C (P ＞ 0.05).Fracture healing was found in all patients and no nonunion was observed.Excellent rate of Majeed score in Group A [80％ (24/30)] and Group C [82％ (23/28)] was higher than that in Group B [54％ (17/31)],but the there was no significant difference between Groups A and C (P ＞0.05).Complication rate in Group B [29％ (9/31)] and GroupC [29％ (8/28)] were higher than that in Group C [3％ (1/30)],but the there was no significant difference between Groups B and C (P ＞ 0.05).Conclusion For sacral fractures,homeopathic reduction with minimally invasive adjustable plate can reduce operation time and intraoperative radiographic time,improve reduction rate and lower incidence of complications.

Objective To compare and analyze the epidemiological features of adult patients with distal femoral fracture between the east and west areas in China from 2010 to 2011.Methods The data of adult patients with distal femoral fracture treated from January 2010 through December 2011 in 63 hospitals were collected through the PACS system and case reports checking system.The data from 35 hospitals in the east area were classified as group A and those from 28 hospitals in the west area as group B.The analytic items included gender,age and AO classification.Results A total of 2,523 adult distal femoral fractures were collected,involving i,544 males and 979 females,with a male to female ratio of 1.58:1.The adult femoral fractures predominated in an age range from 41 to 50 years (18.94％) and their high-risk type was 33-A (50.18％).In group A of 1,650 cases,there were 1,027 males and 623 females,with a male to female ratio of 1.65:1 and a median age of 48 years;in group B of 873 cases,there were 517 males and 356 females,with a male to female ratio of 1.45:1 and a median age of 45 years.There were no significant differences in the age distribution and gender proportion between groups A and B (P ＞ 0.05).The age distribution showed that the peak ranges were from 31 to 60 years in both groups.The proportion of type 33-A was the most and that of type 33-B the least in both groups.The proportion of type 33-A in group B (53.49％) was significantly higher than in group A (48.42％) while that of type 33-B in group B (16.84％) was significantly lower than in group A (21.39％) (P ＜ O.05).Conclusions Adult distal femoral fractures were common in middle-aged males and their high-risk type was 33-A.Their peak age was from 31 to 60 years in both east and west areas in China.They were more common in men.The predominant fracture type was 33-A in both areas.The east area witnessed a significant higher proportion of type 33-B and a significant lower proportion of type 33-A than the west area.

Objective To compare and analyze the epidemiological features of Colles fractures between Eastern and Western China from 2010 to 2011.Methods The data of patients with Colles fracture treated from January 2010 to December 2011 in 63 hospitals in Eastern and Western China were analyzed retrospectively.The patients from the 35 hospitals in Eastern China were defined as group A and those from the 28 hospitals in Western China as group B.The 2 groups were analyzed and compared in terms of gender,age and laterality.Results A total of 9,255 Colles fractures were collected.The total male/female ratio was 0.82:1.Their ages ranged from 1 to 110 years,with a median age of 51 years.The Colles fractures predominated in an age range from 51 to 60 years.There were 5,006 left sides and 4,249 right sides.There were 5,639 Colles fractures in group A,accounted for 2.55％ of the total body fractures and 22.09％ of the distal ultra-radius fractures.There were 3,616 Colles fractures in group B,accounted for 3.98％ of the total body fractures and 37.55％ of the distal ultra-radius fractures.The male/female ratio was 0.72:1 in group A and 0.99:1 in group B.The median age was 54 years (from 1 to 110 years) for group A and 45 years (from 1 to 99 years) for group B.There were significant differences between the 2 groups in all the above items (P ＜0.05).The largest proportion of age group was from 51 to 60 years and the smallest proportion of age group was ≥81 years for both groups.The proportions of age groups from 1 to 10 years,from 51 to 60 years,from 61 to 70 years,from 71 to 80 years and ≥81 years in group A were larger than in group B while those from 11 to 20 years,from 21 to 30 years,from 31 to 40 years and from 41 to 50 years in group A were smaller than in group B.There were significant differences between the 2 groups in all the proportions of age group (P ＜0.05).The Colles fractures predominated on the left side in both groups,showing no significant difference between the 2 groups (P ＞ 0.05).Conclusions The Colles fractures from 2010 to 2011 predominated in the elderly and female patients in China.The proportions of Colles fractures in all body fractures and distal ultra-radius fractures in Eastern China were lower than those in Western China.There were significant differences in gender and age proportions between the 2 areas.Eastern China had a larger proportion of female patients and a higher median age than Western China.

Objective To compare and analyze the epidemiological features of adult tibial plateau fractures from 2010 to 2011 between West China and East China.Methods The data of adult patients with tibial plateau fracture treated from January 2010 to December 2011 in 63 hospitals from West China and East China were collected through the PACS system and case reports checking system.The data of 28 hospitals from West China were classified as West group while the data of 35 hospitals from East China as East group.The analytic items included gender,age,age distribution and type of Schaztker classification.Results A total of 4,603 adult tibial plateau fractures were collected.The largest age proportion was from 41 to 50 years,with 41 to 50 years in males and 51 to 60 years in females.The highest age proportion in group A was from 51 to 60 years,and that in group B was from 41 to 50 years,showing significant differences between the 2 groups in age distribution (P ＜ 0.05).There were 3,346 cases in group A,including 2,438 males and 998 females with a male to female ratio of 2.35:1;there were 1,257 cases in group A,including 821 males and 436 females with a male to female ratio of 1.88:1.There were significant differences between the 2 groups in gender distribution (P ＜ 0.05).The high-risk fracture type was Schaztker type Ⅵ in both groups,with 898 cases in group A and 411 ones in group B;the lowest fracture type was Schaztker type Ⅴ in both groups,with 214 cases in group A and 149 ones in group B.There were significant differences between the 2 groups in fracture type ratios (P ＜ 0.05).Conclusions Adult tibial plateau fractures predominated in males in both East and West China.The average age of the patients from East China was higher than that from West China.The high-risk type was Schaztker type Ⅵ in both areas.

Objective To compare the epidemiological characteristics of adult single fractures of the cuneiform between the east and west areas in China from 2010 through 2011.Methods Thirty-five hospitals in the east coast area (group A) and 28 hospitals in the west inland area (group B) were selected for this investigation. The data of adult single fracture of the cuneiform treated between January 2010 and De-cember 2011 at the 63 hospitals were collected through the PACS system and medical records inquiry system. The epidemiological characteristics concerning age, gender and fracture classification were compared between the 2 groups. Results A total of 457 adult single fractures of the cuneiform were collected, involving 384 cases in group A and 73 cases in group B. They accounted respectively for 4.38% (384/8,772) and 3.53% (73/2, 068) of the adult tarsal bone fractures in the same period, showing no significant difference (P >0.05), accounted respectively for 1.71% (384/22, 455) and 1.15% (73/6, 354) of the adult foot frac-tures, showing a significant difference (P <0.05), and accounted respectively for 0.20% (384/192,991) and 0.09% (73/81, 143) of all the adult fractures, showing a significant difference (P <0.05). The median age was 39 years in group A (29, 50) and 36 years in group B (25, 45), showing a significant difference (P <0.05). The male to female ratio was 1.61:1 (237/147) for group A and 1.52:1 (44/29) for group B. The peak age range of the fracture for males was from 21 to 30 years old in both groups, and its proportion was 28.69% (68/237) in group A and 38.64% (17/44) in group B. The peak age range of the fracture for females was from 41 to 50 years old in both groups, and its proportion was 26.53% (39/147)in group A and 27.59% (8/29) in group B. All the above comparisons were statistically insignificant (P> 0.05). The proportion of the age group of≥61 years was significantly larger in group A than in group B (P <0.05). The high risk type of the fracture was type 85-A1 in both groups, and its proportion was 61.98% (238/384) in group A and 52.05% (38/73) in group B. The proportion of type 85-B1 was significantly larger in group B than in group A (P <0.05). Conclusions Adult single fractures of the cuneiform were more common in young and male patients. The proportion of elderly patients (≥61 years old) was significantly larger in the east area. The high risk type of the fracture was simple fracture involving the medial cuneiform bone (type 85-A) in both areas. The proportion of the comminuted fracture of the medial cuneiform (type 85-B1) was significantly larger in the west area.

Objective To analyze and compare epidemiological characteristics of adult single metatarsal fractures between the east and west areas in China from 2010 through 2011.Methods Thirty-five hospitals in the east area (group A) and 28 hospitals in the west area (group B) participated in this epidemiological investigation of adult single metatarsal fractures treated from January 2010 through December 2011.Data concerning gender,age and fracture location and type were documented and compared between groups A and group B.Results There were 4,779 fractures in group A and 1,708 in group B,accounting for 21.28％ (4,779/22,455) and 26.88％ (1,708/6,354) of the adult foot fractures,and 2.48％ (4,779/192,991) and 2.10％ (1,708/81,143) of all the adult fractures,respectively,showing significant differences between the 2 groups (P ＜ 0.05).The ratio of male to female was 1.21:1 in group A and 1.48:1 in group B,showing a significant difference (x2 =11.768,P =0.001).The median age of group A (43 years) was significantly older than that of group B (40 years) (Z =-6.275,P ＜ 0.001).The proportions of the patients aged from 21 to 30 years (19.02％) and of those aged from 31 to 40 years (18.62％) in group A were significantly lower than those in group B (22.66％ and 21.60％),but the proportion of the patients aged from 51 to 60 years in group A (21.09％) was significantly higher than that in group B (14.64 ％) (P ＜ 0.05).The proportions of type 87-A (40.18％) and type 87-C (5.52％) in group A were significantly lower than those in group B (44.38％ and 8.20％),but the proportion of type 87-B in group A (54.30％) was significantly higher than that in group B (47.42％) (P ＜ 0.05).There was no significant difference between the 2 groups in the distribution of fracture locations (P ＞ 0.05).Conclusions The most common single metatarsal fracture was that of the fifth metatarsal bone and the fractures of proximal metatarsal bone accounted for the largest proportion in both the cast and west areas.The west area had higher proportions of male patients and single metatarsal fracture than the east area.