Objective:To report construction of Evidence-Based Guidelines for the Diagnosis and Treatment of Distal Radius Fractures in Adults (2024) using the Delphi method.Methods:Literature related to the study of adult distal radius fractures was fully searched for and evaluated. An expert group was established from representative experts from all over the nation. The related clinical issues were established by consulting the experts in the form of electronic questionnaires, strictly following the Delphi research method. After the first draft of Evidence-Based Guidelines for the Diagnosis and Treatment of Distal Radius Fractures in Adults (2024) was written, an expert consultation questionnaire was designed for the recommendation opinions to determine the recommendation strength.Results:The clinical issues were determined by 2 rounds of correspondence based on the Delphi method. For the both rounds of correspondence, the questionnaire recovery rates were respectively 88.68% (47/53) and 98.11% (52/53), and the expert authority coefficients >0.7. According to the screening criteria based on the importance of clinical issues (mean importance score <3.5 points or a coefficient of variation ≥0.25 points and a full score ratio <30%) and expert opinions, a total of 40 clinical issues were deleted in the first round of determination of clinical issues, and a total of 5 clinical issues deleted in the second round of determination of clinical issues. The reliability analysis of the results of the 2 rounds of questionnaires showed that the Cronbach α coefficient was >0.9. In the questionnaire to determine the recommendation strength, according to the screening criteria for the consistency of recommendation strength (consistency ≥ 70%) and expert opinions, a total of 26 recommendations were screened in the first round. In the second round when the remaining 4 recommendations were investigated, one recommendation reached the consistency of recommendation strength ≥ 70%. Eventually, 27 recommendations were formed.Conclusion:The Evidence-Based Guidelines for the Diagnosis and Treatment of Distal Radius Fractures in Adults (2024) constructed using the Delphi method shows good scientific validity, authority, and reliability, providing methodological references for guideline development and research.

Objective:To report construction of Evidence-Based Guidelines for the Diagnosis and Treatment of Distal Radius Fractures in Adults (2024) using the Delphi method.Methods:Literature related to the study of adult distal radius fractures was fully searched for and evaluated. An expert group was established from representative experts from all over the nation. The related clinical issues were established by consulting the experts in the form of electronic questionnaires, strictly following the Delphi research method. After the first draft of Evidence-Based Guidelines for the Diagnosis and Treatment of Distal Radius Fractures in Adults (2024) was written, an expert consultation questionnaire was designed for the recommendation opinions to determine the recommendation strength.Results:The clinical issues were determined by 2 rounds of correspondence based on the Delphi method. For the both rounds of correspondence, the questionnaire recovery rates were respectively 88.68% (47/53) and 98.11% (52/53), and the expert authority coefficients >0.7. According to the screening criteria based on the importance of clinical issues (mean importance score <3.5 points or a coefficient of variation ≥0.25 points and a full score ratio <30%) and expert opinions, a total of 40 clinical issues were deleted in the first round of determination of clinical issues, and a total of 5 clinical issues deleted in the second round of determination of clinical issues. The reliability analysis of the results of the 2 rounds of questionnaires showed that the Cronbach α coefficient was >0.9. In the questionnaire to determine the recommendation strength, according to the screening criteria for the consistency of recommendation strength (consistency ≥ 70%) and expert opinions, a total of 26 recommendations were screened in the first round. In the second round when the remaining 4 recommendations were investigated, one recommendation reached the consistency of recommendation strength ≥ 70%. Eventually, 27 recommendations were formed.Conclusion:The Evidence-Based Guidelines for the Diagnosis and Treatment of Distal Radius Fractures in Adults (2024) constructed using the Delphi method shows good scientific validity, authority, and reliability, providing methodological references for guideline development and research.

Objective:To investigate the major considerations of domestic orthopaedic trauma surgeons in China when they diagnose and treat Mason type Ⅱ radial head fractures.Methods:A questionnaire survey was conducted from January 15, 2022 to January 16, 2022 using the convenience sampling method among domestic orthopedic trauma surgeons in China. The survey covered the surgeons' basic information, evaluation of Mason type Ⅱ radial head fractures, treatment preferences, and surgical indications recognized.Results:The present survey retrieved 474 eligible questionnaires. 358 surgeons (75.5%, 358/474) believed that the Morrey modified classification for Mason type Ⅱ radial head fracture could properly guide their diagnosis and treatment. 460 surgeons (97.0%, 460/474) believed that diagnosis of the fracture should be based on a combination of elbow X-ray and elbow CT examinations. Young age (80.2%, 380/474), dominant side involvement (66.2%, 314/474), concomitant ipsilateral upper limb injury (78.7%, 373/474), large fracture displacement (67.7%, 321/474), separation of fracture fragments from the main bone (91.6%, 434/474), and fracture involvement area >30% (81.6%, 387/474) were the main factors considered by the orthopedic trauma surgeons when they chose surgical treatment. Large fracture displacement (71.7%, 340/474), especially large articular steps (83.5%, 443/474), separation of fracture fragments from the main bone (75.9%, 360/474), and limited forearm rotation or joint clicking (82.7%, 392/474) found during physical examination were recognized as surgical indications for Mason type Ⅱ fracture by orthopedic trauma surgeons.Conclusion:Domestic orthopedic trauma surgeons in China prefer surgical treatment for Mason type Ⅱ radial head fractures with loss of cortical contact and large displacement, especially large articular steps.

Objective:To investigate the current status and developing trends of study of adult radial head fracture and its treatment.Methods:The literature related to radial head fracture from January 2010 to September 2022 was reviewed through Web of science database. A bibliometric method and visualization software were used to study all the data collected and the 100 most-cited studies related to the treatment of radial head fracture to understand the research status, related cooperation, research trends and research hotspots in the field of adult radial head fracture.Results:A total of 387 studies were included, with a citation frequency of 4,982 times, an average citation frequency of 12.9 times for each study, and an H index of 36. The most studies were published in 2020 (38 studies). The citation frequency increased year by year, reaching the highest (783 times) in 2019. For the 100 most-cited studies, the citation frequency was 2,235 times, and the average citation frequency was 22.4 times for each study. The United States (100 studies), Harvard University (30 studies), Journal of Shoulder and Elbow Surgery (69 studies), and Ring D (19 studies) were, respectively, the most contributing country/region, institution, journal, and author. The country/region, institution, and author that participated the most in the collaboration were, respectively, the United States, Amphia Hospital, and Eygendaal D. Radial head fractures of Mason types Ⅱ and Ⅲ and combined with other elbow fractures and dislocations have attracted the intense attention since 2010. The current research hotspots are combined injuries and radial head prosthesis. Conclusion:Analysis of the bibliometric characteristics of the literature related to adult radial head fracture since 2010 displays the current research status and research hotspots to help following researchers to fully understand the historical development and recent hotspots in the field of adult radial head fracture.

Objective:To compare the outcomes of isolated Mason type Ⅱ radial head fracture between operative and non-operative treatments.Methods:A retrospective study was conducted to analyze the data of patients who had been treated for isolated Mason type Ⅱ radial head fracture either operatively or nonoperatively at Department of Trauma and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University from January 2017 to October 2020. The patients were divided into a non-operative group and an operative group according to their treatment method. After 1:1 propensity score matching method was used to match the patients in the 2 groups, a total of 58 pairs of patients were successfully matched. In the operative group, there were 24 males and 34 females with a mean age of (40±14) years and a body mass index of (23.7±3.4) kg/m 2; in the non-operative group, there were 22 males and 36 females with a mean age of (42±13) years and a body mass index of (23.5±3.9) kg/m 2. Elbow flexion-extension, forearm rotation, Mayo elbow performance score (MEPS), Quick-disabilities of the arm, shoulder and hand (q-DASH) score and complications were compared between the 2 groups. Results:There was no significant difference in the baseline data between the 2 groups, indicating comparability ( P>0.05). All the patients were followed up for (24±9) months. At the last follow up in the operative and the non-operative groups, respectively, the elbow flexion-extension was 134° (132°, 136°) and 134°(131°, 136°), the forearm rotation 176° (174°, 179°) and 178° (175°, 179°), the MEPS 100 (100, 100) and 100 (100, 100), the q-DASH score 0 (0, 0) and 0 (0, 0), showing no significant differences between the 2 groups in the above items ( P>0.05). Elbow pain was reported respectively in 4 (6.9%) and 6 (10.3%) patients in the operative and non-operative groups, showing no significant difference between the 2 groups ( P>0.05). Conclusion:The outcomes of operative and non-operative treatments of isolated Mason type Ⅱ radial head fracture are comparable.

Objective:To evaluate the effectiveness of perioperative fasting abbreviation in traumatic patients with orthopaedic trauma and diabetes mellitus undergoing selective surgery.Methods:The patients were selected for this prospective nonrandomized controlled study who had undergone selective surgery from June 2019 to June 2021 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. They were divided into an intervention group and a control group according to the wards where they stayed. The intervention group was fasted for solids from 0 o'clock on the surgery day and received oral solution with 6.25% maltodextrin which had been prepared by the nutritional department 3 hours prior to surgery. The control group was fasted for either liquids or solids from the midnight before surgery. All patients were evaluated according to the wake-up score and defensive reflex score after surgery. Once they were awakened, they were allowed slag-free drinks. Normal food was allowed if there was no discomfort after 2 hours. The 2 groups were compared in terms of basic information, actual preoperative fasting time, total amount of preoperative drinking, and postoperative time for initial drinking and eating. The perioperative subjective feelings (anxiety, thirst, hunger, nausea, fatigue, dizziness, sweating, stomach discomfort, etc.), grip strength and blood glucose were observed and compared between the 2 groups. Adverse reactions in the 2 groups were also observed.Results:A total of 135 patients were included, including 52 in the intervention group and 83 in the control group. The intervention group consisted of 22 males and 30 females aged from 30 to 84 years; the control group consisted of 39 males and 44 females aged from 29 to 81 years. There was no significant difference in the basic information between the 2 groups, showing comparability ( P>0.05). The intervention group had significantly shorter preoperative fasting time [3.5 (2.5, 6.3) h versus 12.0 (9.0, 16.0) h], significantly higher water intake before surgery [300 (200, 300) mL versus 100 (100, 200) mL], significantly shorter postoperative fasting time [0.08 (0, 1.25) h versus 2.00(0, 6.00) h], and significantly reduced time to return to normal diet [2.0 (2.0, 2.3) h versus 3.0(2.0, 6.0) h] than the control group (all P<0.05). The symptoms of anxiety, fatigue, sweating, and stomach discomfort in the intervention group were significantly fewer than those in the control group throughout the evaluation period. The thirst in the intervention group was significantly alleviated than that in the control group immediately after returning to the ward after surgery, and the dizziness and hunger were significantly alleviated than those in the control group when the patients left the ward to the operation room before surgery and immediately after returning to the ward. The symptom of nausea after returning to normal diet in the intervention group was significantly relieved compared with the control group. All the comparisons above showed statistically significant differences ( P<0.05). The blood glucose in the intervention group 2 hours after taking slag-free drinks was significantly higher than that in the control group ( Z=-2.108, P=0.035). There was no significant difference in the blood glucose between the 2 groups during other measurement periods ( P>0.05). There were no serious adverse reactions in either of the 2 groups. Conclusion:The protocol of perioperative fasting abbreviation may be safe and feasible for the patients with orthopaedic trauma and diabetes mellitus undergoing selective surgery, because it shows benefits of improving the patients' subjective feelings and stabilizing the blood glucose perioperatively.

Objective:To investigate the current situation of perioperative fasting management in patients with orthopaedic trauma waiting for elective surgery (those combined with diabetes mellitus included) and the surgeons' awareness in China.Methods:From November 1st to December 31st, 2021, the questionnaire forms were distributed through WeChat in the exchange group of National Enhanced Recovery Surgery (ERAS) and the exchange group of national training orthopaedists in Beijing Jishuitan Hospital. The survey contents included: time for preoperative water deprivation and for postoperative recovery of drinking in patients without diabetes mellitus, the rationales for orthopaedists to choose perioperative dietary management, the orthopaedists＇understanding of the existing guidelines, time for preoperative water deprivation and postoperative recovery of drinking and diabetes-related issues in patients with diabetes mellitus, and the time for postoperative recovery in all the patients (For the postoperative recovery of eating, there is no difference between patients with and without diabetes mellitus). The relationships were analyzed between some professional data of the orthopaedists and their rationales for choice of management strategies and their understanding of the guidelines.Results:A total of 565 valid questionnaires were collected. 12.92% (73/565) of orthopaedists required their patients without diabetes mellitus not to drink for at least 2 hours. In fact, the proportion of water prohibition from 0 o'clock on the day of operation was still the highest [24.07% (136/565)]. Respectively, 22.83% (129/565) and 42.12% (238/565) of the orthopaedists chose "water intake is allowed once awakened" and "water intake after at least 6 hours after operation" for their patients without diabetes mellitus. 33.98% (192/565) of the orthopaedists required all the patients fasted for at least 6 hours before surgery, and 44.25% (250/565) of the orthopaedists chose "eating can be resumed if there is no discomfort for 2 hours after water intake" .21.06% (119/565) of the orthopaedists demonstrated that they were quite familiar with the guidelines and carried out perioperative dietary management according to the guidelines. The management of water deprivation was more inconsistent for patients with diabetes mellitus, and more hospitals followed the traditional principles for water deprivation. The proportions of water deprivation starting at 0 o'clock on the day of operation, 8 hours before operation, 6 hours before operation and 4 hours before operation accounted respectively for 22.83% (129/565), 19.12% (108/565), 21.95% (124/565), and 18.94%% (107/565). The level of an orthopaedist's hospital and the professional rank of an orthopaedist were the factors related to the orthopaedist's understanding of the guidelines ( P<0.05). Conclusions:The current perioperative dietary management guidelines are not widely implemented or well known in Chinese faculties of orthopaedic trauma. The process of perioperative dietary management needs to be optimized for the patients combined with diabetes mellitus.

Objective:To explore the characteristics and clinical values of preoperative imaging signs and intraoperative stress test in the surgery of the Weber type B fracture without medial malleolar fracture.Methods:The data of 52 patients were reviewed who had been treated at Orthopaedic Trauma Department, Beijing Jishuitan Hospital for Weber type B ankle fracture without medial malleolar fracture from January 2018 to December 2021.They were assigned into 2 groups depending on their results of intraoperative stress test. In the positive group of 21 cases showing a positive intraoperative stress test, there were 19 males and 2 females with an age of (34.4±10.2) years; in the negative group of 31 cases showing a negative intra operative stress test, there were 22 males and 9 females with an age of (39.5±14.8) years. The 2 groups were compared in terms of the medial clear space, tibiofibular clear space and vertical length of the fibular fracture on the preoperative X-ray film, as well as the relative size of the posterior malleolar fracture fragment on the preoperative CT. The imaging characteristics of intraoperative stress tests were also observed.Results:There was no significant difference between the 2 groups in the preoperative general data, showing comparability between groups ( P>0.05). The medial clear space (7.2±2.5) mm and the vertical length of the fibular fracture [49.2 (33.7, 58.7) mm] in the positive group were significantly larger than those in the negative group [(4.5±1.7) mm and 29.6 (24.7, 36.0) mm] ( P<0.05). There was no significant difference between the 2 groups in the lower tibiofibular space [(6.0±1.9) mm versus (5.2 ± 1.4) mm] or in the relative size of posterior malleolar fracture measured by CT [15.8% (6.9%, 19.1%) versus 12.7% (0%, 18.9%)] ( P>0.05). The intraoperative stress test imaging data of a total of 22 cases were collected from the 2 groups (11 cases from each of the 2 groups). During the stress test, only the medial clear space was widened with no widening of the inferior tibiofibular space was found in 7 cases (5 cases in the positive group and 2 cases in the negative group). Conclusions:A routine stress test is recommended for Weber B ankle fracture without medial malleolus fracture, because instability sometimes exists after fibular fixation. Patients with a wider medial clear space and a longer fibular fracture line on X-ray after injury are more likely to be afflicted by instability after fibular fixation. In the patients with a widened medial clear space but without a widened inferior tibiofibular clear space during an intraoperative stress test, it calls for further study whether it is necessary to fix the inferior tibiofibular joint.

Objective To study the expressions of hypoxia inducible factor-1 α (HIF-1 α) and carbonic anhydrase 9 (CA9) in different molecular subtypes of breast carcinoma and their relationships with basallike subtype.Methods The expressions of HIF-1α and CA9 were detected by immunohistochemistry in five subtypes of breast carcinoma (n =803).The relationships of the expressions of HIF-1α and CA9 with the clinicopathologic parameters of basal-like subtype and with the prognosis of patients were analyzed.Results The positive expression rates of HIF-1α and CA9 protein in breast carcinoma were much higher than those in paratumor breast tissues (43.96％ vs.3.86％,x2 =354.858,P ＜ 0.001;19.80％ vs.4.61％,x2 =86.495,P ＜ 0.001).The positive expression rates of HIF-1α in Luminal A,Luminal B,epidermal growth factor receptor-2 (HER-2) over-expression,basal-like and normal breast-like subtypes were 31.97％,25.00％,56.06％,77.89％ and 55.76％ respectively,and the positive expression rates of CA9 were 7.48％,5.56％,60.61％,40.00％ and 27.88％ respectively,with significant differences (x2 =88.628,P ＜ 0.001;x2 =147.128,P ＜0.001).The positive expression rates of HIF-1α and CA9 in estrogen receptor (ER)-negative breast carcinomas(HER-2 over-expression,basal-like and normal breast-like) were significantly higher than those in ER-positive subtypes (Luminal A and Luminal B,all P ＜ 0.005).There was a significant positive correlation between HIF-1 α and CA9 (C =0.315,P =0.001),and both were correlated with the lymph node metastasis (x2 =4.542,P =0.033;x2 =7.025,P =0.008),pTNM stage (x2 =5.390,P =0.020;x2 =10.179,P =0.001) and poor prognosis (x2 =4.353,P =0.037;x2 =6.056,P =0.014) of basal-like subtype.Conclusion Over-expressions of HIF-1α and CA9 may be related to the ER-negative breast cancer more closely,and both may play important roles in the occurrence and development of basal-like subtype.Overexpressions of HIF-1α and CA9 may suggest the poorer prognosis of patients with basal-like breast carcinoma.

Objective To investigate the systolic synchrony of the left ventricle in patients with left ventricular hypertrophy (LVH) or with heart failure but preserved ejection fraction (HF-PEF),and to evaluate the impact of systolic dyssynchrony on left ventricular function.Methods During June 2011 to May 2014,a total of 352 patients(160 males,192 females,average age:(67.6±7.8)years) with essential hypertension (EH) were enrolled in this retrospective study.Ultrasonic and G-MP1 were performed for assessment of left ventricular remodeling and systolic synchrony and the results were statistically analyzed by oneway analysis of variance and x2 test.Relationship between BNP and synchronic parameters as well as other clinical factors were analyzed by partial correlation analysis.Results The EH patients were divided into hypertension group (rt =182),LVH group (n =74) and HF-PEF group (n =96).In comparison to hypertension group,significant LVH developed in LVH and HF-PEF groups although the LVEF was still preserved.The LVMI of the 3 groups were (94.4±10.1),(121.1±9.8) and (123.2±10.9) g/m2,respectively(F=8.66,P＜0.05).The LVEF was (58.6±7.3)％,(60.8±10.4)％ and (55.1±4.6)％,respectively(F=2.89,P＞0.05).Diastolic dysfunction was identified in LVH and HF-PEF groups with significantly reduced E/A ratio (1.19±0.23,0.80±0.28,0.67±0.17;F=13.46,P＜0.05).Remarkable left ventricular systolic dyssynchrony with phase histogram bandwidth (PHB) of (88.4±8.6) ° and phase standard deviation (PSD) of (23.6±1.9)° and increased BNP of (228.4±69.7) ng/L were revealed in HF-PEF group.The BNP in HF-PEF group was significantly higher than that in LVH group((92.5±13.6) ng/L;q=8.63,P＜0.05).Positive correlation was found between BNP level and PHB,PSD,LVMI,respectively (r=0.277-0.331,all P＜0.05).Conclusion Left ventricular systolic dyssynchrony is concomitant with HF-PEF patients induced by EH,and this dyssynchrony might be one of the factors leading to diastolic dysfunction.