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 investigate the reliability and repeatability of 3 classification systems for coronal fractures of distal humerus.Methods:Included were the imaging data (X-ray and CT scan) of the 64 patients with distal humeral coronal fracture who had been admitted to the outpatient and emergency departments of Beijing Jishuitan Hospital from January, 2015 to December, 2021. Four orthopedic surgeons (1 chief surgeon, 1 associate chief surgeon, 1 attending surgeon, and 1 resident surgeon) served as observers who classified the fractures by their imaging data respectively according to the Bryan-Morrey, Ring and Dubberley classifications. Four weeks later when the imaging data of 64 patients were renumbered, the 4 orthopedic surgeons performed the same classifications again. Inter-observer and intra-observer Kappa values were calculated for the 3 classifications. Landis and Koch Kappa's Benchmark Scale was used to interpret the results.Results:Interobserver confidence: The average agreement of the Bryan-Morrey classification was 75.0%, and its Kappa value was 0.546, indicating moderate agreement. The average consistency of Ring classification was 74.7%, and its Kappa value was 0.702, indicating high consistency. The average consistency of Dubberley classification was 84.1%, and its Kappa value was 0.785, indicating high consistency. Intra-observer repeatability: The average consistency of Bryan-Morrey classification was 89.9% and its Kappa value was 0.824 for the same observer. The average consistency of Ring classification was 91.0%, and its Kappa value was 0.884. The average consistency of Dubberley classification was 91.8%, and its Kappa value was 0.888.Conclusions:The 3 classification systems for distal humeral coronal fractures all demonstrate high reproducibility. As the Dubberley classification system is relatively more reliable, it has a certain guiding value for the treatment of coronal fractures of the distal humerus. However, in clinical practice, an optimal surgical strategy should take into account various factors that may affect fracture typing.

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 establish pre- column derivatization-HPLC fingerprint of polysaccharide from Achyranthes bidentata，and to determine the contents of monosaccharide components ，so as to provide reference for quality evaluation of A. bidentata decoction pieces. METHODS ：Taking 10 batches of A. bidentata decoction pieces from different manufacturers as samples，the polysaccharides were extracted by water extraction and alcohol precipitation ，hydrolyzed by trifluoroacetic acid ，and then derivatized by 1-phenyl-3-methyl-5-pyrazolone for HPLC analysis. The determination was performed on Hanbon Hedera C 18 column with column temperature of 30 ℃ at the flow rate of 1.2 mL/min. The mobile phase consisted of acetonitrile- 0.02 mol/L ammonium acetate solution （gradient elution ）. The detection wavelength was set at 250 nm，and sample size was 20 μL. HPLC fingerprint was established and similarity evaluation was performed for 10 batches of A. bidentata polysaccharide by using TCM Chromatogramic Fingerprint Similarity Evaluation System （2012A edition ）. The common peak was identified by comparing with the reference substance ，and cluster analysis was performed by using SPSS 25.0 software. The contents of identified monosaccharides were determined by HPLC. RESULTS ：The similarity of 10 batches of A. bidentata polysaccharide were all higher than 0.95. Nine common peaks were fixed and a total of 5 common peaks were identified ，namely anhydrous glucose （peak 1）， mannose（peak 2），rhamnose（peak 4），galacturonic acid （peak 5）and arabinose （peak 7）. Results of cluster analysis showed that S1 sample was classified into one category ；S2，S5，S8 and S 9 samples were clustered into one category ；S3，S4，S6，S7 and S10 samples were clustered into one category. Results of content determination showed that the contents of anhydrous glucose in 10 batches of samples ranged from 6.17 to 17.55 mg/g；those of mannose ranged from 3.31 to 7.66 mg/g；those of rhamnose ranged from 38.80 to 73.97 mg/g；those of galacturonic acid ranged from 2.49 to 8.95 mg/g；those of arabinose ranged from 11.30 to 28.58 mg/g. CONCLUSIONS ：Established pre-column derivatization HPLC fingerprints and content determination method can provide reference for quality evaluation of A. bidentata decoction pieces.

OBJECTIVE：The establ ish the qu ality standard of Achyranthes bidentata decoction pieces and establish the fingerprint of decoction pieces of different origins. METHODS ：TLC method was used to identify A. bidentata decoction pieces. The contents of water ，total ash and ethanol-soluble extract in A. bidentata decoction pieces were determined according to the method in 2015 edition of Chinese Pharmacopoeia （part Ⅳ）. UV spectrophotometry was used to determine the content of total steroid. The content of β-ecdysterone in A. bidentata decoction pieces was determined by HPLC. HPLC method was used to establish the fingerprint of 10 batches of A. bidentata decoction pieces. Using β-ecdysterone（No. 10 peak）as reference ，similarity evaluation was conducted by using Similarity Evaluation System for TCM Chromatographic Fingerprints （2012 edition），and the common peaks were determined. SPSS 21.0 software was used for cluster analysis and principal component analysis so as to evaluate the comprehensive quality of A. bidentata decoction pieces. RESULTS ：Results of TLC identification showed that the spots with the same color on the corresponding positions of β-ecdysterone and ginsenoside Ro control in chromatogram of test sample. The average water content of 10 batches of A. bidentata decoction pieces was 4.07％ -6.33％ . The total ash content was 5.04％ -6.43％ . The ethanol-soluble extract was 6.57％ -11.12％ . The linear range of total sterone （by β-ecdysterone） and β-ecdysterone were 0.01-0.08 mg/mL and 68.5-479.5 µg/mL （R2＞0.999）， respectively. RSDs of precision ，stability and repeatability tests were all less than 3％. The average recovery rates were 98.85％（RSD＝1.89％，n＝6）and 100.34％（RSD＝ 2.12％，n＝9），respectively. The average contents were 0.34％-0.56％ and 0.07％-0.09％，respectively. There were 24 common peaks in 10 batches of A. bidentata decoction pieces ，and the similarity was all over 0.900. Cluster analysis results showed that 10 batches of A. bidentata decoction pieces could be grouped into 4 categories，among which S 1，S3，S6 and S 10 were one category ， S2，S7 and S 8 were one category ，S4 and S 9 were one category ，and S 5 was one category. The results of principal component analysis showed that the cumulative variance contribution rate of the first four principal components was 86.774％. The order of comprehensive quality is S 8＞S5＞S9＞S4＞S3＞S7＞S6＞S10＞S2＞S1. CONCLUSIONS ：The established quality standard ， content deter mination method and HPLC fingerprint are stable and accurate ，and can be used for the quality evaluation of A. bidentata decoction pieces. Δ 基金项目：国家科技部重点研发计划（No.2018YFC1707105） ＊硕士研究生。研究方向：中药质量控制。E-mail：995354085@