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Proximal femoral fractures are one of the most challenging kinds of fractures in current orhopaedic traumatology.Theclinicalresearchononesortofthefractures,theintertrochanticfracture,however,isnotstrongenoughtomeetthechallenge.Thepreoperativeradiologicaldiagnosisshouldbeabletopreciselydetectthestabilityofintertrochanticfracturethroughpayingmoreattentiontotheevaluationoftheintegrityoftheinternalarcandcomminutionextentsoftheposteriorcortex.Currently,operativetherapyattheearlystageisthemaintreatmentforintertrochanticfractures,suchasdynamichipscrews(DHS),Gammanails,andproximalfemoralnails(PFN).Thecentralfixationbyintramedullarynailsisthefirstchoiceintreatingtheunstableintertrochanticfractures,especiallythereverseones.Theapplicationoffluoro-navigationandotherauxiliaryoperativetechniquesintheinternalfixationofproximalfemoralfractures,andtheclinicalresearchofEvidenceBasedMedicinewillimprove the diagnosis and treatment of intertrochantic fractures.

Shoulder surgery has rapidly grown into an independent branch of o rthopedics in the developed countries, but not in China, for only several large -scale Chinese hospitals have set up an independent department of shoulder surg ery. Advancement of arthroscopy and increasing application of displacement of ar tificial humeral head have enriched the treatment methods of shoulder problems s o that many of the previous contradictions can be resolved through surgery. This issue of Chinese Journal of Orthopaedic Trauma(CJOT) introduces some procedures and experience of the shoulder surgery, including operative managements of shou lder dislocation, fracture of shoulder blade, acromion impingement syndrome and shoulder instability. Surgeons should achieve as much as possible minimal invasi on and optimal functional recovery of the shoulder as long as they do not dramat ically increase the expenses of the patients.

As everyone knows, foot and ankle play a decisive role in human activities. In the recent ten years, management of lesions of foot and ankle has drawn increasing attention and interest of orthopedic scholars so that great progress has been made in this field, but there have still been many controversial issues. This review gives a brief introduction of the most up to date development and problems in the research of foot and ankle fractures, and also suggests some basic principles in treating such fractures.

The techniques and concepts in the field of orthopaedic trauma have been changed in these years by new ideas of osteosynthesis, minimal invasive surgery (MIS), computer assisted orthopaedic surgery (CAOS) and evidence based medicine (EBM). This paper briefly introduces the development trend in orthopaedic trauma through discussion of the papers exchanged in the 2nd Congress of Chinese Orthopaedic Trauma Association.

This issue features papers concerning intra articular fractures that covers surgical managements of fractures of tibial plateau at lower limbs, patella, calcaneus, glenoid cavity at upper limbs, Pilon fracture and Barton fracture. Fracture displacement, articular step off and injury of soft issue that are often associated with intra articular fractures, especially those caused by high energy, make the treatment all the more difficult. The key points for a successful treatment are accurate judgment of the severity of the injury, proper timing of the operation, application of minimally invasive skills, possibly maximum anatomic reduction and alignment of the fracture and maximum functional recovery. The author emphasizes that treatment of intra articular fractures should be individualized.

Objective To analyze the factors influencing the total cost of hospitalization after internal fixation of intertrochanteric fracture.Methods Enrolled in this study were 142 patients with intertrochanteric fracture who had been treated at our department between March 2013 and August 2014.They were 54 men and 88 women,aged from 24 to 95 years (average 69.8 years).Intramedullary fixation was adopted in 135 cases while extramedullary fixation in 7.By AO classification,32 cases were type A 1,75 type A2 and 35 type A3.We analyzed their demographic data,fracture-associated factors,bleeding-associated factors and surgery-associated factors.For univariate analysis,the independent sample t test was performed between 2 groups.One-Way ANOVA analysis was performed among several groups.For multivariate analysis,multivariate linear regression analysis was performed.P ＜ 0.05 was regarded as statistically significant.Results The independent sample test revealed that the total cost of hospitalization for those with preoperative deep venous thrombosis (6.9 ± 1.0 × 105 (￥)) was significantly higher than for those without (5.0 ± 0.8 × 105 (￥)) and the total cost for those undergoing intramedullary fixation (5.5 ± 1.2 × 105 (￥)) was significantly higher than for those undergoing extramedullary fixation (4.4 ±0.7 × 105 (￥)) (P ＜ 0.05).The multiple linear regression analyses showed that preoperative deep venous thrombosis (t =11.750,P ＜ 0.001),perioperative transfusion (t =2.803,P =0.006),hospital stay (t =5.949,P ＜ 0.001) and intraoperative blood loss (t =2.885,P =0.005) were the independent factors influencing the total cost of hospitalization.Conclusions Preoperative deep venous thrombosis,perioperative transfusion,intraoperative blood loss,and hospital stay may influence the total cost of hospitalization for patients undergoing internal fixation of intertrochanteric fracture.More attention should be paid to control of the total cost of hospitalization in addition to ensuring the perioperative life safety.

Impacted femoral neck fractures should be treated operatively as displaced fracture. Many authors suggested emergency operation. The principle of treatment of femoral neck fractures is anatomic reduction, fragmental compression,and rigid fixation. Closed reduction must be done in most cases. When close anatomic reduction can not be achieved, open reduction should be considered.Implants used recently consist of pins , screws,hook pins and gliding screws with side plate. Every implant has its own advantages, disadvantages and indications. The principle of treatment of femoral neck fractures in young patients is emergency operation (within 12h after trauma), anatomic reduction (open reduction when necessary), and rigid fixation with screws. Some authors stated the necessity of anterior capsularoctomy.

Osteoporosis is considered as the most important factor which causes the fracture of the femoral neck. Comminution of fracture and rigidity of fixation are greatly affected by the degree of osteoporosis. Femoral neck fractures in young patients are mainly caused by severe trauma. Although Garden classification is widely accepted in classifying femoral neck fractures, in the recent decades some doctors have found out some shortcomings in Garden classification in practical application. It has been suggested to classify the femoral neck fractures simply into displaced and undisplaced ones. Arthroplasty used to be thought as the choice of treatment of femoral neck fractures in the elderly. Application of arthroplasty must accord with the indications, not only with the age of the patient or the degree of the displacement of the fracture. There is no X ray diagnosis specially for the avascular necrosis of femoral head secondary to femoral neck fracture, other than Ficat Arlet grade system. MRI is considered to be the only method to diagnose the avascular necrosis of femoral head at an early stage and to defect its extent and location.

Objective To study middle-and-long-term results of the conservative management of the supination-eversion fractures of ankle. Methods A retrospective study was done for the 43 patients with supination-eversion fracture of ankle who were treated from February 1999 to August 2004 in our department, and followed up. Five patients belonged to stage Ⅰ , 10 to stage Ⅱ , none to stage Ⅲ and 28 to stage Ⅳ . The average duration of follow-up was 69 months (16 to 84 months). Results The middle-and-long-term results were graded according to the Ankle Hindfoot Clinical Rating System of the American Orthopaedic Foot & Ankle Society(AOFAS). Of the stageⅠ patients, five got satisfactory results. Of the stage Ⅱ patients, nine got satisfactory results and one unsatisfactory. Of the stage Ⅳ patients, 26 got satisfactory results and two unsatisfactory. Conclusions The middle-and-long-term follow-ups show that most of the supination-eversion fractures of ankle can be treated conservatively with a satisfactory result. Surgical treatment should be indicated for those whose conservative management cannot reach satisfactory results.