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.

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.

Objective To investigate the clinical efficacy of paraspinal muscle gap approach in the short segment internal fixation of thoracolumbar fractures.Methods Forty-five patients with thoraco-lumbar fractures but without spinal decompression underwent posterior short segment internal fixation,in-cluding 20 cases via paraspinal muscle gap approach(group A)and 25 cases via traditional posterior mid-line approach.Operative time,intraoperative blood loss,postoperative drainage,visual analogue scale (VAS)score,correction rate of Cobb angle and correction rate of vertebral collapse were recorded and the surgical results were compared between the groups.Results All patients got bony union without internal fixation loosening,broken nails or broken rods.There were significant differences in operative time [(88 ± 17)min vs(105 ±14)min],blood loss [(121 ±24)ml vs(230 ±31 )ml]and postoperative drainage [(66 ±28)ml vs(250 ±45)ml]between group A and B respectively(P<0.05).The differences in cor-rection rate of the Cobb angle [(82.3 ±1.58)% vs(83.5 ±3.71)%],correction rate of the vertebral collapse [(88.22 ±3.18)%vs(87.19 ±2.16)%]and postoperative VAS score were not significant be-tween group A and B respectively(P>0.05 ).Conclusion Internal fixation via paraspinal muscle gap approach has the advantages of less trauma,simple approach,short operative time,less blood loss,quick recovery after surgery.It is consistent with the modern concept of minimal invasion and worthy of sprea-ding.

Objective To explore the effect of nicotine on rats callus content and maturity in the process of fracture healing.Methods Sixty male Sprague-Dawley rats were randomly divided into model group,mild nicotine group and severe nicotine group (n =20/each group).The 3-mm bone defects fracture models were made in the junction of the lower 1/3 of the rat left radial.Five rats of each group were sacrificed randomly in the 3,7,14,21 days after surgery,respectively.The left radial were collected as the observed object.The callus thickness and maturity of the specimens were detected by HE staining.Results At the 3rd days after modeling,the difference in specimens callus thickness between each treatment group and the model group was not statistically significant (P ＞ 0.05),no difference in the maturity of the callus under the microscope; callus thickness in mild and severe nicotine groups and model group was (1.59 ± 0.09) mm,(1.43 ± 0.12) mm,(1.39 ± 0.09) mm at the 7th day after modeling,(1.98 ± 0.12) mm,(1.78 ± 0.08)mm and (1.68 ± 0.09) mm at the 14th day after modeling,and (2.39 ± 0.09) mm,(1.93 ± 0.11) mm,(1.89 ± 0.09) mm at the 21 st day after modeling; The difference of callus thickness in specimens between each treatment group and the model group had statistical significance (P ＜ 0.05,P ＜0.01),callus thickness and maturity of the treatment group were lower than that in the model group.Conclusions Nicotine affects the proliferation and differentiation of callus,reduces callus formation,inhibits maturity transformation of bone,and delays the healing process of fracture.