Objective:To compare the safety and efficacy of 3D-printed porous bioceramic artificial bone and artificial bone substitutes in the treatment of limb bone defects.Methods:A total of 220 patients with post-traumatic limb bone defects admitted to Xijing Hospital Affiliated to Air Force Medical University of the Chinese People's Liberation Army (34 cases), the Third Hospital of Hebei Medical University (60 cases), Xi'an Honghui Hospital (28 cases), the Third Hospital of Southern Medical University (18 cases), Changsha Third Hospital (28 cases), Foshan Traditional Chinese Medicine Hospital (16 cases), Foshan Fuxing Chancheng Hospital (12 cases), and Henan Provincial Orthopaedic Hospital (24 cases) from May 2022 to October 2023 were included as research subjects. According to the manufacturing method of the bone graft material, the subjects were randomly divided into the 3D printed porous bioceramic artificial bone group (3D printing group) and the artificial bone substitute group (non-3D printing group) at a ratio of 1:1 by the envelope method. Adverse events that might be related to the surgery were selected through correlation evaluation and classified as abnormal laboratory indicators, systemic or other site symptoms and abnormalities, and local symptoms and abnormalities of the affected limb. The safety of the two groups was compared. The bone graft fusion rate, bone defect repair and healing rate, and short form 12 (SF-12) score of the two groups were calculated to evaluate the postoperative recovery.Results:Thirty-two cases were excluded (4 cases refused to use their data after reconsideration, 7 cases were not used after preoperative assessment, and 21 cases exceeded the standard for body mass index and laboratory indicators upon re-examination). A total of 188 cases were randomly divided into the 3D printing group and the non-3D printing group according to the random method, with 94 cases in each group. Among them, 11 cases in the 3D printing group and 9 cases in the non-3D printing group dropped out due to loss to follow-up. Finally, 168 cases completed the follow-up, including 83 cases in the 3D printing group and 85 cases in the non-3D printing group. In the 3D printing group, there were 53 males and 30 females, with an average age of 47.9±12.7 years; in the non-3D printing group, there were 53 males and 32 females, with an average age of 48.6±12.9 years. A total of 51 cases in the two groups experienced adverse events related to the surgery, including 13 cases of abnormal laboratory indicators (5 cases in the 3D printing group and 8 cases in the non-3D printing group), 15 cases of systemic or other site symptoms and abnormalities (9 cases in the 3D printing group and 6 cases in the non-3D printing group), and 23 cases of local symptoms and abnormalities of the affected limb (13 cases in the 3D printing group and 10 cases in the non-3D printing group). There was no statistically significant difference in the incidence of adverse events between the two groups ( P>0.05). The bone graft fusion rates of the 3D printing group and the non-3D printing group at 6 months after surgery were 99%(82/83) and 99%(84/85), respectively, and the bone defect repair and healing rates were 89%(74/83) and 89%(76/85), respectively. At the time of 12 months after surgery, the bone graft fusion rates were 99%(82/83) and 99%(84/85), respectively, and the bone defect repair and healing rates were 94%(78/83) and 92%(78/85), respectively. There was no statistically significant difference in the bone graft fusion rate and bone defect repair and healing rate between the two groups ( P>0.05). The SF-12 scores during the screening period were 27.82±2.96 points and 27.22±4.23 points in the 3D printing group and the non-3D printing group, respectively, and at 3 months after surgery were 28.08±3.13 points and 27.64±3.16 points, at 6 months after surgery were 29.42±3.10 points and 28.55±3.45 points, and at 12 months after surgery were 29.78±2.80 points and 29.58±2.94 points, respectively. There was no statistically significant difference between the groups ( P>0.05). Both groups of surgeries were successfully completed without any serious surgical or bone graft-related complications. Conclusion:The safety and efficacy of 3D-printed porous bioceramic artificial bone in the treatment of limb bone defects are not significantly different from those of currently clinically applied artificial bone substitutes.

Objective:To evaluate the therapeutic role of balanced matching concept in the surgical release of moderate and severe elbow stiffness after trauma.Methods:A retrospective study was conducted to analyze the clinical data of 20 patients who had been treated by surgical release from June 2022 to January 2024 for elbow stiffness after moderate and severe trauma at Department of Orthopedic Trauma, The First Hospital Affiliated to Air Force Medical University of PLA using the balanced matching concept (combination of elbow soft tissue balance and bone matching). There were 15 males and 5 females, with an age of (33.0±8.9) years. Six left sides and 14 right sides were affected. The elbow stiffness was severe in 13 cases and moderate in 7 cases. Six patients had mainly bony stiffness, 4 patients mainly soft stiffness, and 10 patients mixed stiffness. The elbow flexion and extension, Mayo elbow performance score (MEPS) and disabilities of the arm, shoulder, and hand (DASH) score were recorded and compared before release and at the last follow-up. The recurrence of ectopic ossification, infection, iatrogenic fracture and other complications of the elbow joint of the affected limb were recorded.Results:All the 20 patients were followed up for (16.6±3.5) months. At the last follow-up, the elbow flexion and extension (121.8°±8.9° and 14.8°±8.2°) were significantly greater than those before operation (73.5°±25.7° and 47.3°±19.2°), and the MEPS and DASH scores [ (90.0±5.6) points, (5.6±3.0) points] were significantly better than those before operation [(53.0±12.8) points, (62.1±14.0) points] ( P<0.05). Iatrogenic fracture of the ulna occurred in 1 patient, and pinky numbness occurred in 1 patient after surgery. None of the patients had recurrence of ectopic ossification or wound infection. Conclusion:In the surgical release of moderate and severe elbow stiffness after trauma, the concept of balanced matching plays a positive role by facilitating the functional restoration of the elbow and reducing the incidence of complications.

In February 2023, a 48-year-old male with cough and expectoration was admitted to the Department of Pulmonary and Critical Care Medicine of Peking University People’s Hospital. CT indicated mediastinal soft-tissue mass under the tracheal carina. Meta-genomics next generation sequencing of mediastinal abscess suggested infection with Tropheryma whipplei, which was positive for periodic acid-Schiff staining. The patient had no history of diarrhea, weight loss, or joint pain. The patient was diagnosed with Whipple’s disease and treated with ceftriaxone followed by trimethoprim-sulfamethoxazole therapy. After 1-year post-discharge therapy, the patieny’s symptoms and general condition improved significantly, and remained to follow.

Objective:To evaluate the therapeutic role of balanced matching concept in the surgical release of moderate and severe elbow stiffness after trauma.Methods:A retrospective study was conducted to analyze the clinical data of 20 patients who had been treated by surgical release from June 2022 to January 2024 for elbow stiffness after moderate and severe trauma at Department of Orthopedic Trauma, The First Hospital Affiliated to Air Force Medical University of PLA using the balanced matching concept (combination of elbow soft tissue balance and bone matching). There were 15 males and 5 females, with an age of (33.0±8.9) years. Six left sides and 14 right sides were affected. The elbow stiffness was severe in 13 cases and moderate in 7 cases. Six patients had mainly bony stiffness, 4 patients mainly soft stiffness, and 10 patients mixed stiffness. The elbow flexion and extension, Mayo elbow performance score (MEPS) and disabilities of the arm, shoulder, and hand (DASH) score were recorded and compared before release and at the last follow-up. The recurrence of ectopic ossification, infection, iatrogenic fracture and other complications of the elbow joint of the affected limb were recorded.Results:All the 20 patients were followed up for (16.6±3.5) months. At the last follow-up, the elbow flexion and extension (121.8°±8.9° and 14.8°±8.2°) were significantly greater than those before operation (73.5°±25.7° and 47.3°±19.2°), and the MEPS and DASH scores [ (90.0±5.6) points, (5.6±3.0) points] were significantly better than those before operation [(53.0±12.8) points, (62.1±14.0) points] ( P<0.05). Iatrogenic fracture of the ulna occurred in 1 patient, and pinky numbness occurred in 1 patient after surgery. None of the patients had recurrence of ectopic ossification or wound infection. Conclusion:In the surgical release of moderate and severe elbow stiffness after trauma, the concept of balanced matching plays a positive role by facilitating the functional restoration of the elbow and reducing the incidence of complications.

Objective:To compare the safety and efficacy of 3D-printed porous bioceramic artificial bone and artificial bone substitutes in the treatment of limb bone defects.Methods:A total of 220 patients with post-traumatic limb bone defects admitted to Xijing Hospital Affiliated to Air Force Medical University of the Chinese People's Liberation Army (34 cases), the Third Hospital of Hebei Medical University (60 cases), Xi'an Honghui Hospital (28 cases), the Third Hospital of Southern Medical University (18 cases), Changsha Third Hospital (28 cases), Foshan Traditional Chinese Medicine Hospital (16 cases), Foshan Fuxing Chancheng Hospital (12 cases), and Henan Provincial Orthopaedic Hospital (24 cases) from May 2022 to October 2023 were included as research subjects. According to the manufacturing method of the bone graft material, the subjects were randomly divided into the 3D printed porous bioceramic artificial bone group (3D printing group) and the artificial bone substitute group (non-3D printing group) at a ratio of 1:1 by the envelope method. Adverse events that might be related to the surgery were selected through correlation evaluation and classified as abnormal laboratory indicators, systemic or other site symptoms and abnormalities, and local symptoms and abnormalities of the affected limb. The safety of the two groups was compared. The bone graft fusion rate, bone defect repair and healing rate, and short form 12 (SF-12) score of the two groups were calculated to evaluate the postoperative recovery.Results:Thirty-two cases were excluded (4 cases refused to use their data after reconsideration, 7 cases were not used after preoperative assessment, and 21 cases exceeded the standard for body mass index and laboratory indicators upon re-examination). A total of 188 cases were randomly divided into the 3D printing group and the non-3D printing group according to the random method, with 94 cases in each group. Among them, 11 cases in the 3D printing group and 9 cases in the non-3D printing group dropped out due to loss to follow-up. Finally, 168 cases completed the follow-up, including 83 cases in the 3D printing group and 85 cases in the non-3D printing group. In the 3D printing group, there were 53 males and 30 females, with an average age of 47.9±12.7 years; in the non-3D printing group, there were 53 males and 32 females, with an average age of 48.6±12.9 years. A total of 51 cases in the two groups experienced adverse events related to the surgery, including 13 cases of abnormal laboratory indicators (5 cases in the 3D printing group and 8 cases in the non-3D printing group), 15 cases of systemic or other site symptoms and abnormalities (9 cases in the 3D printing group and 6 cases in the non-3D printing group), and 23 cases of local symptoms and abnormalities of the affected limb (13 cases in the 3D printing group and 10 cases in the non-3D printing group). There was no statistically significant difference in the incidence of adverse events between the two groups ( P>0.05). The bone graft fusion rates of the 3D printing group and the non-3D printing group at 6 months after surgery were 99%(82/83) and 99%(84/85), respectively, and the bone defect repair and healing rates were 89%(74/83) and 89%(76/85), respectively. At the time of 12 months after surgery, the bone graft fusion rates were 99%(82/83) and 99%(84/85), respectively, and the bone defect repair and healing rates were 94%(78/83) and 92%(78/85), respectively. There was no statistically significant difference in the bone graft fusion rate and bone defect repair and healing rate between the two groups ( P>0.05). The SF-12 scores during the screening period were 27.82±2.96 points and 27.22±4.23 points in the 3D printing group and the non-3D printing group, respectively, and at 3 months after surgery were 28.08±3.13 points and 27.64±3.16 points, at 6 months after surgery were 29.42±3.10 points and 28.55±3.45 points, and at 12 months after surgery were 29.78±2.80 points and 29.58±2.94 points, respectively. There was no statistically significant difference between the groups ( P>0.05). Both groups of surgeries were successfully completed without any serious surgical or bone graft-related complications. Conclusion:The safety and efficacy of 3D-printed porous bioceramic artificial bone in the treatment of limb bone defects are not significantly different from those of currently clinically applied artificial bone substitutes.

Objective:To identify the risk factors affecting the healing of defective bony nonunion.Methods:The studies reporting the risk factors for healing of defective bony nonunion between January 2000 and March 2022 were retrieved by computer from the VIP, Wanfangdata, CNKI, Web of Science, PubMed, and Medline databases. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included studies. the RevMan 5.3 software was used to perform a meta-analysis of the general factors, injuries and surgical-related factors affecting the healing of defective bony nonunion.Results:Included in this Meta analysis were 17 studies with 1,236 patients. The NOS score of the included studies was from 5 to 8. The meta-analysis showed the following: age ( MD=-4.27, 95% CI: -8.29 to 2.91, P < 0.01), smoking ( OR=3.56, 95% CI: 2.81 to 6.32, P < 0.01), soft tissue defect ( OR=3.54, 95% CI: 2.21 to 5.69, P < 0.01), combined ipsilateral fibular fracture ( OR=4.18, 95% CI: 1.24 to 14.03, P=0.02), venous thrombosis ( OR=4.27, 95% CI: 1.05 to 17.44, P=0.04), and postoperative infection ( OR=2.96, 95% CI: 1.97 to 4.47, P < 0.01) were significant risk factors for the healing of defective bone nonunion. Minor bone defect ( SMD=-0.67, 95% CI: -1.25 to -0.10, P=0.02), proximal to distal bone transport ( OR=-0.42, 95% CI: 0.22 to 0.77, P < 0.01), short-term external fixation ( MD=-3.92, 95% CI: -7.10 to -0.73, P=0.02), and autologous bone grafting ( OR=0.39, 95% CI: 0.16 to 0.95, P=0.04) were protective factors for the healing of defective bony nonunion. Conclusions:High age (senility), smoking, soft tissue defect, ipsilateral fibular fracture, venous thrombosis, and postoperative infection are risk factors affecting the healing of defective bony nonunion. Minor bone defect, proximal to distal bone transport, short-term external fixation, and autologous bone grafting are protective factors affecting the healing of defective bony nonunion. Surgeons can predict early the prognosis of patients with defective bony nonunion based on the above factors.

Objective To investigate the efficacy of anti-infective reconstituted bone xenograft (ARBX) combined with external fixation in the treatment of adult infective nonunion of humeral shaft.Methods A retrospective case series study was conducted to analyze the clinical data of 18 patients with infected nonunion of humeral shaft admitted to Xijing Hospital of Air Force Military Medical University from January 2014 to December 2016.There were 10 males and eight females,aged 19-62 years [(36.9 ± 11.8)years].According to Umiarov classification of infective nonunion,there were 11 patients with type Ⅲ and seven with type Ⅳ.All patients were treated with anti-infective reconstituted bone xenograft (ARBX) combined with external fixation.The number of operations,bone healing time,bone healing rate,infection control rate,postoperative weight bearing time,the time of external fixation removal,postoperative complications,erythrocyte sedimentation rate (ESR),and C-reactive protein (CRP) before and after operation were recorded.Fracture healing and functional recovery were evaluated using the Johner-Wruch lower limb function score.Results The patients were followed up for 12-30 months [(21.3 ±5.6)months].The operation was performed for (1.4 ±0.9) times,with time of bone healing for (16.6 ± 5.8)months,bone healing rate of 83％ (15/18),and infection control rate of 94％ (17/18).The postoperative weight bearing time in 15 patients who obtained bone healing was (3.3 ± 1.5)months after operation,and the external fixation removal time was (18.5 ± 4.2) months after operation.There were three patients with nonunion after operation including one with infection recurrence.Five patients were found with nail tract infection.ESR and CRP at postoperative 3 months [(13.1 ± 8.4)mm/h and (5.6 ± 4.6)mg/L] were significantly lower than those before operation [(47.3 ± 19.2)mm/h and (23.4 ± 7.4) mg/L] (P ＜ 0.05).According to Johner-Wruch lower limb function scores,the results were excellent in nine patients,good in four,fair in one,and poor in four,with excellent and good rate of 72％.Conclusion ARBX combined with External fixation can effectively treat infective nonunion of humeral shaft,improve bone healing rate,and promote function recovery.

Objective: To establish an efficient classification and treatment system for limb long bone defects. Methods: Based on the length of bone defect, soft tissue injury and wound infection, a new classification and treatment system was proposed with reference to Gustilo-Anderson classification for open fractures and Orthopedic Trauma Association (OTA) classification. Results: We divided the limb long bone defects into 3 types, each of which was subdivided into 4 subtypes depending on concomitant soft tissue defect and/or infection. Type Ⅰ are bone defects less than 4 cm in length, including type Ⅰa (simple bone defects with a limited extent), type Ⅰb (bone and soft tissue defects), type Ⅰc (bone defects with infection) and type Ⅰd (bone defects with infection and soft tissue defects). Type Ⅱ are bone defects ranging from 4 to 10 cm in length, including type Ⅱa (simple bone defects with a large extent), type Ⅱb (bone and soft tissue defects), type Ⅱc (bone defects with infection) and type Ⅱd (bone defects with infection and soft tissue defects). Type Ⅲ are bone defects larger than 10 cm in length, including type Ⅲa (simple bone defects with a very large extent), type Ⅲb (bone and soft tissue defects), type Ⅲc (bone defects with infection) and type Ⅲd (bone defects with infection and soft tissue defects). Conclusion Our new classification and treatment system for long limb bone defects is more efficient and intuitive, facilitating clinical diagnosis and treatment of limb long bone defects.

Objective To compare the effectiveness of expandable intramedullary nail(EIMN) versus locked compression plate (LCP) in the treatment of humeral shaft fractures of AO types A and B.Methods The clinical data were retrospectively analyzed and compared of the 44 humeral shaft fractures which had been treated between May 2012 and February 2016.There were 26 men and 18 women,from 23 to 66 years of age (average,41.5 years).By AO classification,22 cases were type 12-A and 22 type 12-B.EINM was used in 22 patients with an average age of 41.3 ± 1 1.7 years and LCP in 22 ones with an average age of 41.6 ± 10.3 years.The 2 groups were compared in terms of intraoperative blood loss,operative time,hospital stay,union time,union rate,Constant and Mayo scores at the final follow-ups,and complications as well.Results The 2 groups were compatible without significant differences in the preoperative demographic data (P ＞ 0.05).All the 44 patients were followed up for 10 to 18 months (average,12 months).The intraoperative blood loss (76.4 ± 18.66 mL),operative time (69.1 ± 13.2 min),incision length (5.8 ± 1.5 cm) and union time (13.2 ± 8.4 w) in the EIMN group were significantly better than those in the LCP group (138.6 ± 39.4 mL,96.4 ± 14.2 min,8.5 ± 1.4 cm and 18.4 ± 6.6 w,respectively) (P ＜ 0.05).There was also a significant difference between the 2 groups in the total complication rate[18.2％ (4/22) versus 50.0％ (11/22)] (P ＜0.05).No deep infection or should pain was observed in either group.Conclusions Inthe treatment of humeral shaft fractures of AO types 42-A and 42-B,compared with LCP,EIMN may have advantages of less intraoperative blood loss,operative time,union time and complications.The 2 methods are similar in hospital stay and final functional recovery of the should joint.