BACKGROUND:The number of hip fracture patients with dementia is increasing with an aging population,posing challenges for surgical treatment. OBJECTIVE:To determine the effect of dementia on postoperative complications in older patients with hip fractures. METHODS:Patients aged over 60 years old with hip fractures from 2000 to 2019 at Chinese PLA General Hospital were included.Dementia patients with a preexisting diagnosis of dementia at admission were identified.Each dementia patient was matched,for age±5 years,gender,and fracture type with 10 non-dementia patients.The differences in postoperative complications were compared between the two groups,including pneumonia,respiratory failure,gastrointestinal bleeding,urinary tract infection,surgical site infection,deep venous thrombosis,pulmonary embolism,angina pectoris,arrhythmia,heart failure,myocardial infarction,stroke,and death.The impact of dementia on major complications was evaluated using multivariate conditional logistic regression. RESULTS AND CONCLUSION:A total of 2 887 patients were included,of whom 125(4.3%)were dementia patients and matched with 1 243 non-dementia patients.The average age of dementia patients was(80.6±7.4)years;64.8%were female;53.6%were intertrochanteric fractures,and 46.4%were femoral neck fractures.Major complications occurred in 25(20.0%)patients with dementia and 123(9.9%)patients without dementia(P<0.01).The risk of major complications was 200.0 per 1 000 persons(95%CI,139.3-278.6)in dementia patients and 99.0 per 1 000 persons(95%CI,83.6-116.9)in non-dementia patients.Multivariate conditional logistic regression showed that a 2-fold risk of major postoperative complications after hip fracture surgery was found in dementia patients than in those without dementia(adjusted OR,2.11;95%CI,1.08-4.10).The results show that dementia is an independent risk factor for postoperative complications in elderly patients with hip fractures.Appropriate preoperative risk assessment and corresponding preventive and therapeutic measures should be given to this vulnerable population to mitigate postoperative complications.

Bone Transplantation/adverse effects* ; Transplantation, Autologous/adverse effects*

Objective:To explore which configuration schemes of proximal humerus internal locking system (PHILOS) fixation with endosteal augmentation can provide the optimal biomechanical stability for treatment of osteoporotic proximal humeral fractures by means of finite element analysis.Methods:Based on the CT data of the humerus of an old female volunteer (78 years old, with a bone density T-value of -3.0), a three-dimensional finite element model of the humerus was established by digital medical software such as Mimics 19.0, Geomagic Studio 12, and Creo 2.0 ANSYS Workbench2019. Next, a model of unstable proximal humerus fracture was established and subjected respectively to 5 different fixations: simple PHILOS fixation (PHILOS group), PHILOS plus 6-cm fibula fixation with calcar screws (PHILOS-F-C-6 group), PHILOS plus 6-cm fibula fixation without calcar screws (PHILOS-F-6 group), PHILOS plus 9-cm fibula fixation with calcar screws (PHILOS-F-C-9), and PHILOS plus 9-cm fibula fixation without calcar screws (PHILOS-F-9 group). After a stress mode of shoulder joint abduction at 25° was simulated, a compressive load of 200N was applied to the 5 fixation models. The stress distribution and displacement of fracture ends in different fixation models were tested, and the biomechanical stability was compared among the 5 different internal fixations.Results:Under a shoulder joint abduction at 25° and a load of 200 N, the maximum stress and the displacement of the fracture ends in PHILOS-F-C-9 group (38.678 Mpa and 0.012 mm) decreased by 30.08% and 45.45%, respectively, compared with PHILOS-F-C-6 group (55.321 Mpa and 0.022 mm), and decreased by 12.48% and 15.38%, respectively, in PHILOS-F-9 group (77.012 Mpa and 0.033 mm) compared with PHILOS-F-6 group (88.106 Mpa and 0.039 mm). The maximum stress and the displacement of the fracture ends in PHILOS-F-C-6 group decreased by 37.21% and 43.59%, respectively, compared with PHILOS-F-6 group while decreased by 49.83% and 63.63% in PHILOS-F-C-9 group compared with PHILOS-F-9 group, respectively.Conclusion:For treatment of osteoporotic proximal humeral fractures with medial instability, PHILOS fixation with longer fibula endosteal augmentation plus insertion of calcar screws is a more appropriate choice which can reduce the stress of internal fixation and reduce the displacement of the fracture ends.

In recent years, with the rapid development of computer and robotic technology, surgical robots have been applied more widely in the field of orthopedics. Compared to traditional surgery, surgical robots utilize advanced navigation systems, high-precision mechanical arms, and automated surgical planning systems to achieve high precision, minimal invasiveness, and low risk in minimally invasive orthopaedic surgeries. The complex anatomy, critical injury severity, and high surgical risks associated with pelvic fractures make the application of surgical robots in minimally invasive pelvic fracture surgery particularly advantageous. However, unlike spine and joint surgical robots that only require navigation and positioning functions, fracture surgery involves two steps: reduction and fixation. The reduction process needs to solve the problems such as the coupling relationship between the fracture ends, the safety of soft tissue pulling, and the rigid control of the fragments, so the research and development process of fracture surgical robot is full of challenges. This article discusses the application status of surgical robot in pelvic fractures, and prospects its future direction, which would provide reference for promoting the scientific research and industrial development of orthopedic robot.

Objective:To compare treatment effect of the new multi-dimensional cross locking plate-II (MDC-LP-II) and locking compression plate (LCP) as additional plates in the treatment of nonunion after intramedullary nailing treatment of subtrochanteric fractures.Methods:A retrospective analysis was performed on 23 patients with nonunion after subtrochanteric fractures treated with intramedullary nails from January 2019 to January 2021. According to the type of additional plate, it was divided into MDC-LP-II group and LCP group. There were 12 patients in MDC-LP-II group, including 10 males and 2 females, with an age of 36.83±12.61 years, a body mass index (BMI) of 25.09±2.37 kg/m 2, the time from the last operation to this treatment was 12.25±2.93 months, the number of previous operations was 1.33±0.65, 5 cases of hypertrophic nonunion, 7 cases of atrophic nonunion, and the length of bone nonunion defect was 1.19±0.78 cm. In the LCP group, there were 11 cases, 9 males and 2 females, aged 30.55±8.85 years, BMI was 26.74±5.05 kg/m 2, a time of 12.82±4.40 months after the last operation, the number of previous operations was 1.36±0.96, 5 cases of hypertrophic nonunion, 6 cases of atrophic nonunion, and the length of bone nonunion defect was 1.20±0.57 cm. The incision length, additional plate length, number of screws, number of bicortical screws, intraoperative blood loss, blood transfusion, healing time of nonunion, Harris hip score, lower extremity functional scale (LEFS) and the medical outcomes study item short from health survey-36 (SF-36) were compared between the two groups. Results:All 23 patients were followed up. The follow-up time of MDC-LP-II group was 14.17±2.55 months, and that of LCP group was 14.45±3.75 months, with no significant difference ( t=0.22, P=0.834). In MDC-LP-II group, the incision length was 7.25±2.01 cm, the plate length was 9.25±0.62 cm, the number of screws was 7.17±0.94, the number of bicortical screws was 7.17±0.94, the intraoperative blood loss was 279.17±169.84 ml, and the blood transfusion was 166.67±187.05 ml. In LCP group, the incision length was 15.45±4.72 cm, the plate length was 15.51±2.38 cm, the number of screws was 5.09±0.95, the number of bicortical screws was 1.82±1.72, the intraoperative blood loss was 481.82±227.24 ml, and the blood transfusion was 685.45±299.95 ml. There were significant differences in incision length ( P<0.05), plate length ( P<0.05), number of screws ( P<0.05), number of bicortical screws ( P<0.05), intraoperative blood loss ( P<0.05), and blood transfusion volume ( P<0.05) between the two groups. The fracture healing rate was 100% in MDC-LP-II group and 64% in LCP group at 6 months after operation, and the difference was statistically significant ( P<0.05). At 12 months after operation, the healing rate of LCP group was 91%, and the difference was not statistically significant ( P=0.478). The Harris score 92.83±8.04 and LEFS 74.92±6.68 at the last follow-up in MDC-LP-II group and the Harris hip score 83.36±9.89 and LEFS 66.27±7.68 at the last follow-up in LCP group were significantly different between the two groups ( P<0.05). In terms of SF-36, scores of physical function, physical pain, general health status, vital vitality and mental health of MDC-LP-II group were higher than those of LCP group. No complications related to the use of MDC-LP-II or LCP fixation were observed in both groups. Conclusion:On the basis of preserving the original intramedullary nail, MDC-LP-II compared with LCP as additional plates in the rebuilding of nonunion after intramedullary nailing treatment of subtrochanteric fractures, it can effectively enhance the stability of the broken ends in a much smaller operating range, reduce the surgical trauma, protect the local blood supply and accelerate the healing of the broken end of the fracture. The patients who received MDC-LP-II treatment had better lower limb function recovery and quality of life.

Humans ; Venous Thromboembolism/prevention & control* ; Anticoagulants/therapeutic use* ; Pulmonary Embolism ; Patients ; Hospitalization ; Risk Factors

Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

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.

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.