Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective:To evaluate a novel self-designed elbow flexion-extension axis guide that is easy to operate, accurately positioned, and X-ray-free.Methods:This study collected the elbow joint CT scans from 60 normal adults [40 males and 20 females with an age of (38.1±9.3) years] at Department of Orthopedics, The Third Hospital of Xiamen between September and December 2024. The scan images were imported into 3D modeling software for systematic measurement of key anatomical parameters of the distal humerus. The structural design of a novel elbow flexion-extension axis guide was completed based on these measurements, combined with the anatomical data of the distal humerus reported in 6 relevant articles between January 2008 and December 2024 retrieved from the CNKI and PubMed databases. After physical models of the distal humerus from the 60 healthy adults were fabricated using 3D printing technology, they were divided into 2 even groups: a guide-assisted group ( n=30) where the positioning needle was inserted with the assistance of the elbow flexion-extension axis guide and a conventional group ( n=30) where the positioning needle was inserted freehand. The entry deviation, exit deviation, inter-axial angle, inter-axial distance, operation time, and fluoroscopic verifications in positioning of elbow flexion-extension axis were compared between the 2 groups. Results:The guide-assisted group demonstrated significantly smaller values than the conventional group in entry deviation [(1.52±0.70) mm versus (2.29±1.00) mm], exit deviation [(2.83±1.49) mm versus (4.95±1.63) mm], inter-axial angle (3.46°±0.93° versus 6.45°±1.21°), and operation time [(92.0±17.0) s versus (509.5±42.3) s] (all P<0.05). The conventional group required an average of (10.7±2.1) fluoroscopic verifications, while the guide-assisted group eliminated radiation exposure. No statistically significant difference was observed in the inter-axial distance between the 2 methods in positioning of elbow flexion-extension axis ( P>0.05). Conclusion:As the novel self-designed elbow flexion-extension axis guide can improve accuracy in positioning the elbow flexion-extension axis without requiring fluoroscopy, it significantly shortens intraoperative positioning time, and is handy to use.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective:To evaluate a novel self-designed elbow flexion-extension axis guide that is easy to operate, accurately positioned, and X-ray-free.Methods:This study collected the elbow joint CT scans from 60 normal adults [40 males and 20 females with an age of (38.1±9.3) years] at Department of Orthopedics, The Third Hospital of Xiamen between September and December 2024. The scan images were imported into 3D modeling software for systematic measurement of key anatomical parameters of the distal humerus. The structural design of a novel elbow flexion-extension axis guide was completed based on these measurements, combined with the anatomical data of the distal humerus reported in 6 relevant articles between January 2008 and December 2024 retrieved from the CNKI and PubMed databases. After physical models of the distal humerus from the 60 healthy adults were fabricated using 3D printing technology, they were divided into 2 even groups: a guide-assisted group ( n=30) where the positioning needle was inserted with the assistance of the elbow flexion-extension axis guide and a conventional group ( n=30) where the positioning needle was inserted freehand. The entry deviation, exit deviation, inter-axial angle, inter-axial distance, operation time, and fluoroscopic verifications in positioning of elbow flexion-extension axis were compared between the 2 groups. Results:The guide-assisted group demonstrated significantly smaller values than the conventional group in entry deviation [(1.52±0.70) mm versus (2.29±1.00) mm], exit deviation [(2.83±1.49) mm versus (4.95±1.63) mm], inter-axial angle (3.46°±0.93° versus 6.45°±1.21°), and operation time [(92.0±17.0) s versus (509.5±42.3) s] (all P<0.05). The conventional group required an average of (10.7±2.1) fluoroscopic verifications, while the guide-assisted group eliminated radiation exposure. No statistically significant difference was observed in the inter-axial distance between the 2 methods in positioning of elbow flexion-extension axis ( P>0.05). Conclusion:As the novel self-designed elbow flexion-extension axis guide can improve accuracy in positioning the elbow flexion-extension axis without requiring fluoroscopy, it significantly shortens intraoperative positioning time, and is handy to use.

Objective:To study the minimally invasive fixation with virtual self-designed screws between the iliac plates for acetabular posterior column fractures and compare the differences between genders.Methods:The CT data were collected from the 80 patients with normal pelvis who had undergone pelvic CT scan due to physical examination or trauma at Department of Orthopaedics, The Third Hospital of Xiamen from June 2021 to June 2022. There were 40 males and 40 females with an age of (45.0±12.4) years. The virtual screws between the minimally invasive iliac plates were designed with design software after 3D modeling. The insertion point, screw length, screw diameter, angle between the screw and the coronal plane of the pelvis, angle between the screw and the sagittal plane of the pelvis, angle ε between the screw and the anterior edge bone crest line of the greater sciatic notch, and bone channel volume were measured. Comparisons of the above data were made between genders. Results:The insertion point of the screw between the minimally invasive iliac plates was located between the anterior superior iliac spine and the iliac tubercle nodule, going toward the area between the ischial spine and the small ischial notch. The screw length was (139.64±8.46) mm, the screw diameter (8.95±1.16) mm, and the bone channel volume (51.91±10.77) cm 3. The screw length [144.34±7.58) mm], screw diameter [9.50±0.98) mm], angle between the screw and the sagittal plane of the pelvis (31.14°±2.74°), and bone channel volume [(57.82±8.82) cm 3] for males were significantly larger than those for females [(134.95±6.48) mm, (8.40±1.07) mm, 26.72°±2.74°, and (46.01±9.22) cm 3], while the angle between the screw and the sagittal plane of the pelvis [(35.74°±3.85°) mm] and angle ε between the screw and the anterior edge bone crest line of the greater sciatic notch (11.96°±4.57°) for males were significantly smaller than those for females (36.89°±2.96° and 14.17°±5.15°) (all P < 0.05). Conclusions:Fixation with screws between the iliac plates provides a new treatment for acetabular posterior column fractures, because the screws can be placed percutaneously in a minimally invasive manner or antegradely. The screw length, screw diameter, angle between the screw and the sagittal plane of the pelvis, and bone channel volume for males are significantly larger than those for females, while the angle between the screw and the sagittal plane of the pelvis and the angle between the screw and the anterior edge bone crest line of the greater sciatic notch for males are significantly smaller than those for females. Therefore, the angles between the iliac plate screw and the sagittal and coronal planes of the pelvis should be adjusted according to gender in screw placement.

To understand the adverse reactions of Kan,glaite injection and its incidenceand explore the factors affecting the safety of Kan,glaite Injection in clinical use.Methods A noninterventional and prospective hospital based monitoring study and nested case-control study were conducted.All hospitalized cancer patients receiving Kan.glaite injections from 28 hospitals in northeast, north, central,east, south, southwest, northwest regions of China from September 2013 to September 2014 were enrolled in this study. The main monitoring contents included the general status of patients, the drug administration (including indications and combined use), medication safety, and so on. Patients developing adverse reactions related to Kan,glaite injection distributed in the case group and patients who did not develop adverse reactions were randomly selected and distributed into the control group with a ratio of l : 3 , and the factors that affect the safe use of Kan,glaite injection were analyzed.Results A total of 5 022 cancer patients were entered into the study, including 2 926 males and 2 096 females with age from 9 t0 95 years and their average age was (60 + 12) years. The top five tumors were lung cancer (1 456 patients,28.99%) ,intestinal cancer (867 patients,17.26% ) , marmuary cancer ( 372 patients, 7.41% ) , gastric cancer ( 346 patients, 6.89%) , and liver cancer (335 cases,6.67%). There were 3 863 patients (76.92% ) with tumor stage III and IV, 348 patients with allergic history (6.93%) ; 2 524 patients were complicated with other diseases (50.26% ) ; 4 687 patients (93.33%) had combined drug therapy.During the monitoring period,751(14.95%) of 5 022 patients developed adverse events and of them, 18 cases met the criteria of causality of adverse reactions, including 7 cases of phlebitis, 3 cases of nausea and vomiting, 3 cases of chills, 2 cases of rash, 1 case of palpitation, 1 case of transammase increase, and l case of fever. The incidence of adverse reactions was 0.36%. Univariate analysis showed that the incidence of adverse reactions in patients with combined diseases was higher than that in patients without combined diseases (X2=5.4723,P=0.019),the incidence of adverse reactions in patients with combined western medication was higher than that in patients with combined westem and Chinese medication (P=0.002).Logistic regression analysis showed that the influencing factors of adverse reactions were coexisting diseases (OR=1. 636, 95%C/:1.100-2.433,P= 0.013)and combined medication (OR=1.475,95%C/:1.108-1.965,P=0.027).Nested case-control study showed that the influencing factors of adverse reactions induced by Kan.glaite injection were radiotherapy (OR= 1.864,95% C/:0.930-3.736,P<0.01)and corubined medication (OR=1.622,95% C/:1.102-2.389,P<0.01) .Conclusions The incidence of adverse reactions of Kan,glaite injection in clinical application is lower and the safety is good. Coexisting diseases, combined medication and radiotherapy are main factors affecting its clinical safety.

To understand the adverse reactions of Kan,glaite injection and its incidenceand explore the factors affecting the safety of Kan,glaite Injection in clinical use.Methods A noninterventional and prospective hospital based monitoring study and nested case-control study were conducted.All hospitalized cancer patients receiving Kan.glaite injections from 28 hospitals in northeast, north, central,east, south, southwest, northwest regions of China from September 2013 to September 2014 were enrolled in this study. The main monitoring contents included the general status of patients, the drug administration (including indications and combined use), medication safety, and so on. Patients developing adverse reactions related to Kan,glaite injection distributed in the case group and patients who did not develop adverse reactions were randomly selected and distributed into the control group with a ratio of l : 3 , and the factors that affect the safe use of Kan,glaite injection were analyzed.Results A total of 5 022 cancer patients were entered into the study, including 2 926 males and 2 096 females with age from 9 t0 95 years and their average age was (60 + 12) years. The top five tumors were lung cancer (1 456 patients,28.99%) ,intestinal cancer (867 patients,17.26% ) , marmuary cancer ( 372 patients, 7.41% ) , gastric cancer ( 346 patients, 6.89%) , and liver cancer (335 cases,6.67%). There were 3 863 patients (76.92% ) with tumor stage III and IV, 348 patients with allergic history (6.93%) ; 2 524 patients were complicated with other diseases (50.26% ) ; 4 687 patients (93.33%) had combined drug therapy.During the monitoring period,751(14.95%) of 5 022 patients developed adverse events and of them, 18 cases met the criteria of causality of adverse reactions, including 7 cases of phlebitis, 3 cases of nausea and vomiting, 3 cases of chills, 2 cases of rash, 1 case of palpitation, 1 case of transammase increase, and l case of fever. The incidence of adverse reactions was 0.36%. Univariate analysis showed that the incidence of adverse reactions in patients with combined diseases was higher than that in patients without combined diseases (X2=5.4723,P=0.019),the incidence of adverse reactions in patients with combined western medication was higher than that in patients with combined westem and Chinese medication (P=0.002).Logistic regression analysis showed that the influencing factors of adverse reactions were coexisting diseases (OR=1. 636, 95%C/:1.100-2.433,P= 0.013)and combined medication (OR=1.475,95%C/:1.108-1.965,P=0.027).Nested case-control study showed that the influencing factors of adverse reactions induced by Kan.glaite injection were radiotherapy (OR= 1.864,95% C/:0.930-3.736,P<0.01)and corubined medication (OR=1.622,95% C/:1.102-2.389,P<0.01) .Conclusions The incidence of adverse reactions of Kan,glaite injection in clinical application is lower and the safety is good. Coexisting diseases, combined medication and radiotherapy are main factors affecting its clinical safety.

Capillary Leak Syndrome ; complications ; Cholestasis, Intrahepatic ; complications ; Humans ; Mucocutaneous Lymph Node Syndrome ; complications