Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Bone Transplantation/adverse effects* ; Transplantation, Autologous/adverse effects*

Objective:To evaluate the clinical efficacy of the Chinese herbal medicine compound Kangliu Pill combined with conventional Western medicine therapy in the treatment of patients with malignant glioma after surgery.Methods:A total of 100 patients with malignant glioma (grade Ⅲ-Ⅳ), who met the inclusion criteria and underwent surgery from January 2017 to November 2019, were divided into the treatment group of 48 patients and the control group of 52, according to the treatment method. The control group was treated with conventional surgery plus radiotherapy, and the treatment group was treated with Kangliu Pill on the basis of the control group. The patients were followed up for 1 to 2 years, and the survival rate, progression-free survival and median survival were recorded. The Karnofsky functional status score (KPS) and quality of life score (QOL) were used to evaluate the patients' survival and quality of life, and the adverse reactions during the treatment period were observed.Results:After treatment, the 1-year survival rates [97.92% (47/48) vs. 80.77% (42/52); χ2=5.847, P=0.016] and 2-year survival rates [89.47% (33/48) vs. 42.31% (22/52); χ2=7.051, P=0.008] in the treatment group were significantly higher than those in the control group. After treatment, the progression-free survival [(23.94±13.12) months vs. (15.82±8.65) months; t=3.63, P<0.01] in the treatment group was significantly higher than that of the control group. After treatment, the survival analysis using the life table method yielded a median survival of 21.13 months in the treatment group and 12.00 months in the control group, with statistically significant differences in median survival and cumulative survival rates between two groups ( P=0.001). The KPS and QOL scores in the treatment group were higher than those in the control group, but the differences between the groups were not statistically significant ( P>0.05). There was no serious adverse events occurred during the treatment period in both groups. Conclusion:Adjuvant therapy with Kangliu Pill can improve survival rate, prolong progression-free survival, median survival, improve quality of life, and enhance the efficacy of patients with malignant glioma after surgery.

By taking the neurosurgery residency program of Brigham and Women's Hospital as an example,the neurosurgery residency training system of United States is introduced,which emphasizes on the progressive gaining of the trainee with regard to medical knowledge,surgical skills,decision-making strategy,humanity,professionalism,inter-human communication ability and updated neuroscience research.This training system can shed some light on our own neurosurgery residency program,which only begins to take shape in recent years.