Open reduction and internal fixation are the preferred methods for treating intra-articular fractures of the distal humerus. However, in cases of comminuted fractures, open reduction and internal fixation may result in loss of reduction. Although total elbow arthroplasty can be used as an alternative treatment option, total elbow arthroplasty has several limitations, including excessive bone removal, strict weight-bearing restrictions, polyethylene liner wear, and alterations in biomechanical properties. Elbow hemiarthroplasty is emerging as a novel surgical technique, only the distal end of the humerus is replaced while the proximal end of the ulna and radius is retained. Particularly for patients with high functional demands, elbow hemiarthroplasty may be a viable treatment option. This technique is particularly suitable for young patients with severely comminuted and non-reconstructive intra-articular fractures. Postoperative complications of elbow hemiarthroplasty include elbow stiffness, proximal wear of the ulna and radius, and prosthesis loosening, etc. In some cases, total elbow prosthesis revision is required. Existing research has initially confirmed that elbow hemiarthroplasty has certain advantages in terms of safety and elbow joint function recovery. Additionally, to better accommodate the anatomical characteristics of the Chinese population, customized 3D-printed prostheses based on the contralateral distal humerus and the ipsilateral proximal ulna and radius can be utilized. Further research and development of elbow hemiarthroplasty and novel technologies tailored to the Chinese population should be encouraged to enhance the precise treatment of complex elbow injuries in China.

Objective:To explore the surgical treatment strategies for Mason type III radial head fractures complicated with adult Bado type II Monteggia fractures.Methods:A retrospective analysis was performed on the clinical data of 25 adult patients with Mason type III radial head fractures complicated with adult Bado type II Monteggia fractures, admitted to the Upper Extremity Orthopaedics Department of Zhengzhou Orthopaedic Hospital from June 2013 to June 2023. There were 15 males and 10 females, with an average age of 43.5±14.7 years (range: 20-67 years). Among them, 5 cases were complicated with humeroulnar joint dislocation. The patients were divided into two groups: 17 cases were treated with open reduction and internal fixation (ORIF) of radial head fractures combined with ORIF of proximal ulnar fractures (open reduction group), and 8 cases were treated with radial head replacement combined with ORIF of proximal ulnar fractures (radial head replacement group). At the last follow-up, elbow joint range of motion was recorded, and pain, elbow function, and subjective upper limb function were evaluated using the Visual Analogue Scale (VAS), Mayo Elbow Performance Score (MEPS), and Disabilities of the Arm, Shoulder and Hand (DASH) scale. The incidence of complications was also recorded.Results:All 25 patients were followed up for an average of 25.6±9.0 months (range: 12-45 months). At the last follow-up, the affected elbows in the open reduction group had a flexion of 124.47°±12.59° (range, 90°-140°), extension of 21.12°±10.07° (range, 10°-50°), pronation of 48.59°±11.62° (range, 20°-61°), and supination of 48.53°±8.43° (range, 30°-60°). In the radial head replacement group, the affected elbows showed flexion of 128.75°±13.17° (range, 100°-140°), extension of 14.00°±7.71° (range, 0°-25°), pronation of 61.25°±10.26° (range, 60°-80°), and supination of 71.88°±10.33° (range, 60°-80°). The MEPS score in the open reduction group was 82(75, 85) points (range, 55-90 points), the VAS pain score was 1(1, 2) points (range, 0-3 points), and the DASH score was 9(8, 14) points. In the radial head replacement group, the MEPS score was 90(85, 90) points (range, 85-90 points), the VAS pain score was 1(0, 1) points (range, 0-1 points), and the DASH score was 5(5, 6) points. Complications included 5 cases of heterotopic ossification, 1 case of incision infection, 1 case of nonunion, 1 case of ulnar nerve injury combined with traumatic arthritis, and 1 case of proximal radioulnar bone bridge formation.Conclusions:Both radial head replacement and open reduction internal fixation combined with proximal ulnar fracture fixation can effectively treat Mason type III radial head fractures complicated with adult Bado type II Monteggia fractures. There was no significant difference in postoperative flexion and extension, but the radial head replacement group demonstrated better forearm rotation and DASH scores postoperatively.

Objective:To establish a quality standard for the bacterial endotoxin test method of fructose sodium diphosphate injections(FDP injections),so as to provide reference for the formulation and revision of the national standard for this drug.Methods:The interference test and bacterial endotoxins test of 22 batch samples of FDP in-jections from nine manufacturers were performed with TALs,and the bacterial endotoxins of samples were tested and the results were judged.Results:A bacterial endotoxin limit value of 0.72 EU·mg-1 for fructose sodium diphos-phate was established,which was suitable for 22 batches of FDP injections met the requirements.Conclusion:The bacterial endotoxin test method established in this study can be used to substitute the rabbit pyrogen test and meet the quality control requirements of FDP injections.

Objective:To summarize the relevant evidence of the prevention and management of early childhood caries, so as to provide reference for clinical practice.Methods:A systematic search was conducted across the following databases: Embase, CINAHL, PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang Data, and VIP Information. In addition, relevant guideline platforms and official websites of professional dental associations were consulted to obtain clinical guidelines, evidence summaries, expert consensus statements, systematic reviews, and Meta-analyses related to the prevention and management of early childhood caries. The retrieval time limit was from database establishment to April 11, 2024. The included literature was assessed for quality, and evidence was extracted and summarized.Results:A total of 14 articles were included, consisting of 8 guidelines, 2 expert consensus, 1 evidence summary, and 3 systematic evaluations.These covered 7 areas: assessment and evaluation, fluoride application, fissure sealing, oral health education, behavior guidance, dietary guidance, and social support, resulting in 32 best evidence statements.Conclusions:The best evidence for prevention and management of early childhood caries can provide evidence-based evidence for clinical prevention and management of early childhood caries.

Objective:To establish a quality standard for the bacterial endotoxin test method of fructose sodium diphosphate injections(FDP injections),so as to provide reference for the formulation and revision of the national standard for this drug.Methods:The interference test and bacterial endotoxins test of 22 batch samples of FDP in-jections from nine manufacturers were performed with TALs,and the bacterial endotoxins of samples were tested and the results were judged.Results:A bacterial endotoxin limit value of 0.72 EU·mg-1 for fructose sodium diphos-phate was established,which was suitable for 22 batches of FDP injections met the requirements.Conclusion:The bacterial endotoxin test method established in this study can be used to substitute the rabbit pyrogen test and meet the quality control requirements of FDP injections.

Open reduction and internal fixation are the preferred methods for treating intra-articular fractures of the distal humerus. However, in cases of comminuted fractures, open reduction and internal fixation may result in loss of reduction. Although total elbow arthroplasty can be used as an alternative treatment option, total elbow arthroplasty has several limitations, including excessive bone removal, strict weight-bearing restrictions, polyethylene liner wear, and alterations in biomechanical properties. Elbow hemiarthroplasty is emerging as a novel surgical technique, only the distal end of the humerus is replaced while the proximal end of the ulna and radius is retained. Particularly for patients with high functional demands, elbow hemiarthroplasty may be a viable treatment option. This technique is particularly suitable for young patients with severely comminuted and non-reconstructive intra-articular fractures. Postoperative complications of elbow hemiarthroplasty include elbow stiffness, proximal wear of the ulna and radius, and prosthesis loosening, etc. In some cases, total elbow prosthesis revision is required. Existing research has initially confirmed that elbow hemiarthroplasty has certain advantages in terms of safety and elbow joint function recovery. Additionally, to better accommodate the anatomical characteristics of the Chinese population, customized 3D-printed prostheses based on the contralateral distal humerus and the ipsilateral proximal ulna and radius can be utilized. Further research and development of elbow hemiarthroplasty and novel technologies tailored to the Chinese population should be encouraged to enhance the precise treatment of complex elbow injuries in China.

Objective:To explore the surgical treatment strategies for Mason type III radial head fractures complicated with adult Bado type II Monteggia fractures.Methods:A retrospective analysis was performed on the clinical data of 25 adult patients with Mason type III radial head fractures complicated with adult Bado type II Monteggia fractures, admitted to the Upper Extremity Orthopaedics Department of Zhengzhou Orthopaedic Hospital from June 2013 to June 2023. There were 15 males and 10 females, with an average age of 43.5±14.7 years (range: 20-67 years). Among them, 5 cases were complicated with humeroulnar joint dislocation. The patients were divided into two groups: 17 cases were treated with open reduction and internal fixation (ORIF) of radial head fractures combined with ORIF of proximal ulnar fractures (open reduction group), and 8 cases were treated with radial head replacement combined with ORIF of proximal ulnar fractures (radial head replacement group). At the last follow-up, elbow joint range of motion was recorded, and pain, elbow function, and subjective upper limb function were evaluated using the Visual Analogue Scale (VAS), Mayo Elbow Performance Score (MEPS), and Disabilities of the Arm, Shoulder and Hand (DASH) scale. The incidence of complications was also recorded.Results:All 25 patients were followed up for an average of 25.6±9.0 months (range: 12-45 months). At the last follow-up, the affected elbows in the open reduction group had a flexion of 124.47°±12.59° (range, 90°-140°), extension of 21.12°±10.07° (range, 10°-50°), pronation of 48.59°±11.62° (range, 20°-61°), and supination of 48.53°±8.43° (range, 30°-60°). In the radial head replacement group, the affected elbows showed flexion of 128.75°±13.17° (range, 100°-140°), extension of 14.00°±7.71° (range, 0°-25°), pronation of 61.25°±10.26° (range, 60°-80°), and supination of 71.88°±10.33° (range, 60°-80°). The MEPS score in the open reduction group was 82(75, 85) points (range, 55-90 points), the VAS pain score was 1(1, 2) points (range, 0-3 points), and the DASH score was 9(8, 14) points. In the radial head replacement group, the MEPS score was 90(85, 90) points (range, 85-90 points), the VAS pain score was 1(0, 1) points (range, 0-1 points), and the DASH score was 5(5, 6) points. Complications included 5 cases of heterotopic ossification, 1 case of incision infection, 1 case of nonunion, 1 case of ulnar nerve injury combined with traumatic arthritis, and 1 case of proximal radioulnar bone bridge formation.Conclusions:Both radial head replacement and open reduction internal fixation combined with proximal ulnar fracture fixation can effectively treat Mason type III radial head fractures complicated with adult Bado type II Monteggia fractures. There was no significant difference in postoperative flexion and extension, but the radial head replacement group demonstrated better forearm rotation and DASH scores postoperatively.

Objective:To summarize the relevant evidence of the prevention and management of early childhood caries, so as to provide reference for clinical practice.Methods:A systematic search was conducted across the following databases: Embase, CINAHL, PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang Data, and VIP Information. In addition, relevant guideline platforms and official websites of professional dental associations were consulted to obtain clinical guidelines, evidence summaries, expert consensus statements, systematic reviews, and Meta-analyses related to the prevention and management of early childhood caries. The retrieval time limit was from database establishment to April 11, 2024. The included literature was assessed for quality, and evidence was extracted and summarized.Results:A total of 14 articles were included, consisting of 8 guidelines, 2 expert consensus, 1 evidence summary, and 3 systematic evaluations.These covered 7 areas: assessment and evaluation, fluoride application, fissure sealing, oral health education, behavior guidance, dietary guidance, and social support, resulting in 32 best evidence statements.Conclusions:The best evidence for prevention and management of early childhood caries can provide evidence-based evidence for clinical prevention and management of early childhood caries.

Objective:To evaluate the surgical treatment of ulnar olecranon avulsion fracture complicated with radial head fracture.Methods:A retrospective study was conducted to analyze the clinical data of 13 patients who had been treated at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital for ulnar olecranon avulsion fracture complicated with radial head fracture from July 2016 to February 2022. There were 9 males and 4 females with an age of (38.1±11.7 years), and 6 cases on the dominant side and 7 cases on the non-dominant side. According to Mason classification of radial head fractures, there were 1 case of type Ⅰ, 1 cases of type Ⅱ and 11 cases of type Ⅲ. All patients were treated surgically and their radial head fractures were prioritized. For radial head fractures, 10 patients were treated with open reduction and internal fixation, and 3 patients with radial head replacement. For ulnar olecranon avulsion fractures, 11 patients were treated with repair of tendon insertions, and 2 patients with tendon repair only. At the last follow-up, the elbow mobility was recorded, and Mayo elbow performance score (MEPS), visual analogue scale (VAS) for pain, and Disabilities of the Arm, Shoulder and Hand (DASH) scoring were applied to assess the elbow function, pain, and subjective upper extremity function. Complications and secondary surgeries were also followed up.Results:The 13 patients were followed up for (37.6±18.5) months after operation. At the last follow-up, the flexion and extension was 102.3°±19.6° (from 70° to 130°), and the pronation-supination was 149.6°±20.0° (from 110° to 170°). Nonunion of the radial head fracture occurred in 1 patient, stiffness of the elbow in 3 patients, and ulnar nerve dysfunction in 1 patient. A total of 4 secondary surgeries were performed in 3 patients. At the last follow-up, in the 13 patients, the MEPS score was 100.0 (85.0, 100.0) points with a range from 75 to 100 points; the VAS score was 0.0(0.0, 2.0) point with a range from 0 to 3 points; the DASH score was 2.5 (1.3, 8.3) points with a range from 0 to 21 points.Conclusions:As ulnar olecranon avulsion fracture complicated with radial head fracture is not common, timely identification and clear diagnosis of such injury is very important. Surgical treatment may result in fine outcomes.

Objective:To compare the efficacy between olecranon sled fixation and tension band wiring fixation in the treatment of Mayo ⅡA olecranon fractures.Methods:A retrospective study was conducted to analyze the data of 54 patients with Mayo ⅡA olecranon fracture who had been admitted to Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital from October 2018 to February 2021. There were 20 males and 34 females with an age of (45.5±17.7 years), and 36 left and 18 right sides. They were divided into 2 groups according to different methods of internal fixation. Group A (25 cases) was subjected to olecranon sled fixation and group B (29 cases) to tension band wiring fixation. Preoperative data, operation time, reoperations and complications during follow-up were recorded and compared between the 2 groups. In both groups at the last follow-up, the range of the elbow motion, the Mayo elbow performance score (MEPS) and the Disabilities of the Arm, Shoulder and Hand (DASH) score were recorded to evaluate the elbow function.Results:The 2 groups were comparable because there were no significant differences in all their preoperative demographic data ( P>0.05). There were no significant differences between the 2 groups either in follow-up time [(32.8±8.9) months for group A and (35.8±9.0) months for group B] or in operation time [60.0 (60.0, 82.5) min for group A and 60.0 (60.0, 67.5) min for group B] ( P>0.05). At the last follow-up in group A and group B, respectively, the flexion and extension of the elbow was 141.0°±8.4° and 140.0 (140.0, 150.0)°, the pronation-supination 180.0 (175.0, 180.0)° and 180.0 (175.0, 180.0)°, the MEPS score 100.0 (85.0, 100.0) and 100.0 (92.5, 100.0), and the DASH score 4.2 (1.7, 6.3) and 5.8 (1.3, 8.3), all showing no statistically significant differences between the 2 groups ( P>0.05). Olecranon skin irritation occurred in 5 patients (20.0%,5/25) in group A and in 15 patients (51.7%,15/29) in group B, and 7 patients (28.0%,7/25) in group A and 21 patients (72.4%,21/29) in group B underwent removal of internal fixation, both showing statistically significant differences between the 2 groups ( P<0.05). Conclusion:In the treatment of Mayo ⅡA olecranon fractures, compared with tension band wiring fixation, olecranon sled fixation may lead to comparable efficacy in fixation and functional recovery, but significantly reduced rates of complications and internal fixation removal.