Objective:To evaluate a novel self-designed elbow flexion-extension axis guide that is easy to operate, accurately positioned, and X-ray-free.Methods:This study collected the elbow joint CT scans from 60 normal adults [40 males and 20 females with an age of (38.1±9.3) years] at Department of Orthopedics, The Third Hospital of Xiamen between September and December 2024. The scan images were imported into 3D modeling software for systematic measurement of key anatomical parameters of the distal humerus. The structural design of a novel elbow flexion-extension axis guide was completed based on these measurements, combined with the anatomical data of the distal humerus reported in 6 relevant articles between January 2008 and December 2024 retrieved from the CNKI and PubMed databases. After physical models of the distal humerus from the 60 healthy adults were fabricated using 3D printing technology, they were divided into 2 even groups: a guide-assisted group ( n=30) where the positioning needle was inserted with the assistance of the elbow flexion-extension axis guide and a conventional group ( n=30) where the positioning needle was inserted freehand. The entry deviation, exit deviation, inter-axial angle, inter-axial distance, operation time, and fluoroscopic verifications in positioning of elbow flexion-extension axis were compared between the 2 groups. Results:The guide-assisted group demonstrated significantly smaller values than the conventional group in entry deviation [(1.52±0.70) mm versus (2.29±1.00) mm], exit deviation [(2.83±1.49) mm versus (4.95±1.63) mm], inter-axial angle (3.46°±0.93° versus 6.45°±1.21°), and operation time [(92.0±17.0) s versus (509.5±42.3) s] (all P<0.05). The conventional group required an average of (10.7±2.1) fluoroscopic verifications, while the guide-assisted group eliminated radiation exposure. No statistically significant difference was observed in the inter-axial distance between the 2 methods in positioning of elbow flexion-extension axis ( P>0.05). Conclusion:As the novel self-designed elbow flexion-extension axis guide can improve accuracy in positioning the elbow flexion-extension axis without requiring fluoroscopy, it significantly shortens intraoperative positioning time, and is handy to use.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective:To evaluate a novel self-designed elbow flexion-extension axis guide that is easy to operate, accurately positioned, and X-ray-free.Methods:This study collected the elbow joint CT scans from 60 normal adults [40 males and 20 females with an age of (38.1±9.3) years] at Department of Orthopedics, The Third Hospital of Xiamen between September and December 2024. The scan images were imported into 3D modeling software for systematic measurement of key anatomical parameters of the distal humerus. The structural design of a novel elbow flexion-extension axis guide was completed based on these measurements, combined with the anatomical data of the distal humerus reported in 6 relevant articles between January 2008 and December 2024 retrieved from the CNKI and PubMed databases. After physical models of the distal humerus from the 60 healthy adults were fabricated using 3D printing technology, they were divided into 2 even groups: a guide-assisted group ( n=30) where the positioning needle was inserted with the assistance of the elbow flexion-extension axis guide and a conventional group ( n=30) where the positioning needle was inserted freehand. The entry deviation, exit deviation, inter-axial angle, inter-axial distance, operation time, and fluoroscopic verifications in positioning of elbow flexion-extension axis were compared between the 2 groups. Results:The guide-assisted group demonstrated significantly smaller values than the conventional group in entry deviation [(1.52±0.70) mm versus (2.29±1.00) mm], exit deviation [(2.83±1.49) mm versus (4.95±1.63) mm], inter-axial angle (3.46°±0.93° versus 6.45°±1.21°), and operation time [(92.0±17.0) s versus (509.5±42.3) s] (all P<0.05). The conventional group required an average of (10.7±2.1) fluoroscopic verifications, while the guide-assisted group eliminated radiation exposure. No statistically significant difference was observed in the inter-axial distance between the 2 methods in positioning of elbow flexion-extension axis ( P>0.05). Conclusion:As the novel self-designed elbow flexion-extension axis guide can improve accuracy in positioning the elbow flexion-extension axis without requiring fluoroscopy, it significantly shortens intraoperative positioning time, and is handy to use.

Objective:To study the minimally invasive fixation with virtual self-designed screws between the iliac plates for acetabular posterior column fractures and compare the differences between genders.Methods:The CT data were collected from the 80 patients with normal pelvis who had undergone pelvic CT scan due to physical examination or trauma at Department of Orthopaedics, The Third Hospital of Xiamen from June 2021 to June 2022. There were 40 males and 40 females with an age of (45.0±12.4) years. The virtual screws between the minimally invasive iliac plates were designed with design software after 3D modeling. The insertion point, screw length, screw diameter, angle between the screw and the coronal plane of the pelvis, angle between the screw and the sagittal plane of the pelvis, angle ε between the screw and the anterior edge bone crest line of the greater sciatic notch, and bone channel volume were measured. Comparisons of the above data were made between genders. Results:The insertion point of the screw between the minimally invasive iliac plates was located between the anterior superior iliac spine and the iliac tubercle nodule, going toward the area between the ischial spine and the small ischial notch. The screw length was (139.64±8.46) mm, the screw diameter (8.95±1.16) mm, and the bone channel volume (51.91±10.77) cm 3. The screw length [144.34±7.58) mm], screw diameter [9.50±0.98) mm], angle between the screw and the sagittal plane of the pelvis (31.14°±2.74°), and bone channel volume [(57.82±8.82) cm 3] for males were significantly larger than those for females [(134.95±6.48) mm, (8.40±1.07) mm, 26.72°±2.74°, and (46.01±9.22) cm 3], while the angle between the screw and the sagittal plane of the pelvis [(35.74°±3.85°) mm] and angle ε between the screw and the anterior edge bone crest line of the greater sciatic notch (11.96°±4.57°) for males were significantly smaller than those for females (36.89°±2.96° and 14.17°±5.15°) (all P < 0.05). Conclusions:Fixation with screws between the iliac plates provides a new treatment for acetabular posterior column fractures, because the screws can be placed percutaneously in a minimally invasive manner or antegradely. The screw length, screw diameter, angle between the screw and the sagittal plane of the pelvis, and bone channel volume for males are significantly larger than those for females, while the angle between the screw and the sagittal plane of the pelvis and the angle between the screw and the anterior edge bone crest line of the greater sciatic notch for males are significantly smaller than those for females. Therefore, the angles between the iliac plate screw and the sagittal and coronal planes of the pelvis should be adjusted according to gender in screw placement.

Currently, the definition, classification and Chinese nomenclature of intra-hepatic cholangiocarcinoma (ICC) are controversial. Whether ICC belongs to liver cancer or carcinoma of bile duct is debatable, and the two terms"intrahepatic cholangiocarcinoma"and"cholangiocellular carcinoma"are simultaneously used without distinction, bringing great confusions to clinical practice. Based on authoritative literatures at home and abroad, the authors give suggestions on the definition, classification and Chinese nomenclature of ICC, as well as the classification of carcinoma of bile duct, which recommend that the Chinese translation of "cholangiocarcinoma" should be "epithelial carcinoma of bile duct (cholangiocellular carcinoma)", the mass-forming type ICC should be classified as primary liver cancer, naming as"intrahepatic cholangiocarcinoma"and the periductal-infiltrating type and intraductal-growing type ICCs still be classified as carcinoma of bile duct, naming as"perihilar cholangiocarcinoma". The authors recommend to classify carcinoma of bile duct into: perihilar cholangiocarcinoma, hilar cholangiocarcinoma, and distal cholangiocarcinoma.

Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.

Objective To investigate the expressions of Wnt3a and Wnt5a in papillary thyroid carcinoma (PTC) and their clinical significances. Methods Immunohistochemical SABC method was used to detect the expressions of Wnt3a and Wnt5a proteins in PTC tissues and their paracancerous tissues collected from 79 patients in Dandong First Hospital from January 2014 to June 2018, and the relationships between the expressions of Wnt3a and Wnt5a proteins and clinicopathological features of PTC patients were analyzed. The expressions of Wnt3a and Wnt5a proteins in 10 pairs of fresh PTC tissues and paracancerous tissues were detected by Western blot. Results The results of immunohistochemistry showed that the positive expression rates of Wnt3a and Wnt5a proteins in PTC tissues were significantly higher than those in paracancerous tissues [69.6％ (55/79) vs. 25.3％ (20/79), 60.8％ (48/79) vs. 20.2％ (16/79)], and the differences were statistically significant (χ 2 values were 31.092 and 26.894, both P < 0.01). The results of Western blot showed that the expressions of Wnt3a and Wnt5a proteins in 10 pairs of fresh PTC tissues was significantly higher than those in paracancerous tissues(1.61±0.40 vs. 0.43±0.14, 1.38±0.291 vs. 0.36±0.13), and the differences were statistically significant (t values were 16.234 and 13.493, both P < 0.01). The expressions of Wnt3a and Wnt5a in PTC tissues were correlated with TNM stage, differentiation, extramembranous invasion and lymph node metastasis (Wnt3a: χ2 values were 6.645, 15.945, 8.783 and 11.220; Wnt5a: χ2 values were 21.525, 7.611, 17.880 and 12.581, all P < 0.05), but not with patients'age, sex and tumor diameter (all P > 0.05). There was a positive correlation between Wnt3a and Wnt5a proteins expressions in PTC (r = 0.597, P < 0.01).Conclusion The abnormal expressions of Wnt3a and Wnt5a proteins in PTC may be related to the development of PTC.

Objective To compare cable tension band fixation with other 3 fixations in terms of biomechanical stability for tibial avulsion fractures of the anterior cruciate ligament (ACL).Methods Eighty fresh porcine knees were randomized into 4 equal groups (n =20).For each knee,all the soft tissues were removed only to keep the femur-ACL-tibia complex.The knee complexes were used to create fracture models of standard Meyers-Mc Keever type Ⅲ at the ACL attachment region using a swing saw.The fracture fragments in the 4 groups were subjected to fixation respectively with intramedullary lag screws,high-strength suture,tension band wire and cable tension band.All the specimens were subsequently tested on a Material Testing Machine at a load rate of 60 mm/mm.The 4 groups were compared in terms of ultimate failure load,yield load,and fragmental displacement under single-cycle loading and multi-cyclic loadings.Results Cable tension band fixation displayed significantly higher ultimate failure,higher yield load and lower fragmental displacement than all the other 3 fixations (P ＜ 0.05).Conclusion As cable tension band fixation,which is convenient and economical,provides better biomechanical stability than other 3 fixations for tibial avulsion fractures of the ACL,it may allow earlier functional and weight-bearing exercise after operation.

To understand the adverse reactions of Kan,glaite injection and its incidenceand explore the factors affecting the safety of Kan,glaite Injection in clinical use.Methods A noninterventional and prospective hospital based monitoring study and nested case-control study were conducted.All hospitalized cancer patients receiving Kan.glaite injections from 28 hospitals in northeast, north, central,east, south, southwest, northwest regions of China from September 2013 to September 2014 were enrolled in this study. The main monitoring contents included the general status of patients, the drug administration (including indications and combined use), medication safety, and so on. Patients developing adverse reactions related to Kan,glaite injection distributed in the case group and patients who did not develop adverse reactions were randomly selected and distributed into the control group with a ratio of l : 3 , and the factors that affect the safe use of Kan,glaite injection were analyzed.Results A total of 5 022 cancer patients were entered into the study, including 2 926 males and 2 096 females with age from 9 t0 95 years and their average age was (60 + 12) years. The top five tumors were lung cancer (1 456 patients,28.99%) ,intestinal cancer (867 patients,17.26% ) , marmuary cancer ( 372 patients, 7.41% ) , gastric cancer ( 346 patients, 6.89%) , and liver cancer (335 cases,6.67%). There were 3 863 patients (76.92% ) with tumor stage III and IV, 348 patients with allergic history (6.93%) ; 2 524 patients were complicated with other diseases (50.26% ) ; 4 687 patients (93.33%) had combined drug therapy.During the monitoring period,751(14.95%) of 5 022 patients developed adverse events and of them, 18 cases met the criteria of causality of adverse reactions, including 7 cases of phlebitis, 3 cases of nausea and vomiting, 3 cases of chills, 2 cases of rash, 1 case of palpitation, 1 case of transammase increase, and l case of fever. The incidence of adverse reactions was 0.36%. Univariate analysis showed that the incidence of adverse reactions in patients with combined diseases was higher than that in patients without combined diseases (X2=5.4723,P=0.019),the incidence of adverse reactions in patients with combined western medication was higher than that in patients with combined westem and Chinese medication (P=0.002).Logistic regression analysis showed that the influencing factors of adverse reactions were coexisting diseases (OR=1. 636, 95%C/:1.100-2.433,P= 0.013)and combined medication (OR=1.475,95%C/:1.108-1.965,P=0.027).Nested case-control study showed that the influencing factors of adverse reactions induced by Kan.glaite injection were radiotherapy (OR= 1.864,95% C/:0.930-3.736,P<0.01)and corubined medication (OR=1.622,95% C/:1.102-2.389,P<0.01) .Conclusions The incidence of adverse reactions of Kan,glaite injection in clinical application is lower and the safety is good. Coexisting diseases, combined medication and radiotherapy are main factors affecting its clinical safety.