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.

Elbow Triad refers to an elbow dislocation combined with fractures of the radial head and the coronoid process, representing a complex elbow injury. Management of the elbow triad is challenging and often yields poor outcomes, frequently leading to complications such as elbow instability, ulnar nerve injury, and elbow stiffness. The injury mechanism of the elbow triad typically involves a fall on an outstretched arm, subjecting the forearm to supination, axial loading, and valgus stress. This force sequence results in progressive disruption of the elbow's anatomical structures from lateral to medial. Diagnosis requires particular attention to imaging assessment, and special attention should be paid to differentiating coronoid process fractures from elbow dislocation. Currently, there is no independent classification system, and diagnosis often relies on the modified Mason classification for radial head fractures and the Regan-Morrey and O'Driscoll classifications for coronoid process fractures. Non-surgical indications must be strictly defined and include: congruent joint reduction, absence of bony block to motion, a small or non-displaced coronoid fracture fragment, and inherent elbow stability. For the majority of cases requiring surgical treatment, a lateral approach is recommended, with a combined over-the-top approach when necessary. During surgery, the coronoid process fracture, radial head fracture, and lateral soft tissues should be addressed sequentially, with restoration of stability being crucial. Postoperative care should include early functional exercises and pay attention to preventing complications such as elbow instability, traumatic elbow stiffness, and ulnar nerve injury.

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.

Elbow Triad refers to an elbow dislocation combined with fractures of the radial head and the coronoid process, representing a complex elbow injury. Management of the elbow triad is challenging and often yields poor outcomes, frequently leading to complications such as elbow instability, ulnar nerve injury, and elbow stiffness. The injury mechanism of the elbow triad typically involves a fall on an outstretched arm, subjecting the forearm to supination, axial loading, and valgus stress. This force sequence results in progressive disruption of the elbow's anatomical structures from lateral to medial. Diagnosis requires particular attention to imaging assessment, and special attention should be paid to differentiating coronoid process fractures from elbow dislocation. Currently, there is no independent classification system, and diagnosis often relies on the modified Mason classification for radial head fractures and the Regan-Morrey and O'Driscoll classifications for coronoid process fractures. Non-surgical indications must be strictly defined and include: congruent joint reduction, absence of bony block to motion, a small or non-displaced coronoid fracture fragment, and inherent elbow stability. For the majority of cases requiring surgical treatment, a lateral approach is recommended, with a combined over-the-top approach when necessary. During surgery, the coronoid process fracture, radial head fracture, and lateral soft tissues should be addressed sequentially, with restoration of stability being crucial. Postoperative care should include early functional exercises and pay attention to preventing complications such as elbow instability, traumatic elbow stiffness, and ulnar nerve injury.

Objective:To explore the comparison of imaging characteristics and diagnostic value between ultrasound and CT in patients with pulmonary tuberculosis in Tibetan population in plateau region.Methods:From May 2022 to November 2023,a total of 100 patients with pulmonary tuberculosis of Tibetan population in plateau region,who admitted to Qinghai Provincial Hospital of Traditional Chinese Medicine,were selected as the study objects.All of them were examined by ultrasound and CT.The ultrasonic imaging characteristics of the lesions of patients with pulmonary tuberculosis in plateau region were dynamically observed.And then,the diagnostic effects of ultrasound and CT on pulmonary tuberculosis in the Tibetan population in the plateau region were compared.Results:There was no significant difference in the positive rate of pulmonary tuberculosis in Tibetan population of plateau region between ultrasound and CT examinations(x2=0.421,P＞0.05).The diagnostic sensitivity,diagnostic specificity and Yoden index of ultrasound diagnosis were respectively 97.80%,44.44%and 42.24%,and these of CT diagnosis were respectively 96.77%,42.86%and 39.63%,and the differences were not significant(x2=0.184,0.004,0.272,P＞0.05),respectively.There was no significant difference in detection rate of the distribution of pulmonary tuberculosis lesions in Tibetan population in plateau region between ultrasound and CT examinations(x2=2.011,P＞0.05).There were no significant differences in the detection rates of atelectasis,cavity,calcification and accompany of pleural effusion between ultrasound and CT examinations in patients with pulmonary tuberculosis in Tibetan population in plateau region(x2=0.190,0.197,0.190,0.046,P＞0.05).Conclusion:There are no significant differences in positive detection rate,the detection rate of the distribution of diseased lung lobes,the detection rates of the complication of pulmonary tuberculosis or associated signs such as atelectasis,cavity,calcification and accompany of pleural effusion between ultrasound and CT examinations.The medical resource of plateau region is lack,which is shorter of large examination equipment.Therefore,using ultrasound examination to conduct general survey and preliminary diagnosis for pulmonary tuberculosis is more suitable to the plateau region that lacks CT equipment or is affected by electricity

Objective:To examine the prevention effecacy and safety of preprotein convertase subtilisin-kexin 9 (PCSK9) inhibitors in stroke in patients with atherosclerotic cardiovascular disease (ASCVD) at primary and secondary prevention.Methods:PubMed, Embase, Web of Science, Cochrane Library, and Wanfang and CNKI databases were searched for randomized controlled trials comparing evolocumab, alirocumab, tafolecimab or inclisiran (experimental group) with placebo or conventional therapy (control group) in hyperlipidemia and ASCVD from inception to March 2024. Valid data were extracted after screening and applying Cochrane Literature quality assessment tool to assess the literature quality. Efficacy outcome (incidences of stroke and ischemic stroke) and safety outcome (cardiovascular mortality, and incidences of aminotransferase increased by more than 3 times, creatine kinase increased by more than 3 times, allergic reaction and hemorrhagic stroke) were recorded. Meta analysis of the extracted data was conducted using Stata software to calculate the risk difference ( RD). Results:Twenty articles (21 randomized controlled trials) were included with 62 799 patients. For primary prevention, no significant difference was found between PCSK9 inhibitors and control groups in stroke incidence ( RD=0.000, 95% CI: -0.002-0.003, P=0.905) or ischemic stroke incidence ( RD=0.001, 95% CI: -0.005-0.006, P=0.824); incidence of creatine kinase increased by more than 3 times in the PCSK9 inhibitors group was significantly decreased compared with that in the control group ( RD=-0.005, 95% CI: -0.010-0.000, P=0.039). For secondary prevention, PCSK9 inhibitors group had significantly reduced stroke incidence ( RD=-0.004, 95% CI: -0.006--0.002, P<0.001) and ischemic stroke incidence ( RD=-0.003, 95% CI: -0.005--0.002, P<0.001) compared with control group; no significant differences in cardiovascular mortality, or incidences of aminotransferase increased by more than 3 times, creatine kinase increased by more than 3 times, allergic reaction and hemorrhagic stroke were noted between the PCSK9 inhibitors group and control group ( P>0.05). Conclusion:PCSK9 inhibitors in primary prevention have no significant effect on stroke or ischemic stroke incidences, but can decrease the incidence of creatine kinase increased by more than 3 times; PCSK9 inhibitors in secondary prevention can reduce stroke and ischemic stroke incidences without increasing complications and thus enjoying certain safety.

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.

Objective:To evaluate the preventive role and safety of evolocumab and alirocumab in ischemic stroke in hyperlipidemia and atherosclerotic high-risk cardiovascular patients.Methods:PubMed, Embase, Web of Science, Cochrane Library, Wanfang, and CNKI databases were searched for randomized controlled trials (RCTs) comparing evolocumab or alirocumab (experimental group) with placebo or usual care (control group) in hyperlipidemia and atherosclerotic high-risk cardiovascular patients from database inception to March 2023. References were screened and data were extracted according to the preset inclusion and exclusion criteria; incidence of ischemic stroke was as the efficacy index, and incidences of cardiovascular death, cognitive impairment, aminotransferase increased for more than 3 times and creatine kinase increased for more than 3 times were as the safety index. Cochrane Reviewer Handbook 2.0 was used to evaluate the RCTs literature quality. Meta analysis was performed using Stata software.Results:A total of 11 articles were included, including 12 studies with a total of 53 666 patients. Compared with the control group, the incidence of ischemic stroke in the experimental group was significantly decreased (risk difference [ RD]=-0.004, 95% CI: -0.005--0.002, P<0.001); there were no significant differences in the incidence of cardiovascular death, cognitive impairment, aminotransferase increased for more than 3 times and creatine kinase increased for more than 3 times between the 2 groups ( RD=-0.001, 95% CI: -0.004-0.001, P=0.401; RD=0.000, 95% CI: -0.003-0.002, P=0.638; RD=-0.001, 95% CI: -0.004-0.002, P=0.443; RD=-0.001, 95% CI: -0.003-0.000, P=0.137). Subgroup analysis was performed according to drugs: compared with the control group, the incidence of ischemic stroke was significantly reduced in the evolocumab group and alirocumab group ( RD=-0.004, 95% CI: -0.007--0.001, P=0.006; RD= -0.003, 95% CI: -0.006-0.000, P=0.024); there were no significant differences in incidences of cardiovascular death ( RD=0.001, 95% CI: -0.002-0.004, P=0.619; RD=-0.003, 95% CI: -0.007-0.001, P=0.100), cognitive impairment ( RD=0.001, 95% CI:-0.002-0.004, P=0.463; RD=-0.002, 95% CI: -0.005-0.001, P=0.145), aminotransferase increased for more than 3 times ( RD=0.000, 95% CI: -0.003-0.003, P=0.888; RD=-0.002, 95% CI: -0.007-0.003, P=0.392) or creatine kinase increased for more than 3 times ( RD=0.000, 95% CI: -0.002-0.002, P=0.668; RD=-0.002, 95% CI: -0.005-0.000, P=0.106) between the evolocumab group and alirocumab group. Subgroup analysis was performed according to the medication duration: compared with the control group, no significant differences in incidences of cardiovascular death ( RD=0.000, 95% CI:-0.022-0.022, P=1.000; RD=-0.003, 95% CI: -0.009-0.002, P=0.193; RD=-0.001, 95% CI:-0.004-0.002, P=0.521), cognitive impairment ( RD=-0.003, 95% CI: -0.014-0.008, P=0.569; RD=-0.001, 95% CI: -0.006-0.004, P=0.696; RD=0.000, 95% CI: -0.003-0.002, P=0.735), aminotransferase increased for more than 3 times ( RD=-0.002, 95% CI: -0.016-0.012, P=0.749; RD=-0.002, 95% CI: -0.013-0.010, P=0.773; RD=-0.001, 95% CI: -0.004-0.002, P=0.489) or creatine kinase increased for more than three times ( RD=-0.015, 95% CI: -0.032-0.003, P=0.099; RD= -0.011, 95% CI: -0.025-0.002, P=0.104; RD=0.000, 95% CI: -0.002-0.001, P=0.722) were noted among medication duration<1 year group, medication duration of 1-2 years group and medication duration>2 years group. Conclusion:Both evolocumab and alirocumab can reduce the incidence of ischemic stroke in hyperlipidemia and atherosclerotic high-risk cardiovascular patients, with good safety.