For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

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

Objective:To compare the efficacy of double reverse traction reduction combined with minimally invasive percutaneous plate osteosynthesis (MIPO) and traditional reduction combined with MIPO in treating distal femoral fractures in the elderly.Methods:A retrospective cohort study was conducted to analyze the clinical data of 78 elderly patients with distal femoral fractures admitted to Third Hospital of Hebei Medical University from January 2021 to June 2023, including 16 males and 62 females, aged 60-85 years [(74.5±7.1)years]. The bone mineral density T-score was (-2.1±0.9)SD. According to the Orthopedic Trauma Association (OTA) classification, the fractures were classified as type 33-A1 in 27 patients, type 33-A2 in 36, and type 33-A3 in 15. Forty-three patients underwent traditional reduction combined with MIPO (traditional reduction group), while 35 patients received double reverse traction reduction combined with MIPO (double reverse traction group). The two groups were compared in terms of operation time, intraoperative blood loss, number of intraoperative fluoroscopies, time to initial callus formation, radiographic healing time, range of motion of knee flexion and extension and Knee Society score (KSS) at 1 and 3 months postoperatively and at the last follow-up, and the incidence of postoperative complications.Results:All the patients were followed up for 6-18 months [(14.4±2.6)months]. The operation time, intraoperative blood loss and number of intraoperative fluoroscopies were (73.7±7.6)minutes, (112.4±32.3)ml, and (9.8±4.5)times in the double reverse traction group, which were significantly reduced compared with those in the traditional reduction group [(95.2±10.0)minutes, (139.7±49.5)ml, (15.2±3.9)times] in the traditional reduction group ( P<0.01). There was no significant difference in the time to initial callus formation between the two groups ( P>0.05). The radiographic healing time in the double reverse traction group was (25.9±5.1)weeks, shorter than (29.6±8.2)weeks in the traditional reduction group ( P<0.05). At 1 month postoperatively, range of motion of knee flexion and extension in the double reverse traction group was (96.4±5.0)°, greater than (93.9±3.7)° in the traditional reduction group ( P<0.05), and there was no significant difference between the two groups at 3 months postoperatively or at the last follow-up ( P>0.05). KSS scores at 1 and 3 months postoperatively and at the last follow-up showed no significant difference between the two groups ( P>0.05). No malunions occurred in the double reverse traction group, while 9.3% (4/43) in the traditional reduction group had malunion ( P>0.05). No nonunion or infection was observed in either group. Conclusion:Compared with traditional reduction combined with MIPO, double reverse traction reduction combined with MIPO for elderly distal femoral fractures can shorten operation time, reduce intraoperative blood loss and the number of fluoroscopies, promote fracture healing, and facilitate early recovery of knee joint function.

Objective:To compare the efficacy of double reverse traction reduction combined with minimally invasive percutaneous plate osteosynthesis (MIPO) and traditional reduction combined with MIPO in treating distal femoral fractures in the elderly.Methods:A retrospective cohort study was conducted to analyze the clinical data of 78 elderly patients with distal femoral fractures admitted to Third Hospital of Hebei Medical University from January 2021 to June 2023, including 16 males and 62 females, aged 60-85 years [(74.5±7.1)years]. The bone mineral density T-score was (-2.1±0.9)SD. According to the Orthopedic Trauma Association (OTA) classification, the fractures were classified as type 33-A1 in 27 patients, type 33-A2 in 36, and type 33-A3 in 15. Forty-three patients underwent traditional reduction combined with MIPO (traditional reduction group), while 35 patients received double reverse traction reduction combined with MIPO (double reverse traction group). The two groups were compared in terms of operation time, intraoperative blood loss, number of intraoperative fluoroscopies, time to initial callus formation, radiographic healing time, range of motion of knee flexion and extension and Knee Society score (KSS) at 1 and 3 months postoperatively and at the last follow-up, and the incidence of postoperative complications.Results:All the patients were followed up for 6-18 months [(14.4±2.6)months]. The operation time, intraoperative blood loss and number of intraoperative fluoroscopies were (73.7±7.6)minutes, (112.4±32.3)ml, and (9.8±4.5)times in the double reverse traction group, which were significantly reduced compared with those in the traditional reduction group [(95.2±10.0)minutes, (139.7±49.5)ml, (15.2±3.9)times] in the traditional reduction group ( P<0.01). There was no significant difference in the time to initial callus formation between the two groups ( P>0.05). The radiographic healing time in the double reverse traction group was (25.9±5.1)weeks, shorter than (29.6±8.2)weeks in the traditional reduction group ( P<0.05). At 1 month postoperatively, range of motion of knee flexion and extension in the double reverse traction group was (96.4±5.0)°, greater than (93.9±3.7)° in the traditional reduction group ( P<0.05), and there was no significant difference between the two groups at 3 months postoperatively or at the last follow-up ( P>0.05). KSS scores at 1 and 3 months postoperatively and at the last follow-up showed no significant difference between the two groups ( P>0.05). No malunions occurred in the double reverse traction group, while 9.3% (4/43) in the traditional reduction group had malunion ( P>0.05). No nonunion or infection was observed in either group. Conclusion:Compared with traditional reduction combined with MIPO, double reverse traction reduction combined with MIPO for elderly distal femoral fractures can shorten operation time, reduce intraoperative blood loss and the number of fluoroscopies, promote fracture healing, and facilitate early recovery of knee joint function.

Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

Most patients with spinal cord injury suffer from limb motor dysfunction. Given drugs, surgery and other conventional treatments are often not effective, the patients can only rely on a wheelchair to move or even lie in bed for a long time, seriously affecting their quality of life. Brain computer interface (BCI) technology provides a non-muscular pathway for the recovery of motor function in patients with spinal cord injury, which allows the patients to recover partial motor function through the normal function of their own non-diseased spinal cord or external mechanical devices. After decades of development of BCI technology, signal collection devices can identify and collect the motor signals of the brain more accurately, transform the signal by characteristic analysis, and implement the brain command by using the output device. A large number of experimental and clinical studies have also proved that the application of BCI technology in patients with spinal cord injury can partially improve the motor function of upper and lower limbs. Therefore, BCI technology has attracted more and more attention. The authors summarized the BCI technology and its influence on motor function rehabilitation in patients with spinal cord injury, so as to provide a reference for the rehabilitation of motor function in patients with spinal cord injury.

As the National Health Commission changes the management of novel corona virus infection, the situation and preventive policies for controlling the epidemic have also entered a new stage in China. Perioperative care strategies for orthopedic trauma such as designated isolation and nucleic acid test screening have also been adjusted in the new stage. Based on the perioperative work experiences in the new stage of epidemic from the frontline anti-epidemic staff of orthopedics in domestic hospitals and combined with the literature and relevant evidence-based medical data in perioperative care of orthopedic trauma patients under the current anti-epidemic policies at home and abroad, Chinese Orthopedic Association and Chinese Society of Traumatology organized relevant experts to formulate the Guideline for clinical perioperative care of orthopedic trauma patients in the new stage of novel corona virus infection ( version 2023). The guideline summarized 16 recommendations from the aspects of preoperative diagnosis and treatment, infection prevention, emergency operation and postoperative management to systematically standardize the perioperative clinical pathways, diagnosis and treatment processes of orthopedic trauma in the new stage of novel corona virus infection, so as to provide a guidance and reference for hospitals at all levels to carry out relevant work in current epidemic control policies.