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 explore the relationship between childhood trauma and anxiety in vocational school students, and to analyze the mediating role of emotion dysregulation.Methods:A cross-sectional survey was conducted in one vocational school in Ganzhou, all students completed a series of questionnaires, including the childhood trauma questionnaire (CTQ), difficulties in emotion regulation scale (DERS), and generalized anxiety disorder scale (GAD-7).The cut-off score for anxiety symptom was set GAD-7≥5.The data were analyzed using SPSS 23.0 and SPSS macro program PROCESS V4.0.Results:(1) The rate of anxiety in vocational school students was 42.96%, and girls were 27.1% higher than boys ( OR=1.271, 95% CI=1.095-1.474).(2) The CTQ (44(38, 51)) and DERS (98(89, 111)) in students with anxiety were both significantly higher than those in students without anxiety (39(34, 45), 81(73, 90), Z=-17.910, -33.859, both P<0.001).(3) Regression analysis showed that girls ( β=0.240, OR=1.271, 95% CI=1.095~1.474), childhood trauma ( β=0.028, OR=1.028, 95% CI=1.019~1.037), and emotion dysregulation ( β=0.076, OR=1.080, 95% CI=1.073-1.086) were significant predictors for anxiety.(4) Path analysis and mediating effect showed that childhood trauma positively predicted anxiety ( β=0.059, 95% CI=0.048-0.071) and emotion dysregulation ( β=0.802, 95% CI=0.749-0.854), and emotion dysregulation positively predicted anxiety ( β=0.139, 95% CI=0.132-0.145).Emotion dysregulation had a significant mediating effect (effect value=0.112, 95% CI=0.101-0.121) in the relationship between childhood trauma and anxiety, with the indirect effect accounting for 65.50% of the total effect. Conclusion:The incidence of anxiety symptoms is high among vocational school students, and childhood trauma not only directly affects anxiety symptoms, but also indirectly affects anxiety symptoms through emotion dysregulation.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

As the National Health Commission changes the management of novel corona virus infection, the situation and preventive policies for controlling the epidemic have also entered a new stage in China. Perioperative care strategies for orthopedic trauma such as designated isolation and nucleic acid test screening have also been adjusted in the new stage. Based on the perioperative work experiences in the new stage of epidemic from the frontline anti-epidemic staff of orthopedics in domestic hospitals and combined with the literature and relevant evidence-based medical data in perioperative care of orthopedic trauma patients under the current anti-epidemic policies at home and abroad, Chinese Orthopedic Association and Chinese Society of Traumatology organized relevant experts to formulate the Guideline for clinical perioperative care of orthopedic trauma patients in the new stage of novel corona virus infection ( version 2023). The guideline summarized 16 recommendations from the aspects of preoperative diagnosis and treatment, infection prevention, emergency operation and postoperative management to systematically standardize the perioperative clinical pathways, diagnosis and treatment processes of orthopedic trauma in the new stage of novel corona virus infection, so as to provide a guidance and reference for hospitals at all levels to carry out relevant work in current epidemic control policies.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.

Objective:To explore the relationship between rumination and depression and suicide attempts, and the mediating effect of rumination between depression and suicide attempts in adolescents with depressive disorder.Methods:Clinical interviews and questionnaires were conducted on 331 adolescents aged 11-18 with depressive disorders.Depressive symptoms were assessed with patient health questionnaire-9 (PHQ-9). Rumination was assessed with ruminative responses scale-10 (RRS-10), and Chinese version of the sociality module of MINI5.0 was used to assess suicide.SPSS 23.0 software was applied to descriptive statistics, Chi-square test, t-test, Spearman correlation analysis and hierarchical regression analysis, and the SPSS macro program PROCESS V 3.4 was used for Bootstrap mediating effect. Results:The incidence of suicide attempts in adolescents with depressive disorder was 53.78%, which was significantly higher in girls (59.48%) than that in boys (40.40%), and the difference was significant ( χ2=10.16, P<0.01). In contrast to the non-suicide attempt group, suicide attempt group had higher scores on PHQ-9((11.08±9.26) vs (14.43±7.49), t=-3.634, P<0.01), brooding ((10.76±3.89) vs (12.44±3.87), t=-3.926, P<0.01), reflection ((10.05±3.54) vs (11.20±3.33), t=-3.044, P<0.01) and rumination total score ((20.81±6.78) vs (23.64±6.42), t=-3.898, P<0.01). Regression analysis revealed that girl ( β=0.175, t=3.228, P=0.001), depressive symptoms ( β=0.168, t=3.082, P=0.002), rumination ( β=0.138, t=2.364, P=0.019) were risk factors for suicide attempts.Rumination played a complete mediating effect between depressive symptoms and suicide attempts (effect value=0.013, 95% CI=0.003-0.027). Depression symptoms significantly and positively predicted rumination ( P<0.01), and rumination significantly and positively predicted suicide attempts ( P<0.05). Conclusion:The incidence of suicide attempts was high in adolescents with depressive disorders.Depressive symptoms affect suicide attempts mainly through rumination.Clinicians should assess the rumination of adolescents with depressive disorders.In addition, clinicians should implement concurrent psychotherapy to adjust the cognitive response and reduce rumination, in order to improve the mental health and reduce suicide attempts.

Objective:To explore the mediating effect of resilience between perceived stress and insomnia in medical staff.Methods:A questionnaire survey was conducted among 1 163 medical staff. All subjects were assessed with the insomnia severity index (ISI), simplified Chinese version of Connor-Davidson resilience scale (CD-RISC-10) and perceived stress scale (PSS-10). SPSS 20.0 software was used for common method biases test, descriptive statistics, difference analysis, correlation analysis, hierarchical regression analysis, and SPSS PROCESS V3.4 was used for Bootstrap mediating effect.Results:①The perceived stress (16.28±6.35) was positively correlated with insomnia (6.14±5.80)( r=0.404, P<0.01), and psychological resilience was negatively correlated with insomnia and perceived stress in medical staff ( r=-0.279, P<0.01, r=-0.399, P<0.01). ②Psychological resilience played a partial mediating role between perceived stress and insomnia in medical staff, with the mediating effect as 0.051, accounting of 13.82% of the total effect. Conclusion:Psychological resilience can reduce the negative effects of perceived stress on sleep and is a protective factor for insomnia in medical staff. Clinically, reducing perceived stress and improving psychological resilience can reduce insomnia in medical staff.

Objective:To investigate the characteristics of complications after internal fixation with hallo nails for femoral neck fractures according to OTA/AO classification and analyze the reasons for differences in complications of different classifications based on the current theories and lever-fulcrum balance theory.Methods:A retrospective case series analysis was made on clinical data of 113 patients with femoral neck fractures treated in Peking University People's Hospital from January 2014 to June 2020. There were 49 males and 64 females, with the age of 21-89 years [61(52, 72)years]. According to OTA/AO classification, there were 5 patients with type B1.1 fractures, 18 with type B1.2, 16 with type B1.3, 44 with type B2.1, 5 with type B2.2, 12 with type B2.3 and 13 with type B3. All patients were treated by percutaneous internal fixation with hallo nails. Complications were recorded during follow-up including femoral head necrosis, nonunion, screw back-sliding and screw cut-out. Causes of internal fixation complications were analyzed based on the lever-fulcrum balance theory, taking the location of fulcrum, screw stress (F1), force arm of pressure (L1), resistance of screw (F2) and resistance side (L2) into consideration.Results:All patients were followed up for 1.1-77.5 months [8.2(3.6, 16.6)months]. In all, 24 patients had complications, including femoral head necrosis in 7 patients, nonunion in 3, screw back-sliding in 12 and screw cut-out in 2. The rate of femoral head necrosis of type B1, B2 and B3 was 15%(6/39), 2% (1/61) and 0%, respectively. The rate of femoral head necrosis of type B1 was higher than type B2 ( P<0.05). The nonunion rate was 3%(1/39) in type B1, 3%(2/61) in type B2, and 0% in type B3 ( P>0.05). The rate of screw back-sliding of type B1, B2 and B3 was 3%(1/39), 2%(1/61) and 0%, respectively. The rate of screw back-sliding of type B2.3 and B3 were higher than that of type B1 ( P<0.05). A trend toward a higher rate of screw back-sliding of type B2.3 and B3 was found when compared to type B2.1/2.2, but there was no significant difference ( P>0.05). Moreover, the rate of screw back-sliding showed no significant difference between type B2.3 and B3 ( P>0.05). The rate of screw cut-out was 3%(1/39) in type B1, 2%(1/61) in type B2, and 0% in type B3, which showed no significant difference between type B1 and B2 ( P>0.05). According to the lever-fulcrum balance theory, the extent of pathologic fulcrum of type B1, B2 and B3 gradually increased, resulting in increased L1 and decreased L2. The L1 of type B1, B2 and B3 was (2.2±0.5)cm, (2.8±0.4)cm and (4.7±0.5)cm, respectively ( P<0.01). The L2 of type B1, B2 and B3 was (5.1±0.5)cm, (4.7±0.5)cm, and (3.6±0.4)cm, respectively ( P<0.01). Therefore, the F1 of type B1, B2 and B3 increased progressively. Conclusions:After internal fixation, the rate of femoral head necrosis of type B1 is significantly higher than that of type B2, and the rate of screw back-sliding of type B1 is significantly lower than that of type B3. The lever-fulcrum balance theory can deepen our knowledge of reasons for complications after operation for femoral neck fractures.