Objective:To investigate the efficacy of cementless long-stem total hip arthroplasty (THA) in the treatment of end-stage osteonecrosis of the femoral head (ONFH) combined with ipsilateral subtrochanteric femoral fractures.Methods:A retrospective case series study was conducted on 18 patients with end-stage ONFH combined with ipsilateral subtrochanteric fractures who were admitted to the 940th Hospital of the Joint Logistics Support Force of the PLA from January 2016 to June 2023, including 8 males (8 hips) and 10 females (10 hips), aged 56-79 years [(69.4±7.0)years]. All the patients had Association Research Circulation Osseous (ARCO) stage IV ONFH combined with ipsilateral subtrochanteric fracture (Seinsheimer types II-IV). Parameters recorded included operation duration, intraoperative blood loss, length of hospital stay, time to partial weight-bearing, and time to full weight-bearing. Vertical offset and leg length discrepancy (LLD) were compared preoperatively and at 1 week postoperatively. Visual analogue scale (VAS) score, hip range of motion (flexion, abduction), and Harris hip score (HHS) were compared preoperatively, at 1 week, 3 months postoperatively, and at the last follow-up. Perioperative complications were observed.Results:All the patients were followed up for 12-70 months [(36.4±16.2)months]. Operation duration was (116.4±18.1)minutes. Intraoperative blood loss was (334.4±121.3)ml. The length of hospital stay was 13.0(10.0, 16.3)days. The time to partial weight-bearing was 5.0(3.0, 7.0)days, with time to full weight-bearing for 5.0(4.0, 5.3)weeks. At 1 week postoperatively, the vertical offset [(58.9±4.1)mm] was significantly increased compared to that preoperatively [(49.3±3.3)mm] ( P<0.01), while the LLD [(4.2±3.1)mm] was significantly reduced compared to that preoperatively [(16.2±5.8)mm] ( P<0.01). At 1 week, 3 months postoperatively and at the last follow-up, the VAS scores [3.0(2.0, 3.3)points, 2.0(1.0, 2.0)points, and 1.0(0.0, 2.0)points] were significantly lower than that preoperatively [6.0(5.0, 6.3)points], and decreased with the passage of follow-up time ( P<0.01); the hip flexion angles [(50.4±6.5)°, (94.3±6.4)°, and (104.7±7.4)°] and hip abduction angles [(21.5±4.4)°, (34.9±4.5)°, and (42.9±4.9)°] were lower than those preoperatively [(32.9±6.4)° and (13.4±4.9)°], and decreased with the passage of follow-up time ( P<0.01); the HHS [(58.1±4.9)points, (83.1±2.9)points, and (90.7±2.6)points] were higher than that preoperatively [(33.4±4.4)points], and increased with the passage of follow-up time ( P<0.01). At the last follow-up, 5 patients were rated as excellent, 11 as good, and 2 as fair according to the HHS criteria, with an overall excellent and good rate of 89%. No perioperative complications were observed, including neurovascular injury, secondary fracture, or infection. One patient developed partial deep vein thrombosis of the lower extremity (the popliteal vein) at 2 weeks after surgery, which recovered completely following treatment with a standard oral administration of rivaroxaban, etc. At the last follow-up, no evidence of malunion, prosthesis loosening, subsidence, or dislocation was observed. Conclusion:The use of cementless long-stem THA in the treatment of end-stage ONFH combined with ipsilateral subtrochanteric fractures has advantages of small trauma, early weight-bearing, early pain relief, improved joint motion and function, and few complications.

Objective:To compare the efficacy of posteromedial combined with lateral Frosch approach versus anterior medial and lateral dual incision approach in open reduction and internal fixation for Schatzker type VI tibial plateau fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 41 patients with Schatzker type VI tibial plateau fractures, who were admitted to the 940th Hospital of the Joint Logistics Support Force of the PLA from January 2018 to May 2024, including 23 males and 18 females, aged 34-79 years [(50.7±7.7)years]. Twenty-three patients underwent open reduction and internal fixation via the posteromedial combined with lateral Frosch approach (posterior approach group), while 18 patients underwent the same procedure via the anterior medial and lateral dual incision approach (anterior approach group). The following parameters were compared between the two groups: operation duration, intraoperative blood loss, postoperative drainage volume, depth of articular surface depression and tibial plateau width measured preoperatively, at 7 days, 3 months postoperatively, and at the last follow-up, medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA) measured at 7 days, 3 months postoperatively, and at the last follow-up, visual analogue scale (VAS) scores assessed preoperatively, at 7 days postoperatively, and at the last follow-up, American Knee Society (KSS) score and knee flexion range of motion assessed at 7 days, 3 months postoperatively, and at the last follow-up, fracture healing status at the last follow-up, and incidence of postoperative complications.Results:All the patients were followed up for 12-16 months [(14.3±2.1)months]. The operation duration was (119.6±11.8)minutes in the posterior approach group, which was significantly shorter than (140.3±10.6)minutes in the anterior approach group ( P<0.05). There were no statistically significant differences in intraoperative blood loss or postoperative drainage volume between the two groups ( P>0.05). No significant differences were found in the preoperative depth of articular surface depression or tibial plateau width between the two groups ( P>0.05). At 7 days, 3 months postoperatively, and at the last follow-up, the depth of articular surface depression was 0.8(0.6, 1.0)mm, 0.6(0.5, 0.8)mm, and 0.6(0.5, 0.7)mm in the posterior approach group, which were significantly shorter than 1.1(0.9, 1.3)mm, 0.8(0.7, 1.0)mm, and 0.8(0.7, 1.0)mm in the anterior approach group ( P<0.05). The tibial plateau width at the same time points was 71.0(69.1, 73.5)mm, 70.5(69.2, 72.9)mm, and 70.5(69.3, 72.5)mm in the posterior approach group, which were significantly shorter than 73.0(72.3, 74.2)mm, 71.5(71.0, 73.0)mm, and 71.5(71.1, 72.6)mm in the anterior approach group ( P<0.05). At 7 days, 3 months postoperatively, and at the last follow-up, the MPTA values were (87.4±0.7)°, (87.7±0.6)°, and (87.9±0.5)° in the posterior approach group, which were significantly larger than (85.2±2.5)°, (86.0±2.2)°, and (86.3±2.0)° in the anterior approach group ( P<0.01). The PPTA values at the same time points were (9.5±0.7)°, (9.0±0.5)°, and (8.6±0.4)° in the posterior approach group, which were significantly smaller than (11.2±1.0)°, (10.3±0.8)°, and (9.8±0.7)° in the anterior approach group ( P<0.01). There was no significant difference in the preoperative VAS score between the two groups ( P>0.05). At 7 days postoperatively and at the last follow-up, the VAS scores were 4.0(3.0, 5.0)points and 0.5(0.0, 2.0)points in the posterior approach group, which were significantly lower than 5.0(4.0, 5.0)points and 1.0(1.0, 3.0)points in the anterior approach group ( P<0.05). At 7 days, 3 months postoperatively, and at the last follow-up, the KSS scores were 62.5(57.0, 67.5)points, 75.5(72.0, 82.5)points, and 87.0(82.5, 93.5)points in the posterior approach group, which were significantly higher than 61.5(54.5, 63.0)points, 74.0(68.0, 79.0)points, and 85.5(78.0, 88.5)points in the anterior approach group ( P<0.05). The knee flexion range of motion was 90.0(85.0, 95.0)°, 115.0(109.0, 122.0)°, and 126.0(120.0, 130.0)° in the posterior approach group, which were significantly greater than 80.5(75.2, 85.8)°, 110.0(104.0, 115.0)°, and 119.0(113.0, 122.0)° in the anterior approach group ( P<0.05). At the last follow-up, all the fractures were healed in both groups. No statistically significant difference was found in the incidence of postoperative complications between the two groups ( P>0.05). Conclusion:Compared to the anterior medial and lateral dual incision approach, the posteromedial combined with lateral Frosch approach demonstrates superior advantages in operation duration, reduction quality, pain relief, functional recovery in the treatment of Schatzker type VI tibial plateau fractures, while the incidence of complications is comparable.

Objective:To compare the efficacy of posteromedial combined with lateral Frosch approach versus anterior medial and lateral dual incision approach in open reduction and internal fixation for Schatzker type VI tibial plateau fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 41 patients with Schatzker type VI tibial plateau fractures, who were admitted to the 940th Hospital of the Joint Logistics Support Force of the PLA from January 2018 to May 2024, including 23 males and 18 females, aged 34-79 years [(50.7±7.7)years]. Twenty-three patients underwent open reduction and internal fixation via the posteromedial combined with lateral Frosch approach (posterior approach group), while 18 patients underwent the same procedure via the anterior medial and lateral dual incision approach (anterior approach group). The following parameters were compared between the two groups: operation duration, intraoperative blood loss, postoperative drainage volume, depth of articular surface depression and tibial plateau width measured preoperatively, at 7 days, 3 months postoperatively, and at the last follow-up, medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA) measured at 7 days, 3 months postoperatively, and at the last follow-up, visual analogue scale (VAS) scores assessed preoperatively, at 7 days postoperatively, and at the last follow-up, American Knee Society (KSS) score and knee flexion range of motion assessed at 7 days, 3 months postoperatively, and at the last follow-up, fracture healing status at the last follow-up, and incidence of postoperative complications.Results:All the patients were followed up for 12-16 months [(14.3±2.1)months]. The operation duration was (119.6±11.8)minutes in the posterior approach group, which was significantly shorter than (140.3±10.6)minutes in the anterior approach group ( P<0.05). There were no statistically significant differences in intraoperative blood loss or postoperative drainage volume between the two groups ( P>0.05). No significant differences were found in the preoperative depth of articular surface depression or tibial plateau width between the two groups ( P>0.05). At 7 days, 3 months postoperatively, and at the last follow-up, the depth of articular surface depression was 0.8(0.6, 1.0)mm, 0.6(0.5, 0.8)mm, and 0.6(0.5, 0.7)mm in the posterior approach group, which were significantly shorter than 1.1(0.9, 1.3)mm, 0.8(0.7, 1.0)mm, and 0.8(0.7, 1.0)mm in the anterior approach group ( P<0.05). The tibial plateau width at the same time points was 71.0(69.1, 73.5)mm, 70.5(69.2, 72.9)mm, and 70.5(69.3, 72.5)mm in the posterior approach group, which were significantly shorter than 73.0(72.3, 74.2)mm, 71.5(71.0, 73.0)mm, and 71.5(71.1, 72.6)mm in the anterior approach group ( P<0.05). At 7 days, 3 months postoperatively, and at the last follow-up, the MPTA values were (87.4±0.7)°, (87.7±0.6)°, and (87.9±0.5)° in the posterior approach group, which were significantly larger than (85.2±2.5)°, (86.0±2.2)°, and (86.3±2.0)° in the anterior approach group ( P<0.01). The PPTA values at the same time points were (9.5±0.7)°, (9.0±0.5)°, and (8.6±0.4)° in the posterior approach group, which were significantly smaller than (11.2±1.0)°, (10.3±0.8)°, and (9.8±0.7)° in the anterior approach group ( P<0.01). There was no significant difference in the preoperative VAS score between the two groups ( P>0.05). At 7 days postoperatively and at the last follow-up, the VAS scores were 4.0(3.0, 5.0)points and 0.5(0.0, 2.0)points in the posterior approach group, which were significantly lower than 5.0(4.0, 5.0)points and 1.0(1.0, 3.0)points in the anterior approach group ( P<0.05). At 7 days, 3 months postoperatively, and at the last follow-up, the KSS scores were 62.5(57.0, 67.5)points, 75.5(72.0, 82.5)points, and 87.0(82.5, 93.5)points in the posterior approach group, which were significantly higher than 61.5(54.5, 63.0)points, 74.0(68.0, 79.0)points, and 85.5(78.0, 88.5)points in the anterior approach group ( P<0.05). The knee flexion range of motion was 90.0(85.0, 95.0)°, 115.0(109.0, 122.0)°, and 126.0(120.0, 130.0)° in the posterior approach group, which were significantly greater than 80.5(75.2, 85.8)°, 110.0(104.0, 115.0)°, and 119.0(113.0, 122.0)° in the anterior approach group ( P<0.05). At the last follow-up, all the fractures were healed in both groups. No statistically significant difference was found in the incidence of postoperative complications between the two groups ( P>0.05). Conclusion:Compared to the anterior medial and lateral dual incision approach, the posteromedial combined with lateral Frosch approach demonstrates superior advantages in operation duration, reduction quality, pain relief, functional recovery in the treatment of Schatzker type VI tibial plateau fractures, while the incidence of complications is comparable.

Objective:To investigate the efficacy of cementless long-stem total hip arthroplasty (THA) in the treatment of end-stage osteonecrosis of the femoral head (ONFH) combined with ipsilateral subtrochanteric femoral fractures.Methods:A retrospective case series study was conducted on 18 patients with end-stage ONFH combined with ipsilateral subtrochanteric fractures who were admitted to the 940th Hospital of the Joint Logistics Support Force of the PLA from January 2016 to June 2023, including 8 males (8 hips) and 10 females (10 hips), aged 56-79 years [(69.4±7.0)years]. All the patients had Association Research Circulation Osseous (ARCO) stage IV ONFH combined with ipsilateral subtrochanteric fracture (Seinsheimer types II-IV). Parameters recorded included operation duration, intraoperative blood loss, length of hospital stay, time to partial weight-bearing, and time to full weight-bearing. Vertical offset and leg length discrepancy (LLD) were compared preoperatively and at 1 week postoperatively. Visual analogue scale (VAS) score, hip range of motion (flexion, abduction), and Harris hip score (HHS) were compared preoperatively, at 1 week, 3 months postoperatively, and at the last follow-up. Perioperative complications were observed.Results:All the patients were followed up for 12-70 months [(36.4±16.2)months]. Operation duration was (116.4±18.1)minutes. Intraoperative blood loss was (334.4±121.3)ml. The length of hospital stay was 13.0(10.0, 16.3)days. The time to partial weight-bearing was 5.0(3.0, 7.0)days, with time to full weight-bearing for 5.0(4.0, 5.3)weeks. At 1 week postoperatively, the vertical offset [(58.9±4.1)mm] was significantly increased compared to that preoperatively [(49.3±3.3)mm] ( P<0.01), while the LLD [(4.2±3.1)mm] was significantly reduced compared to that preoperatively [(16.2±5.8)mm] ( P<0.01). At 1 week, 3 months postoperatively and at the last follow-up, the VAS scores [3.0(2.0, 3.3)points, 2.0(1.0, 2.0)points, and 1.0(0.0, 2.0)points] were significantly lower than that preoperatively [6.0(5.0, 6.3)points], and decreased with the passage of follow-up time ( P<0.01); the hip flexion angles [(50.4±6.5)°, (94.3±6.4)°, and (104.7±7.4)°] and hip abduction angles [(21.5±4.4)°, (34.9±4.5)°, and (42.9±4.9)°] were lower than those preoperatively [(32.9±6.4)° and (13.4±4.9)°], and decreased with the passage of follow-up time ( P<0.01); the HHS [(58.1±4.9)points, (83.1±2.9)points, and (90.7±2.6)points] were higher than that preoperatively [(33.4±4.4)points], and increased with the passage of follow-up time ( P<0.01). At the last follow-up, 5 patients were rated as excellent, 11 as good, and 2 as fair according to the HHS criteria, with an overall excellent and good rate of 89%. No perioperative complications were observed, including neurovascular injury, secondary fracture, or infection. One patient developed partial deep vein thrombosis of the lower extremity (the popliteal vein) at 2 weeks after surgery, which recovered completely following treatment with a standard oral administration of rivaroxaban, etc. At the last follow-up, no evidence of malunion, prosthesis loosening, subsidence, or dislocation was observed. Conclusion:The use of cementless long-stem THA in the treatment of end-stage ONFH combined with ipsilateral subtrochanteric fractures has advantages of small trauma, early weight-bearing, early pain relief, improved joint motion and function, and few complications.

Hip fracture in the elderly is characterized by high incidence, high disability rate, and high mortality and has been recognized as a public health issue threatening their health. Surgery is the preferred choice for the treatment of elderly patients with hip fracture. However, lower extremity deep venous thrombosis (DVT) has an extremely high incidence rate during the perioperative period, and may significantly increase the risk of patients′ death once it progresses to pulmonary embolism. In response to this issue, the clinical guidelines and expert consensuses all emphasize active application of comprehensive preventive measures, including basic prevention, physical prevention, and pharmacological prevention. In this prevention system, basic prevention is the basis of physical and pharmacological prevention. However,there is a lack of unified and definite recommendations for basic preventive measures in clinical practice. To this end, the Orthopedic Nursing Professional Committee of the Chinese Nursing Association and Nursing Department of the Orthopedic Branch of the China International Exchange and Promotive Association for Medical and Health Care organized relevant nursing experts to formulate Expert consensus on perioperative basic prevention for lower extremity deep venous thrombosis in elderly patients with hip fracture ( version 2024) . A total of 10 recommendations were proposed, aiming to standardize the basic preventive measures for lower extremity DVT in elderly patients with hip fractures during the perioperative period and promote their subsequent rehabilitation.