Objective To investigate the curative effect of bone plate screw external fixation minimally invasive treatment assisted with 3-dimensional printing extraposition mold in distal radius fractures.Methods The clinical and follow up data in 15 cases of distal radius fractures treated by bone plate screw ex-ternal fixation minimally invasive treatment assisted with 3-dimensional printing extraposition mold were ret-rospectively analyzed.The volar inclination angle,ulnar deviation angle,radius length at the time of before surgery,immediately after surgery,and 2 years after surgery were measured,by using standard anteroposterior and lateral X-ray films,as well as the wrist jiont flexion extension motion and dorsal extension motion at the time of 2 years after surgery were measured by using protractor.The grip strength of the hand 2 years after surgery was measured by using grip strength meter.Visual Analog Scale(VAS)score was used to evaluate the pain level or wrist joint before and 2 years after surgery;Gartland Werley score was used to evaluate the wrist joint function 2 years after surgery.Results The follow-up lasted for 24.0-33.0 months with an aver-age of 26.5 months.The Gartland-Werley scores were excellent in 12 cases,good in 2 cases and fair in 1 case 2 years after surgery.The wrist joint flexion motion was(52.0±11.7)°,the wrist joint dorsal extension motion was(65.0±4.8)°,the grip strength of the affected side was(84.0±4.2)％of the healthy side.Compared with before operation,the volar inclination angle,ulnar deviation angle and radius shortening value and VAS score up were significantly improved 2 years after surgery(P＜0.05),and there was no statistically significant difference in immediately after surgery imaging parameters(volar inclination angle,ulnar deviation angle and radius shortening)immediately after surgery compared to 2 years after surgery(P＞0.05).Conclusion The bone plate screw external fixation minimally invasive treatment assisted with 3-dimensional printing extrapo-sition mold in distal radius fractures has the advantages of individualized bone plate screw,precision guidance position angle,minimal invasion,low demand for skin and soft tissue condition and easy taking out.The fixa-tion is reliable and the joint function recovered well and the short follow up effect is satisfactory.

BACKGROUND:For elderly patients with traumatic hip fractures,the related factors of prognosis are very complex,and the integrity of the lateral wall is one of the influencing factors.It is of important clinical value to understand the effect of lateral wall injury on the prognosis of femoral intertrochanteric fracture. OBJECTIVE:To evaluate the relationship between the integrity of the lateral wall and hip functional recovery and other outcomes in patients with femoral intertrochanteric fractures. METHODS:Totally 82 patients with femoral intertrochanteric fractures were screened and all patients received proximal femoral nail antirotation fixation.According to the thickness of the lateral wall,the patients were divided into the lateral wall intact group(n=31)and lateral wall risk group(n=51).The perioperative indexes,weight-bearing time,fracture healing time,hip joint function and range of motion,postoperative pain and complications were compared between the two groups. RESULTS AND CONCLUSION:(1)The time of hospitalization and the number of fluoroscopies during operation in the lateral wall intact group were significantly lower than those in the lateral wall risk group(P<0.05),but there was no significant difference in other perioperative indexes.(2)Both groups were able to get down to the ground early after surgery and finally complete weight-bearing,but in the lateral wall risk group,the time of fracture healing was longer;the time of complete weight-bearing was significantly delayed;the Harris score of the last follow-up was lower;the range of motion of hip extension and flexion and neck trunk angle on the affected side were smaller(P<0.05).(3)There was no significant difference in the incidence of postoperative complications between the two groups,but the overall incidence of complications in the lateral wall intact group was significantly lower(P<0.05).(4)In summary,after internal fixation of proximal femoral nail antirotation,patients with the intact lateral wall had a relatively better prognosis than those with risk lateral wall.

Objective To compare the efficacy of percutaneous double external fixators (EF) and EF combined with volar locking plate (VLP) in the treatment of AO C1,C2 and C3 type distal radius fracture (DRF). Methods The data of 108 patients with AO C-type DRF from 2019 to 2022 were reviewed. Fifty-one patients were treated with double EF (a no-bridging cemented-pin frame and a conventional wrist-bridging EF) and 57 patients were treated with EF (a conventional wrist-bridging EF) combined with VLP. The imaging parameters (palmar tilt,radial inclination,radial height,ulnar variance,etc.),wrist motion and grip strength were measured. Wrist pain intensity was evaluated by visual analogue scale (VAS). The whole function of the upper limb was assessed by disability of arm shoulder and hand scale (DASH),the wrist function was evaluated by Mayo wrist score (MWS),and the patient satisfaction was evaluated by short assessment of patient satisfaction (SAPS). The incidence of complications was evaluated according to the patient's chief complaint and the surgeon's comprehensive judgement. Results There were no significant differences in age,gender,injury cause,AO types or operation time between the 2 groups (all P>0.05). The time from injury to operation,intraoperative blood loss and hospital stay in the double EF group were superior to those in the EF combined with VLP group (all P<0.001). The patients were followed up for 24 to 33 months. There were no significant differences in palmar tilt,radial inclination,radial height or ulnar variance at the last follow-up (all P>0.05);the VAS score (P=0.025) and SAPS score (P=0.015) in the double EF group were significantly better than those in the EF combined with VLP group. There were no significant differences in the range of motion (flexion,extension,radial deviation,ulnar deviation,pronation or supination),grip strength,MWS or DASH scores between the 2 groups (all P>0.05). The overall complication rate of the double EF group was 13.73％ (7/51),which was lower than that of the EF combined with VLP group (28.07％) (16/57) (P<0.05). Conclusion Percutaneous double EF is easy to operate and relatively safe,with few complications and satisfactory follow-up results. It can be a treatment option for OA C-type DRF.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Objective:To explore the short-term therapeutic outcomes of femoral neck fractures fixated by Femoral Neck System (FNS).Methods:A retrospective analysis was conducted of the 16 patients with femoral neck fracture who had been admitted to the Department of Traumatology & Orthopedics, The Second Affiliated Hospital to Anhui Medical University from January to December 2019. They were 6 males and 10 females, aged from 24 to 69 years (average, 47.5 years). According to the Garden Classification, there were 3 cases of type Ⅱ, 7 cases of type Ⅲ, and 6 cases of type Ⅳ. All the 16 patients were fixated with FNS. Recorded were operation time, frequency of intraoperative fluoroscopy, intraoperative blood loss, quality of postoperative fracture reduction, hospital stay, fracture healing time, and efficacy and complications at the last follow-up.Results:The 16 patients were followed up for 5 to 16 months after operation (average, 9.3 months). According to the Garden indexes, fracture reduction was evaluated as satisfactory in all the 16 patients. The operation time in this group ranged from 25 to 115 min with an average of 41.5 min, the frequency of intraoperative fluoroscopy from 14 to 47 times with an average of 26 times, the intraoperative blood loss from 35 to 210 mL with an average of 76 mL, the hospital stay from 3 to 9 days with an average of 4.6 days, and the fracture healing time from 3 to 6 months with an average of 4.5 months. By the Harris hip scores at the last follow-up, the function of the affected hip was rated as excellent in 10 cases, good in 5 and fair in one. Follow-ups revealed no complications like infection or implant loosening.Conclusions:The FNS is a new type of simple, reliable, safe and minimally invasive internal fixation for the treatment of femoral neck fractures. The plate, bolt, anti-rotation screws and locking screws in FNS can be inserted through a single minimally invasive incision, leading to reliable fixation, limited irritation to the lateral muscular soft tissues, and fine short-term outcomes.

Objective:To compare of the efficacy of Steinman pin-assisted and manual reduction for the treatment of distal femoral fracture with anterograde intramedullary nail.Methods:From January 2014 to August 2018, data of 54 patients with distal femoral fracture were retrospectively analyzed. According to the fracture reduction methods, patients were divided into two groups: bare-handed reduction group and Steinman pin-assisted reduction group (referred to Steinman pin group). There were 16 males and 10 females in bare-handed reduction group, with age of 37.5±9.2 years (range, 21-59 years). According to AO/OTA classification, 16 cases were type 32-A, 7 type 32-B, 3 type 32-C. There were 19 males and 9 females in Steinman pin reduction group, with age of 36.4±9.8 years (range, 18-55 years). According to AO/OTA classification, 19 cases were type 32-A, 7 type 32-B, 2 type 32-C. The reduction time, fluoroscopy times, intraoperative blood loss, fracture healing time, and knee joint function score of American hospital for special surgery (HSS) were compared between the two groups.Results:The amount of blood loss during operation was 142.78±29.76 ml in the bare-handed group, and 94.81±17.71 ml in the Steinman pin group. The reduction time of fracture was 14.19±2.50 min in the bare-handed group and 5.02±1.69 min in the Steinman pin group. The times of fluoroscopy during reduction was 12.56 ±2.01 in the bare-handed group and 5.01±1.51 in the Steinman pin group. There were significant differences in the above indexes ( t=12.19, 4.02, 5.47; all P < 0.05). All 54 patients were followed up for 12-51 months, with an average of 23.4 months. All the fractures healed, and there was no delayed union or nonunion. The healing time was 7.01±1.15 months in the bare-handed group and 5.99±0.97 months in the Steinman pin group. There were no significant difference. The HSS score of knee joint function was 23.7±4.1 before operation, 61.3±4.5 at 1 month after operation, 70.2±4.2 at 2 months after operation, 78.9±5.9 at 3 months after operation, 87.9±4.6 at 6 months after operation, and 93.1±5.8 at 12 months after operation, in the bare-handed group. Meanwhile, in the Steinman pin group, 22.5±3.8 before operation, 62.2±5.1 at 1 month after operation, 69.1±4.7 at 2 months after operation, 79.2±4.3 at 3 months after operation, 88.6±5.3 at 6 months after operation, and 92.3±6.1 at 12 months after operation. There were no significant difference between the two groups ( t=1.113, 0.689, 0.908, 0.212, 0.519, 0.494, P > 0.05). There were significant differences between the two groups at each time point before and after operation ( F=716.42, 815.52, P < 0.001). There were no complications such as injection point infection, vascular and nerve injury, failure of internal fixation and so on. Conclusion:Both groups had good functional recovery after operation. However, compared with bare-handed reduction, Steinman pin groupreduction has less intraoperative blood loss, shorter reduction time and less fluoroscopy times, which is a safer reduction method.

Objective To propose a concept of irreducible tibial shaft fractures and to discuss their imaging characteristics and clinical significance.Methods A retrospective study was performed in 21 patients with tibial shaft fracture who had received intraoperative intramedullary nailing after limited open reduction at Department of Orthopaedics,The Second Affiliated Hospital to Anhui Medical University from November 2013 to June 2018.They were 14 males and 7 females,aged from 21 to 66 years (average,34.9 years).There were 15 left and 6 right sides.Firstly,closed reduction was performed followed by traction,folding and rotation,but repeated attempts failed to achieve smooth reduction or insertion of guide wire.Next,local limited open reduction had to be performed for intramedullary nailing.The X-ray and CT images of the tibial fractures were collected to analyze their imaging characteristics.The imaging manifestations were characterized into 4 types:single-segment type with intact fibula,multiple-segment type,interlocking type where the distal and proximal ends interlock commonly seen in short spiral and short oblique fractures,and incarceration type where the fracture interspace is blocked by a bone fragment.The therapeutic efficacy was evaluated at the final follow-up by knee scores of The Hospital for Special Surgery (HSS) and Kofoed ankle scores.Results Of the 21 patients,2 were single-segment type,4 multiple-segment type,13 interlocking type and 2 incarceration type.They were followed up for 7 to 50 months (average,22.7 months).The fractures united after 5 to 16 months (average,7.3 months).Postoperative knee pain was observed in 3 cases and delayed fracture union in 2.Osteomyelitis,superficial wound infection,implant breakage or malunion occurred in none of the patients.The therapeutic efficacy evaluated at the final follow-up by HSS knee scores and Kofoed ankle scores revealed 15 excellent,4 good and 2 fair cases,yielding an excellent to good rate of 90.5％.Conclusion The concept of irreducible tibial shaft fractures may lead to preoperative awareness on the part of the surgeons so that ineffective repeated reductions can be spared and the damage to the blood supply to the fracture ends and the operation time can be reduced.

BACKGROUND:In an additional changing magnetic field, magnetosomes can invade the tumor cells and inhibit their proliferation.OBJECTIVE: To study the effect of targeted delivery of pHSP70-shPLK1/DOX compounds with magnetosome of magnetotactic bacteria on the treatment of osteosarcoma.METHODS: Human osteosarcoma cell U2OS was divided into four groups: group A: magnetosomes of magnetotactic bacteria+pHSP70-shPLK1/DOX complex; group B: magnetosomes of magnetotactic bacteria; group C: magnetosomes of magnetotactic bacteria+pHSP70-shPLK1/DOX complex, combined with magnetic intervention; group D: magnetosomes of magnetotactic bacteria, combined with magnetic intervention. After 12, 24, 48 and 72 hours of culture, the uptake rate of osteosarcoma cells was observed; cell cycle was evaluated by flow cytometry; PLK1 mRNA and protein expression levels were detected by RT-PCR and western blot, respectively; cell proliferation was explored by MTT assay; cell adhesion and invasion were checked by adhesion assay and Transwel chamber assay, respectively; and the apoptosis rate was measured by apoptosis detection Kit.RESULTS AND CONCLUSION: (1) After culture of 12 and 24 hours, the uptake rate was the highest in group D; meanwhile, the uptake rate was the highest in group B after 48 and 72 hours of culture. (2) The ratio of G2/M phase decreased and the ratio of G0/G1 increased gradualy in group A, group C and group D; the G2/M phase ratio of C group was the lowest at each time point, followed by group D, and that of group A was the highest; and the G2/M phase ratio increased gradualy in group B. (3) Folowing 12 and 24 hours of culture, the expression of PLK1 in group B and group D was higher than that in group A and group C (P < 0.05); in addition, the expression of PLK1 in group B was higher than that in the other three groups after 48 and 72 hours of culture (P < 0.05), and the PLK1 level in group D was higher than that in group A and group C (P < 0.05). (4) The proliferation, adhesion and invasion ability in group B were the highest at different time points, but the apoptosis rate was the lowest. Furthermore, the proliferation, adhesion and invasion abilities in group C were the lowest at different time points, and the apoptosis rate was the highest. To conclude, our experimental results show that the targeted delivery of pHSP70-shPLK1/DOX complex by magnetosomes of magnetotactic bacteria can enhance the apoptosis of osteosarcoma cells and inhibit their proliferation and invasion.

BACKGROUND:Positioning of the distal locking screws of a tibial intramedulary nail is often chalenging and time consuming. The traditional free-hand technique under fluoroscopic control involves considerable radiation exposure.OBJECTIVE: To evaluate the results of a new electromagnetic navigation system (TRIGEN-SURESHOT navigation system) for distal locking of tibial intramedullary nail in tibial diaphyseal fracture and to compare the effects with the free-hand method.METHODS: Forty-five cases of tibial diaphyseal fracture in the Second Hospital of Anhui Medical University from May 2014 to August 2015 were analyzed retrospectively, and were divided into two groups. Patients in navigation group (n=23) were treated with intramedullary nail using the TRIGEN-SURESHOT navigation system for distal locking, and the remainings in free-hand group (n=22) were given the free-hand method.RESULTS AND CONCLUSION: All cases were followed up for 17-32 months. The one-time success rate of distal locking nail operation was 100％ in the navigation group, which was significantly higher than that in the free-hand group (P < 0.05). The locking nail time in the navigation group was significantly less than that in the free-hand group (P < 0.05).No significant differences were found in the incidence of adverse events and fracture healing time between two groups (P > 0.05). To conclude, the effect of the TRIGEN-SURESHOT navigation system for distal locking of tibial intramedullary nail is satisfactory, exhibiting the advantages of short operation time, high success rate, and no radiation.

With a reflection on the grand quantitative analysis in previous historical investigations, microhistory came into being in Italy in the 1960s and the 70s. Microhistory is, in principle, the intensive historical investigation of a relatively well defined smaller object. Notwithstanding, it still has the ambition to draw a larger picture of the history. Microhistory is also characterized by its preference to the exceptional individuals or phenomena, its "narrative" style and the delicate way it deals with historical sources. Essentially, microhistory endeavors to bring the individual's role, the concrete life as well as the diversity and complexity of history to the historical writing. At first, microhistory did not have intersection with the medical history. Nevertheless, the history of medicine echoes microhistory in bringing the concrete and vivid life beings to history. Mainly due to this similarity, historical surveys on medicine from the perspective of microhistory are increasing and gradually develop into a remarkable trend in the international historical academy from the 1980s onwards. As the microhistory is rising and its influence is expanding, the microhistorical approach has been practiced to a certain extent in the historical writings on medicine in China. Concentrating on an individual person, a single event, a particular drug or a specific concept, there already have some studies conduct intensive historical investigation on a small scale. A small part of these researches, for example, those of Chang Che-Chia, Li Shang-jen and etc. could be regarded as perfect examples of microhistory. However, no relevant research is carried out explicitly under the heading of microhistory, instead, they are the offspring of the "new history". Besides, most of these researches could not be regarded as real microhistories, strictly speaking. They do not practice microhistory consciously and they have a long way to go to improve the delicacy of the analysis, to reinforce the narrative style and to grasp the social context of the individual or the event (the link between micro and macro levels). Nevertheless, these studies anyway indicate the invisible influence of microhistory and have paved a way for the future microhistorical investigations on medicine. We believe that microhistory is an undercurrent about to emerge in the field of Chinese medical history. It is the right time to advocate and promote the self-conscious microhistorical investigation, promptly and strongly, while updating the ideas and methods of it to make it a dominant trend rather than an undercurrent in the studies of Chinese medical history. Its rise would not only display the value and significance of microhistory in a better way, but also would help medical history to realize its core idea of history of life, therefore to propel our inquiry into Chinese medical history.
China ; *Historiography ; *History of Medicine