Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease, is the fastest-growing cause of chronic liver disease worldwide, affecting approximately 30% of the global population.Imaging is vital for detecting, quantifying, and monitoring hepatic steatosis—the defining abnormality of MASLD—and subsequent fibrosis—the key determinant of liver-related outcomes. This review summarizes the principles, clinical usage, efficacy, and advancements in various imaging modalities for the noninvasive assessment of hepatic steatosis and fibrosis, with an emphasis on ultrasound, CT, and MRI. Additionally, this review explores the evolving landscape of MASLD diagnostic approaches, including machine-learning techniques, opportunistic screening, standardized imaging guidelines, and therapies, emphasizing the pivotal role that radiologists can play in shaping these developments.

Objective:To explore the efficacy of a new classification system proposed by us applied to the treatment of irreducible intertrochanteric femoral fractures.Methods:A retrospective study was conducted to analyze the clinical data of the 225 patients with irreducible intertrochanteric femoral fracture who had been treated between January 2023 and November 2024 at Zhengzhou Orthopedic Hospital (78 cases), The First Affiliated Hospital of Zhengzhou University (61 cases), Zhengzhou Central Hospital Affiliated to Zhengzhou University (28 cases), Zhengzhou Hospital of Traditional Chinese Medicine (34 cases), and Puyang Hospital of Traditional Chinese Medicine (24 cases). There were 86 males and 139 females, with an age of (74.8±7.9) years. Satisfactory reduction had failed in all patients even after 3 attempts at closed reduction. The patients were divided into 2 groups based on whether the new classification system proposed by our research team in our previous study was used to guide the treatment. The observation group of 116 cases were treated through an extended incision at the head of the intramedullary nail for reduction and fixation under the guidance of the new classification system while the control group of 109 cases were treated by reduction and fixation through a direct anterolateral incision. The operation time, intraoperative blood loss, fracture healing time, Harris hip scores at 3 months after operation and the last follow-up, and incidence of complications were compared between the 2 groups.Results:No statistically significant differences were observed in the baseline characteristics between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (12.6±2.5) months after operation. The operation time, intraoperative blood loss, and fracture healing time [(39.5±9.7) minutes, (106.6±54.8) mL, and (3.1±0.7) months] in the observation group were significantly less than those in the control group [(70.2±11.1) minutes, (322.8±55.5) mL, and (4.5±0.7) months] ( P<0.05). The Harris hip scores at 3 months after operation and the last follow-up in the observation group [(90.3±3.4) points and (93.7±3.2) points] were significantly higher than those in the control group [(75.1±3.8) points and (78.7±3.6) points] ( P<0.05). The incidence of complications in the observation group was 6.0% (7/116), significantly lower than that in the control group [14.7% (16/109)] ( P<0.05). Conclusion:In the treatment of irreducible intertrochanteric femoral fractures, compared with the conventional anterolateral approach for intramedullary nailing, the extended intramedullary head nail approach guided by our new classification system can reduce operation time, intraoperative blood loss, fracture healing time, and incidence of postoperative complications, and improve postoperative hip joint function.

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 investigate the risk factors for new adjacent vertebral fracture after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fracture (OVCF) and their predictive efficacy.Methods:A retrospective cohort study was conducted to analyze the clinical data of 476 OVCF patients admitted to The Affiliated Wuxi People′s Hospital of Nanjing Medical University from January 2018 to December 2024, including 74 males and 402 females, aged 49-91 years [71(65, 79)years]. Among them, 397 patients underwent single-level PKP, while 79 received multi-level PKP. Surgical segments involved T 6 in 9 patients, T 7 in 9, T 8 in 14, T 9 in 12, T 10 in 9, T 11 in 50, T 12 in 110, L 1 in 173, L 2 in 77, L 3 in 46, L 4 in 31, and L 5 in 13. The patients were divided into adjacent vertebral fracture group ( n=55) and non-adjacent vertebral fracture group ( n=421) according to whether adjacent vertebral fracture was observed during the follow-up. The following data were collected in both groups: gender, age, body mass index (BMI), bone mineral density T-value, underlying diseases (hypertension, diabetes, coronary heart disease), prior cerebral infarction, history of OVCF, long-term glucocorticoid use, thoracolumbar fracture, number of operated vertebrae, cement injection approach (unilateral or bilateral), mean cement dose, postoperative vertebral height restoration rate, postoperative Cobb angle correction, postoperative thoracolumbar kyphosis angle correction, and cement distribution score. Univariate and multivariate Logistic stepwise regression analysis were performed to assess and identify independent risk factors for adjacent vertebral fracture in OVCF patients after PKP. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the risk factors′ predictive performance for adjacent vertebral fracture in OVCF patients after PKP. Results:Univariate analysis revealed significant differences in age, bone mineral density T-value, history of OVCF, long-term glucocorticoid use, number of operated vertebrae, and cement distribution score between the two groups ( P<0.05). The multivariate Logistic stepwise regression analysis showed that the bone mineral density T-value ( OR=0.68, 95% CI 0.48, 0.95, P<0.05) and cement distribution score ( OR=0.61, 95% CI 0.49, 0.76, P<0.01) were significantly correlated with new adjacent vertebral fractures after PKP. The ROC curve analysis showed that bone cement distribution score showed better predictive performance (AUC=0.72, 95% CI 0.64, 0.79), compared with bone mineral density T-value (AUC=0.62, 95% CI 0.54, 0.70), while the combined predictive performance of the two factors was the best (AUC=0.75, 95% CI 0.68, 0.81). Conclusions:Bone mineral density T-value and cement distribution score are independent risk factors for new adjacent vertebral fracture in OVCF patients after PKP. The predictive performance of cement distribution score is proved to be good and can be better in combination with bone mineral density T-value.

Acute lateral ankle sprain (ALAS) is one of the most common sport injuries, with high incidence, recurrence and disability rates. Currently, exercise rehabilitation-based non-surgical treatment is the primary management approach for ALAS. However, there remain improper practices such as excessive immobilization or uncontrolled activity, which contribute to recurrent sprains and chronic ankle instability, significantly impairing patients′ athletic function and quality of life. To standardize the non-surgical management of ALAS, improve the cure rates, and reduce the recurrence and disability rates, Chinese Sports Rehabilitation Medicine Training Project of Chinese Medical Association, Foot and Ankle Basics and Orthopedics Group, Orthopedic Branch of Chinese Medical Doctor Association, and Sports Medicine Branch of Jiangsu Medical Association organized relevant experts to formulate Expert consensus on non-surgical treatment for acute lateral ankle sprain ( version 2025), following the principles of scientific vigor, practicality, and innovation. Thirteen recommendations were proposed for standardized treatment protocols across different healing phases, aiming to provide references for standard management of ALAS and improve the therapeutic outcomes.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Objective:To retrospectively analyze the short-term curative effects of various treatment methods for displaced femoral neck fractures in young and healthy elderly individuals aged 65 to 74 years, while also exploring the surgical treatment options available for this population.Methods:A retrospective analysis was conducted on 159 patients with displaced femoral neck fractures(Garden types Ⅲ and Ⅳ)who were treated at Zhengzhou Orthopedic Hospital from July 2019 to June 2021.Among these patients, 75 were male and 84 were female, with ages ranging from 65 to 74 years, and an average age of 69.1±2.9 years.Patients were categorized based on the treatment method received: the total hip arthroplasty(THA)group comprised 77 cases, the hemiarthroplasty(HA)group included 42 cases, and the internal fixation(IF)group contained 40 cases.We compared intraoperative blood loss, operation time, Harris hip joint function scores one-year post-operation, and the incidence of secondary surgeries across the groups.Results:All 159 patients were followed up for a duration of 36 to 60 months(mean 45.1 months)postoperatively.Intraoperative blood loss was recorded as follows: IF group(19.3±7.0 ml), HA group(303.7±33.8 ml, P<0.001), and THA group(453.6±75.6 ml), with statistically significant differences in pairwise comparisons among the three groups(all P<0.001).The operation times were: IF group(40.7±13.1 min), HA group(53.2±7.5 min), and THA group(96.8±23.6 min), again showing statistically significant differences between each pair of groups(all P<0.001).The Harris hip score at one year postoperatively was(82.1±8.0)points, with an excellent and good rate of 82.4%.Specifically, the THA group scored(82.1±8.1)points with an excellent and good rate of 83.1%; the HA group scored(82.3±7.5)points with an excellent and good rate of 83.3%; and the IF group scored(81.8±8.0)points with an excellent and good rate of 80.0%.No statistically significant differences were observed in the excellent and good rates among the three groups(all P>0.05).A chi-square test performed on the overall postoperative complications among the three groups revealed no statistically significant differences( P=0.115). Conclusions:For relatively healthy elderly patients aged 65 to 74 with femoral neck fractures, hip replacement is not the sole treatment option.Treatment plans should be individualized based on patients' health conditions, transcending age limitations, to effectively address the growing challenges posed by femoral neck fractures in an aging society.

Objective:To investigate the risk factors and their predictive efficacy for early postoperative infection in elderly patients with intertrochanteric femur fracture.Methods:A retrospective cohort study was conducted to analyze the clinical data of 286 elderly patients with intertrochanteric femur fracture admitted to Zhengzhou Orthopedic Hospital between August 2021 and August 2024, including 154 males and 132 females, aged 60-80 years [(72.5±5.8)years]. Fracture involved the left side in 148 patients and the right side in 138 patients. Internal fixation was performed on 214 patients and joint replacement on 72. Based on the occurrence of infection within two weeks postoperatively, the patients were divided into infection group ( n=25) and non-infection group ( n=261). Data were collected from the two groups, including basic information [gender, age, body mass index (BMI), cause of injury, fracture side], admission data (fasting blood glucose, diastolic blood pressure, systolic blood pressure), preoperative data [American Society of Anesthesiologists (ASA) classification, AO classification, serum C-reactive protein (CRP), serum albumin (Alb), serum CRP/Alb ratio, time from injury to surgery], and treatment-related information (surgical type, duration of surgery, intraoperative blood loss, quality of intraoperative reduction, postoperative antibiotic use). Univariate analysis and multivariate Logistic stepwise regression analysis were used to identify independent risk factors for early postoperative infection in elderly patients with intertrochanteric femur fracture. The receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated to evaluate the predictive efficacy of each factor. Results:Univariate analysis showed significant differences between the two groups in fasting blood glucose on admission, preoperative serum CRP, preoperative serum Alb, preoperative serum CRP/Alb ratio, and duration of surgery ( P<0.01). There were no significant differences between the two groups in the remaining variables ( P>0.05). Multivariate Logistic stepwise regression analysis indicated that fasting blood glucose on admission ( OR=2.65, 95% CI 1.32, 5.32, P<0.01), preoperative serum CRP ( OR=1.10, 95% CI 1.04, 1.18, P<0.01), preoperative serum Alb ( OR=0.79, 95% CI 0.70, 0.90, P<0.01), preoperative serum CRP/Alb ( OR=143.78, 95% CI 4.46, 46.77, P<0.01), and duration of surgery ( OR=1.07, 95% CI 1.02, 1.11, P<0.01) were significantly associated with early postoperative infection in elderly patients with intertrochanteric femur fracture. ROC curve analysis showed that the sensitivity and specificity of preoperative serum CRP/Alb in predicting early postoperative infection in elderly patients with intertrochanteric femur fracture were 88.00% and 88.10%, and that the AUC of preoperative serum CRP/Alb prediction was 0.92, significantly greater than the AUC predicted separately by fasting blood glucose at admission, preoperative serum CRP, preoperative serum Alb and duration of surgery (0.76, 0.75, 0.77, 0.76, respectively). The optimal cut-off value for the preoperative serum CRP/Alb ratio was 1.78. Conclusions:Fasting blood glucose on admission, preoperative serum CRP, Alb, CRP/Alb ratio, and duration of surgery are independent risk factors for early postoperative infection in elderly patients with intertrochanteric femur fracture. These factors all possess certain predictive value for early postoperative infection, but the preoperative serum CRP/Alb ratio demonstrates the best predictive efficacy.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.