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.

For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

Objective:To explore and practice the construction of an innovative ecosystem that integrates innovation in the National Clinical Research Center for Orthopedics and Sports Rehabilitation, providing references and insights for driving high-quality development of medical care.Methods:Guided by a national policy framework and Industry-Academia-Research-Government-Enterprise Collaborative Innovation, the Center had established six innovation platforms and three systemic pillars. The study analyzed its integrated strategy, which encompassed ecosystem design, platform-enabled empowerment, comprehensive system support, end-to-end coverage, a folded innovation approach, and a standardization-driven mechanism.Results:The Center had built a highly integrated innovation ecosystem, creating a powerful driver for technological advancement and commercialization in orthopedics and sports rehabilitation, accelerating the industrialization of key technologies like surgical robots and 3D-printed implants.Conclusions:Guided by the principle of ″simplifying complex surgeries and standardizing common procedures″, the Center will leverage digital intelligence throughout clinical care, aiming to bridge gaps in healthcare quality so that patients can receive top-tier treatment for major diseases within their home provinces. This commitment to homogenized, high-quality care presents a ″China Model″ for global health and advance the national ″Healthy China″ initiative.

Objective:To analyze the clinical efficacy of the pelvic unlocking reduction device in assisting closed reduction and internal fixation for the treatment of AO/OTA 61-C3 type pelvic fractures.Methods:A retrospective analysis was conducted on 27 patients with AO/OTA 61-C3 pelvic fractures treated with the pelvic unlocking reduction device-assisted reduction and internal fixation between January 2020 and January 2024 in Fourth Medical Center of the People's Liberation Army General Hospital. The cohort included 11 males and 16 females, with a mean age of 30.2±13.9 years (range, 13-55 years). The time from injury to surgery was 16.0 (10.0, 28.0) d (range, 6-175 d). According to the AO/OTA classification, there were 8 cases of type 61-C3.1, 10 cases of type C3.2, and 9 cases of type C3.3. Among them, 10 patients presented with associated lumbosacral nerve injuries, classified as Gibbons grade II in 5 cases, grade III in 1 case, and grade IV in 4 cases. All patients underwent closed reduction and internal fixation assisted by the pelvic unlocking reduction device. Postoperative outcomes were assessed using the visual analogue scale (VAS) for pain, the Majeed pelvic score, and the Harris hip score. Fracture reduction quality was evaluated using the Matta criteria, and overall health status was assessed using the 36-Item Short Form Health Survey (SF-36).Results:All patients successfully underwent the surgery and were followed up for 31.6±12.3 months (range, 12-48 months). The fracture reduction time was 33.45±12.18 min, the total operative time was 283.0±87.9 min, the number of fluoroscopies was 71.33±32.77, and the intraoperative blood loss was 314.1±252.6 ml. At the 12-month postoperative assessment, VAS score was 1.78±0.85, Majeed pelvic score was 87.52±15.03; SF-36 score was 88.93±11.27; and Harris Hip Score was 90.59±11.43. All patients achieved an "excellent" rating according to the Matta radiographic assessment criteria at 12 months postoperatively. Fracture union was confirmed in all cases, with a healing time of 2.9±0.4 months (range, 2.5-3.5 months). No postoperative complications such as shock, nonunion, delayed union, surgical site infection, implant loosening, or deep vein thrombosis were observed. Three patients experienced numbness in the lateral thigh region postoperatively, which was attributed to lateral femoral cutaneous nerve injury. The symptoms resolved completely following removal of the INFIX internal fixator.Conclusion:The pelvic unlocking reduction device-assisted closed reduction and internal fixation demonstrates safety and efficacy in treating AO/OTA 61-C3 type pelvic fractures, yielding satisfactory fracture union and early functional scores.

Objective:To investigate the changes in sympathetic nerve activity after lower limb immobilization and the role of sympathetic nerve in regulating disuse atrophy of skeletal muscles.Methods:The experiment was divided into the following 3 parts: ① Twelve 8-week-old male C57 mice were randomly divided into a blank control group and a hind limb fixation group ( n=6). The blank control group received no intervention while the hind limb fixation group received splint fixation of the hind limbs for 2 weeks before the musculoskeletal multi-dimensional characterization was completed at the behavioral, pathological and molecular levels. ② Thirty-six 8-week-old male C57 mice were selected and randomly divided into a control group and 5 hind limb fixation groups (for 1, 3, 5, 7 and 14 days) ( n=6). The control group was fed normally until 14 days without any intervention while the 5 hind limb fixation groups were sampled after fixation for 1, 3, 5, 7 and 14 days, respectively. The level of norepinephrine in the serum and the expression level of tyrosine hydroxylase (TH), a marker of sympathetic nerve activity in the paraventricular nucleus of hypothalamus (PVN), were detected to observe the plasticity of sympathetic nerve activity. ③ Eighteen 8-week-old male C57 mice were selected and randomly divided into a blank control group, a hind limb fixation group and a hind limb fixation plus medication group ( n=6). The blank control group received no intervention while the 2 fixation groups were injected with phosphate buffer (PBS) and propranolol hydrochloride solution for 2 consecutive weeks, respectively. The parameters related to the skeletal muscles were compared between the 3 groups. Results:① Compared with the control group, the mass and function of skeletal muscles in the hind limb fixation group were statistically significantly decreased ( P<0.05). ② The levels of serum norepinephrine [(3.27±1.03) ng/mL, (9.21±1.05) ng/mL, (6.36±0.88) ng/mL, (3.84±1.00) ng/mL, and (3.91±0.75) ng/mL] and the PVN TH levels (42.00%±5.38%, 61.67%±5.57%, 55.82%±3.11%, 50.90%±2.53%, and 39.17%±9.07%) in the 5 hind limb fixation groups (for 1, 3, 5, 7 and 14 days) were significantly higher than those in the control group [(1.81±0.72)] ng/mL and 23.33%±5.50%] ( P<0.05). ③ The wet weight of the gastrocnemius muscle [(93.50±4.32) mg] and the cross-section area of the tibial anterior muscle [(1,180.00±95.09) μm 2] in the hind limb fixation plus medication group were increased significantly compared with those in the hind limb fixation group [(80.83±9.99) mg and (907.80±121.00) μm 2] ( P<0.05). Conclusions:Overactivation of the sympathetic nervous system occurs in the mice model of skeletal muscle disuse atrophy after hind limb fixation. Inhibition of sympathetic nerve activity may reduce the severity of skeletal muscle atrophy at the lower limbs.

Conventional surgical management of pelvic fractures entails incision and reduction with internal fixation, a procedure associated with significant bleeding, trauma, and a high surgical risk. The advent of advanced imaging techniques and sophisticated surgical instruments has led to a paradigm shift towards minimally invasive surgery as the prevailing treatment modality for such injuries. The efficacy of reduction is pivotal in determining the clinical prognosis of pelvic fractures, underscoring the importance of enhancing the quality of reduction in the minimally invasive surgery. The advent of 3D printing technology, intelligent orthopaedic surgical robots, mixed reality augmentation technology and high-precision optical localization tracking has catapulted minimally invasive pelvic fracture reduction to the forefront of research in the field of orthopaedics. Studies have demonstrated encouraging outcomes. This paper reviews relevant literature, mainly focusing on the evaluation and measurement, open reduction techniques, minimally invasive closed reduction techniques, and surgical robot assisted reduction techniques in treatment of pelvic fractures, to summarize the technical research progress in minimally invasive closed surgical reduction for pelvic fractures.

Pelvic fractures, the most severe bone trauma, account for approximately 3% of all fractures. As they are caused by high-energy injuries, their rates of mortality and disability are high. Over the past two centuries, the treatment strategies for these fractures have evolved from conservative therapy to open reduction and plate fixation, then to closed reduction and percutaneous screw fixation, and recently to screw fixation assisted by artificial intelligence. In the past 40 years, constant progress has been made in the treatment of pelvic fractures. It is generally acknowledged that a personalized treatment plan should be formulated based on each patient's age, fracture type, comorbidities, functional requirements and other factors when an appropriate treatment mode is chosen. The primary aim of treatment is to accelerate functional recovery, decrease the rate of disability after injury, and improve the quality of daily life of the patient. This paper reviews the treatment history of pelvic fractures, discusses the advantages and disadvantages of current treatment options, and looks ahead to future prospects, aiming to offer valuable references for related clinical practice.

The landscape of modern warfare is undergoing profound transformation. With the large-scale, clustered application of high-kinetic weapon systems and intelligent munitions, combat trauma has exhibited distinct characteristics: diversified injury patterns, a significant increase in the proportion of complex injuries, a drastically shortened golden window for treatment, more stringent time-critical requirements, and highly fragmented allocation of medical resources. These emerging trends pose systemic challenges to traditional combat trauma care systems, highlighting deficiencies including delayed injury assessment, experience-dependent medical decision-making, and low efficiency in multi-link coordination. Intelligent technologies for combat trauma care, underpinned by artificial intelligence, the Internet of Things, robotics, and brain-computer interfaces, offer new pathways to address the limitations of traditional care systems. Starting from the new challenges in modern combat trauma care, the author elaborated on the application of intelligent orthopedics across key stages including pre-hospital, in-hospital, and post-hospital care, identified potential issues and countermeasures, aiming to provide theoretical and practical references for the development of an intelligent combat trauma care system.

Objective:To analyze the clinical efficacy of the pelvic unlocking reduction device in assisting closed reduction and internal fixation for the treatment of AO/OTA 61-C3 type pelvic fractures.Methods:A retrospective analysis was conducted on 27 patients with AO/OTA 61-C3 pelvic fractures treated with the pelvic unlocking reduction device-assisted reduction and internal fixation between January 2020 and January 2024 in Fourth Medical Center of the People's Liberation Army General Hospital. The cohort included 11 males and 16 females, with a mean age of 30.2±13.9 years (range, 13-55 years). The time from injury to surgery was 16.0 (10.0, 28.0) d (range, 6-175 d). According to the AO/OTA classification, there were 8 cases of type 61-C3.1, 10 cases of type C3.2, and 9 cases of type C3.3. Among them, 10 patients presented with associated lumbosacral nerve injuries, classified as Gibbons grade II in 5 cases, grade III in 1 case, and grade IV in 4 cases. All patients underwent closed reduction and internal fixation assisted by the pelvic unlocking reduction device. Postoperative outcomes were assessed using the visual analogue scale (VAS) for pain, the Majeed pelvic score, and the Harris hip score. Fracture reduction quality was evaluated using the Matta criteria, and overall health status was assessed using the 36-Item Short Form Health Survey (SF-36).Results:All patients successfully underwent the surgery and were followed up for 31.6±12.3 months (range, 12-48 months). The fracture reduction time was 33.45±12.18 min, the total operative time was 283.0±87.9 min, the number of fluoroscopies was 71.33±32.77, and the intraoperative blood loss was 314.1±252.6 ml. At the 12-month postoperative assessment, VAS score was 1.78±0.85, Majeed pelvic score was 87.52±15.03; SF-36 score was 88.93±11.27; and Harris Hip Score was 90.59±11.43. All patients achieved an "excellent" rating according to the Matta radiographic assessment criteria at 12 months postoperatively. Fracture union was confirmed in all cases, with a healing time of 2.9±0.4 months (range, 2.5-3.5 months). No postoperative complications such as shock, nonunion, delayed union, surgical site infection, implant loosening, or deep vein thrombosis were observed. Three patients experienced numbness in the lateral thigh region postoperatively, which was attributed to lateral femoral cutaneous nerve injury. The symptoms resolved completely following removal of the INFIX internal fixator.Conclusion:The pelvic unlocking reduction device-assisted closed reduction and internal fixation demonstrates safety and efficacy in treating AO/OTA 61-C3 type pelvic fractures, yielding satisfactory fracture union and early functional scores.

The landscape of modern warfare is undergoing profound transformation. With the large-scale, clustered application of high-kinetic weapon systems and intelligent munitions, combat trauma has exhibited distinct characteristics: diversified injury patterns, a significant increase in the proportion of complex injuries, a drastically shortened golden window for treatment, more stringent time-critical requirements, and highly fragmented allocation of medical resources. These emerging trends pose systemic challenges to traditional combat trauma care systems, highlighting deficiencies including delayed injury assessment, experience-dependent medical decision-making, and low efficiency in multi-link coordination. Intelligent technologies for combat trauma care, underpinned by artificial intelligence, the Internet of Things, robotics, and brain-computer interfaces, offer new pathways to address the limitations of traditional care systems. Starting from the new challenges in modern combat trauma care, the author elaborated on the application of intelligent orthopedics across key stages including pre-hospital, in-hospital, and post-hospital care, identified potential issues and countermeasures, aiming to provide theoretical and practical references for the development of an intelligent combat trauma care system.