PURPOSE: To methodically assess the effectiveness of augmentative plating (AP) and exchange nailing (EN) in managing nonunion following intramedullary nailing for long bone fractures of the lower extremity. METHODS: PubMed, EMBASE, Web of Science, and the Cochrane Library were searched to gather clinical studies regarding the use of AP and EN techniques in the treatment of nonunion following intramedullary nailing of lower extremity long bones. The search was conducted up until May 2023. The original studies underwent an independent assessment of their quality, a process conducted utilizing the Newcastle-Ottawa scale. Data were retrieved from these studies, and meta-analysis was executed utilizing Review Manager 5.3. RESULTS: This meta-analysis included 8 studies involving 661 participants, with 305 in the AP group and 356 in the EN group. The results of the meta-analysis demonstrated that the AP group exhibited a higher rate of union (odds ratio: 8.61, 95% confidence intervals (CI): 4.12 - 17.99, p < 0.001), shorter union time (standardized mean difference (SMD): -1.08, 95% CI: -1.79 - -0.37, p = 0.003), reduced duration of the surgical procedure (SMD: -0.56, 95% CI: -0.93 - -0.19, p = 0.003), less bleeding (SMD: -1.5, 95% CI: -2.81 - -0.18, p = 0.03), and a lower incidence of complications (relative risk: -0.17, 95% CI: -0.27 - -0.06, p = 0.001). In the subgroup analysis, the time for union in the AP group in nonisthmal and isthmal nonunion of lower extremity long bones was shorter compared to the EN group (nonisthmal SMD: -1.94, 95% CI: -3.28 - -0.61, p < 0.001; isthmal SMD: -1.08, 95% CI: -1.64 - -0.52, p = 0.002). CONCLUSION In the treatment of nonunion in diaphyseal fractures of the long bones in the lower extremity, the AP approach is superior to EN, both intraoperatively (with reduced duration of the surgical procedure and diminished blood loss) and postoperatively (with an elevated union rate, shorter union time, and lower incidence of complications). Specifically, in the management of nonunion of lower extremity long bones with non-isthmal and isthmal intramedullary nails, AP demonstrated shorter union time in comparison to EN.
Humans ; Bone Nails/adverse effects* ; Bone Plates/adverse effects* ; Femoral Fractures/surgery* ; Fracture Fixation, Intramedullary/methods* ; Fractures, Ununited/surgery* ; Lower Extremity/injuries*

PURPOSE: We carried out the study aiming to explore and analyze the risk factors, the distribution of pathogenic bacteria, and their antibiotic-resistance characteristics influencing the occurrence of surgical site infection (SSI), to provide valuable assistance for reducing the incidence of SSI after traumatic fracture surgery. METHODS: A retrospective case-control study enrolling 3978 participants from January 2015 to December 2019 receiving surgical treatment for traumatic fractures was conducted at Tangdu Hospital of Air Force Medical University. Baseline data, demographic characteristics, lifestyles, variables related to surgical treatment, and pathogen culture were harvested and analyzed. Univariate analyses and multivariate logistic regression analyses were used to reveal the independent risk factors of SSI. A bacterial distribution histogram and drug-sensitive heat map were drawn to describe the pathogenic characteristics. RESULTS: Included 3978 patients 138 of them developed SSI with an incidence rate of 3.47% postoperatively. By logistic regression analysis, we found that variables such as gender (males) (odds ratio (OR) = 2.012, 95% confidence interval (CI): 1.235 - 3.278, p = 0.005), diabetes mellitus (OR = 5.848, 95% CI: 3.513 - 9.736, p < 0.001), hypoproteinemia (OR = 3.400, 95% CI: 1.280 - 9.031, p = 0.014), underlying disease (OR = 5.398, 95% CI: 2.343 - 12.438, p < 0.001), hormonotherapy (OR = 11.718, 95% CI: 6.269 - 21.903, p < 0.001), open fracture (OR = 29.377, 95% CI: 9.944 - 86.784, p < 0.001), and intraoperative transfusion (OR = 2.664, 95% CI: 1.572 - 4.515, p < 0.001) were independent risk factors for SSI, while, aged over 59 years (OR = 0.132, 95% CI: 0.059 - 0.296, p < 0.001), prophylactic antibiotics use (OR = 0.082, 95% CI: 0.042 - 0.164, p < 0.001) and vacuum sealing drainage use (OR = 0.036, 95% CI: 0.010 - 0.129, p < 0.001) were protective factors. Pathogens results showed that 301 strains of 38 species of bacteria were harvested, among which 178 (59.1%) strains were Gram-positive bacteria, and 123 (40.9%) strains were Gram-negative bacteria. Staphylococcus aureus (108, 60.7%) and Enterobacter cloacae (38, 30.9%) accounted for the largest proportion. The susceptibility of Gram-positive bacteria to Vancomycin and Linezolid was almost 100%. The susceptibility of Gram-negative bacteria to Imipenem, Amikacin, and Meropenem exceeded 73%. CONCLUSION Orthopedic surgeons need to develop appropriate surgical plans based on the risk factors and protective factors associated with postoperative SSI to reduce its occurrence. Meanwhile, it is recommended to strengthen blood glucose control in the early stage of admission and for surgeons to be cautious and scientific when choosing antibiotic therapy in clinical practice.
Humans ; Surgical Wound Infection/epidemiology* ; Male ; Female ; Risk Factors ; Retrospective Studies ; Middle Aged ; Adult ; Case-Control Studies ; Fractures, Bone/surgery* ; Aged ; Drug Resistance, Bacterial ; Logistic Models ; Anti-Bacterial Agents/therapeutic use* ; Incidence ; Bacteria/drug effects*

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 investigate the relationship between ST-segment elevation myocardial infarction(STEMI)treatment time nodes and coronary microcirculation dysfunction(CMD)after primary percutaneous coronary intervention(PCI)and its prognosis,providing evidence for early identification of high-risk patients,further optimization of treatment system,shortening treatment time and improving prognosis.Methods This study selected 150 STEMI patients who received primary PCI at the 920th Hospital of the Joint Logistic Support Force of the People's Liberation Army of China from March 2023 to September 2023 as the CMD group after PCI(89 cases),with a microcirculation resistance index(caIMR)of≥40 U based on coronary angiography.caIMR＜40 U was classified as the non-CMD group(61 cases).The clinical data,various examination indicators and imaging data of the two groups of patients were collected,and the occurrence of major adverse cardiovascular events(MACE)within half a year after direct PCI of the patients was followed up.The correlation between the two variables was analyzed using Spearman.Multivariate Logistic regression was used to analyze the relationship between each treatment time point and the occurrence of CMD after direct PCI.Using receiver operating characteristic(ROC)curve analysis to predict the occurrence of CMD after direct PCI.The survival curves between the two groups were plotted using the Kaplan-Meier method.Results The levels of symptom onset-to-balloon(S-to-B),symptom onset-to-first medical contact(S-to-FMC),first medical contact-to-balloon(FMC-to-B),symptom onset-to-door(S-to-D)and first medical contact-to-door(FMC-to-D)in the CMD group were significantly higher than those in the non-CMD group(all P＜0.05).Correlation analysis showed that S-to-D,S-to-FMC,the time from FMC-to-B,and the time from FMC-to-D were all positively correlated with the time from S-to-B(r=0.996,P＜0.001;r=0.937,P＜0.001;r=0.431,P＜0.001;r=0.441,P＜0.001).Multivariate Logistic regression analysis indicated that the duration of S-to-D(OR 2.165,95％CI 1.655-2.830,P＜0.001)was a significant influencing factor for CMD.Moreover,S-to-D has a relatively high predictive value for the occurrence of CMD after direct PCI.The area under the ROC curve is 0.898(95％CI 0.850-0.946,P＜0.001),the optimal cut-off value is 231 min,the sensitivity is 82.0％,and the specificity is 88.5％.Kaplan-Meier curve analysis showed that the cumulative survival rate of MACE outcomes in the CMD group was significantly lower than that in the non-CMD group(Log-rank P=0.009).Conclusions Shortening the S-to-D time can reduce the occurrence of CMD after PCI,thereby reducing the incidence of MACE and improving prognosis.

Objective To investigate the relationship between ST-segment elevation myocardial infarction(STEMI)treatment time nodes and coronary microcirculation dysfunction(CMD)after primary percutaneous coronary intervention(PCI)and its prognosis,providing evidence for early identification of high-risk patients,further optimization of treatment system,shortening treatment time and improving prognosis.Methods This study selected 150 STEMI patients who received primary PCI at the 920th Hospital of the Joint Logistic Support Force of the People's Liberation Army of China from March 2023 to September 2023 as the CMD group after PCI(89 cases),with a microcirculation resistance index(caIMR)of≥40 U based on coronary angiography.caIMR＜40 U was classified as the non-CMD group(61 cases).The clinical data,various examination indicators and imaging data of the two groups of patients were collected,and the occurrence of major adverse cardiovascular events(MACE)within half a year after direct PCI of the patients was followed up.The correlation between the two variables was analyzed using Spearman.Multivariate Logistic regression was used to analyze the relationship between each treatment time point and the occurrence of CMD after direct PCI.Using receiver operating characteristic(ROC)curve analysis to predict the occurrence of CMD after direct PCI.The survival curves between the two groups were plotted using the Kaplan-Meier method.Results The levels of symptom onset-to-balloon(S-to-B),symptom onset-to-first medical contact(S-to-FMC),first medical contact-to-balloon(FMC-to-B),symptom onset-to-door(S-to-D)and first medical contact-to-door(FMC-to-D)in the CMD group were significantly higher than those in the non-CMD group(all P＜0.05).Correlation analysis showed that S-to-D,S-to-FMC,the time from FMC-to-B,and the time from FMC-to-D were all positively correlated with the time from S-to-B(r=0.996,P＜0.001;r=0.937,P＜0.001;r=0.431,P＜0.001;r=0.441,P＜0.001).Multivariate Logistic regression analysis indicated that the duration of S-to-D(OR 2.165,95％CI 1.655-2.830,P＜0.001)was a significant influencing factor for CMD.Moreover,S-to-D has a relatively high predictive value for the occurrence of CMD after direct PCI.The area under the ROC curve is 0.898(95％CI 0.850-0.946,P＜0.001),the optimal cut-off value is 231 min,the sensitivity is 82.0％,and the specificity is 88.5％.Kaplan-Meier curve analysis showed that the cumulative survival rate of MACE outcomes in the CMD group was significantly lower than that in the non-CMD group(Log-rank P=0.009).Conclusions Shortening the S-to-D time can reduce the occurrence of CMD after PCI,thereby reducing the incidence of MACE and improving prognosis.

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 risk factors of early femoral head necrosis in patients with femoral neck fracture after operation,and to establish a nomogram prediction model.Methods A total of 167 patients with femoral neck fracture from Jan-uary 2020 to April 2022 were selected and divided into necrosis group and non-necrosis group according to whether femoral head necrosis occurred in the early postoperative period.There were 21 males and 17 females in the necrosis group,aged from 33 to 72 years old,with an average of(53.49±10.96)years old,and the time from injury to operation ranged from 40 to 67 hours,with average time of(53.46±7.23)hours.There were 72 males and 57 females in the non-necrosis group,aged from 18 to 83 years,with an average of(52.78±12.55)years old,and the time from injury to operation was 18 to 65 hours,with an aver-age time of(39.88±7.79)hours.The potential influencing factors,including patient gender,diabetes mellitus,hypertension,chronic liver disease,posterior inclination angle of the femoral head,operation mode,fracture displacement,fracture line loca-tion,preoperative braking traction,screw arrangement mode,reduction quality,age,body mass index(BMI),and injury to operation time were subjected to single factor analysis.Logistic multivariate regression analysis was conducted for factors with a significance level of P＜0.05.Results The incidence of femoral head necrosis in 167 patients with femoral neck fracture was 22.76％.The following factors were identified as independent risk factors for early postoperative femoral head necrosis in pa-tients with femoral neck fractures:coexisting diabetes[OR=5.139,95％CI(1.405,18.793),P=0.013],displaced fracture[OR=3.723,95％CI(1.105,12.541),P=0.034],preoperative immobilization[OR=3.444,95％CI(1.038,11.427),P=0.043],quality of reduction[OR=3.524,95％CI(1.676,7.411),P=0.001],and time from injury to surgery[OR=1.270,95％CI(1.154,1.399),P=0.000].The Hosmer-Lemeshow goodness-of-fit test(x2=3.951,P=0.862),the area under the receiver operator characteristic(ROC)curve was 0.944[P＜0.001,95％CI(0.903,0.987)],with a sensitivity of 89.50％,the specificity was 88.40％,the maxi-mum Youden index was 0.779,and the overall trend of the model correction curve was close to the ideal curve.Model regres-sion equation was Z=1.637 × diabetes+1.314× fracture displacement+1.237 × preoperative braking traction+1.260 × reduc-tion quality+0.239 ×injury to operation time-18.310.Conclusion The occurrence of early femoral head necrosis in patients with femoral neck fracture postoperatively is affected by multiple factors.The risk early warning model established according to the factors has good predictive efficacy.

Objective:To investigate the clinical significance of excessive inlet view in fluoroscopy-assisted placement of sacroiliac screws.Methods:Included for this prospective study were 47 patients with unstable pelvic fracture who had been admitted to Department of Orthopaedic Trauma, Xi'an Honghui Hospital between January 2020 and January 2021. There were 30 males and 17 females, with a mean age of 39.4 years (from 25 to 66 years). By the Tile classification, 21 fractures were type B and 26 ones type C. The inlet view and the angle of excessive inlet view were measured before operation. The intraoperative placement of sacroiliac screws was assisted by C-arm fluoroscopy navigation in the excessive inlet view. The positions of sacroiliac screws were verified by CT or O-arm fluoroscopy after operation. The screw placement time, fracture reduction quality, fracture healing time, and pelvic function at the last follow-up were recorded.Results:A total of 67 screws were implanted in the 47 patients, including 56 sacroiliac screws. The insertion time for each screw averaged 19.9 min (from 9 to 31 min); the angle of excessive inlet view averaged 17.38° (from 12.1° to 24.8°). Verification by O-arm fluoroscopy or CT revealed that all sacroiliac screws were located in the sacral canal without dislocation or breaking through the cortical bone. By the postoperative Matta scoring, the reduction was excellent in 22 cases, good in 17, acceptable in 6, and poor in 2, giving an excellent to good rate of 83.0%(39/47). The average follow-up time for the 47 patients was 9.5 months (from 5 to 15 months); fracture healing time averaged 10.5 weeks (from 7 to 16 weeks). By the Mejeed scoring at the last follow-up, the pelvic function was excellent in 26 cases, good in 15 and acceptable in 6, giving an excellent to good rate of 87.2% (41/47).Conclusions:Fluoroscopy in the excessive inlet view is a simple and easy intraoperative technique. It can improve accuracy and safety of sacroiliac screw placement because it allows clear identification of the posterior border of the sacrum and effectively avoids iatrogenic injury to the sacral nerve caused by screws breaking through the bone cortex.

Anterior cervical fusion surgery is the first choice for spine surgeons in the treatment of cervical spine diseases. It has significant effects in treating cervical degenerative diseases, trauma and tumors and other cervical diseases. In anterior cervical fusion, it is necessary to use a distractor to properly distract the intervertebral space, so as to fully expose and relieve the compressive factors, restore the physiological height, curvature and stability of the lesion segment, and achieve the best surgical effect. However, there is currently no consensus on the standard distraction height for the intervertebral space during anterior cervical surgery. This article reviewsed the progress of intervertebral space height in anterior cervical fusion from three dimensions:the relationship between intervertebral space height and cervical disc degeneration mechanism, the selection of intervertebral space height during operation, the recovery of intervertebral space height and the postoperative effect, so as to provide theoretical basis and reference for spinal surgeons when performing intervertebral distraction during operation.
Cervical Vertebrae/surgery* ; Humans ; Intervertebral Disc/surgery* ; Intervertebral Disc Degeneration ; Neck ; Spinal Fusion ; Treatment Outcome

Objective:To analyze the functions and indications， formulation， dosage form and medication characteristics of Chinese patent medicines in the 2020 edition of Chinese Pharmacopoeia （part Ⅰ） for treating cough of children， and to provide ideas for the clinical rational application and provide reference for the research and development of new cough medicines for children. Method:The name， dosage form， formulation， functions and indications， usage and dosage， and other information of Chinese patent medicines for cough were collected from the 2020 edition of Chinese Pharmacopoeia （part Ⅰ）， then relevant information was input into Integrative Pharmacology-based Research Platform of Traditional Chinese Medicine v2.0， and data analysis and mining were carried out through the analysis module of prescription medication rule， VOSviewer 1.6.14 was used to make drug clustering network view of Chinese patent medicines for the treatment of exogenous wind cold， exogenous wind heat and phlegm heat cough. Result:In the 2020 edition of Chinese Pharmacopoeia （part Ⅰ）， a total of 75 kinds of Chinese patent medicines for treating cough of children were collected， including 34 kinds of Chinese patent medicines for adults and children， 41 kinds of Chinese patent medicines for children only. There were 7 types of traditional Chinese medicine syndromes， such as wind-cold attacking the lung， wind-heat invading the lung and phlegm-heat obstructing the lung. There were 45 Chinese patent medicines for treating exogenous cough， accounting for 60%， among which 35 kinds were used for exogenous wind-heat cough and 10 kinds were used for wind-cold cough. There were 30 kinds of Chinese patent medicines for treating internal injury cough， including 19 kinds of medicines for phlegm heat obstructing the lung， 4 kinds of medicines for phlegm dampness containing the lung and phlegm food stagnation， 2 kinds of medicines for Yin-deficiency lung heat， 1 kind of medicine for the lung and spleen Qi-deficiency. The formulation analysis showed that Glycyrrhizae Radix et Rhizoma， Platycodonis Radix， Scutellariae Radix， Armeniacae Semen Amarum and Citri Reticulatae Pericarpium appeared frequently， which were mainly cold， bitter and sweet herbs， mainly belonged to the lung and stomach meridians. According to the analysis of administration and dosage forms， 71 kinds of Chinese patent medicines were administered through gastrointestinal tract， including 20 kinds of granules， 15 kinds of oral liquids， others included syrups， pills， capsules， tablets， powers， etc. Only 2 suppositories and 2 injections were administered by nongastrointestinal tract. The usage and dosage of most Chinese patent medicines were not clear. Conclusion:In the 2020 edition of Chinese Pharmacopoeia （part Ⅰ）， the main syndromes of Chinese patent medicines for cough of children are exogenous wind-heat and phlegm-heat obstruction in the lung. Most of the Chinese medicines are cold， bitter and sweet， and their meridians are mainly lung and stomach meridians. Scutellariae Radix， Lonicerae Japonicae Flos and Forsythiae Fructus are the most common medicines of exogenous wind heat syndrome. Perillae Folium， Citri Reticulatae Pericarpium and Ephedrae Herba are the most common medicines of exogenous wind cold syndrome. Meanwhile， Scutellariae Radix， Platycodonis Radix and Armeniacae Semen Amarum are the most common medicines of phlegm heat obstructing the lung syndrome. At present， the dosage forms of Chinese patent medicines used for treating cough of children are too few and the dosage labeling is not comprehensive， so it is necessary to further strengthen the research and development of new Chinese medicines suitable for characteristics of children.