With the rapid development of mobile internet technology, mobile health application (mHealth APP) are increasingly widely used in the field of health management and have been proven to play an important role in the management of chronic diseases. Solid organ transplant recipients face complex health management needs after surgery, including postoperative follow-up, medication management, prevention and treatment of complications and comorbidities, and lifestyle adjustment. mHealth APP can provide solid organ transplant recipients with convenient self-management tools. Although some progress has been made in this field, there are still many challenges, such as insufficient user experience, technological dependence, and data security risks. Therefore, this article discusses the development process, main functions and current application status of mHealth APP, and analyzes its advantages in improving the self-management ability of solid organ transplant recipients, promoting doctor-patient communication and reducing the incidence of complications. At the same time, based on the practical experience of author’s team in developing the “TransMate” mHealth APP, we propose the directions that mHealth APPs should focus on in the future, in order to provide more effective support and services for the health management of solid organ transplant recipients.

Objective:To compare the effectiveness between proximal femoral bionic nail (PFBN) and proximal femoral nail antirotation (PFNA) in the fixation of osteoporotic intertrochanteric fractures of the femur in the aged patients.Methods:A retrospective analysis was conducted of the data of 83 aged patients with intertrochanteric fracture of the femur who had been admitted to Department of Orthopaedics and Traumatology, Peking University People's Hospital from December 2020 to June 2022. The patients were divided into 2 groups based on their methods of internal fixation. In the PFBN group of 40 cases, there were 15 males and 25 females aged (81.4±9.1) years, and 27 cases of type 31-A2 and 13 cases of type 31-A3; in the PFNA group of 43 cases, there were 16 males and 27 females aged (80.2± 11.6) years, and 30 cases of type 31-A2 and 13 cases of type 31-A3. The 2 groups were compared in terms of surgical time, intraoperative blood loss, length of hospital stay, incidence of complications, and visual analogue scale (VAS), activity of daily living (ADL), and Harris hip score at 18 months after surgery.Results:The differences in preoperative general data between the 2 groups were not statistically significant, indicating comparability ( P>0.05). There was no statistically significant difference between the 2 groups in surgical time, intraoperative blood loss, hospital stay, or VAS pain score at 18 months after surgery ( P>0.05). The Harris hip score [(78.1±6.9) points] and ADL score [(69.0±15.0) points] at 18 months after surgery in the PFBN group were significantly higher than those in the PFNA group [(75.0±10.2) points and (61.8±14.9) points] ( P<0.05). The incidence of postoperative complications in the PFBN group was 5.0% (2/40), insignificantly lower than that in the PFNA group (14.0%, 6/43) ( P>0.05). Conclusions:Both PFBN and PFNA can achieve good therapeutic effects in the fixation of osteoporotic intertrochanteric fractures of the femur in the age patients. Compared with PFNA fixation, patients undergoing PFBN fixation may have better functional recovery of the hip joint and higher life quality.

Objective:To investigate the effect of internal fixation of medial support and lateral wall on initial weight-bearing stability of femoral intertrochanteric fracture after reconstruction of intertrochanteric fracture.Methods:Based on the digital model of Sawbones femur, intertrochanteric fracture models with different medial support and lateral wall states were constructed. Combined with various intramedullary and extramedullary fixation methods, the mechanical models after fixation were simplified, and seven mechanical simplified models were obtained. The individual body weight load (70 kg) was simulated by applying concentrated force (700 N) to the end nodes of the femoral head. Through the analysis and calculation of each model in StrucMaster software, the axial force, shear force, bending moment, displacement deformation, and support reaction force of each bar in each mechanical model were obtained, and the results were output through the supporting SMConsole.Results:The median bending moment of model 1 was 11.55(5.57, 18.00) N·m, and the median bending moment was 2.89(2.81, 2.94) rad. The median bending moment of model 2 was 13.72(9.30, 20.05) N·m, and the median bending moment was 2.93(2.77, 3.05) rad. The median bending moment of model 3 was 19.65(10.23, 26.11) N·m, and the median bending moment was 2.93 (2.77, 3.05) rad. The median bending moment of model 4 was 25.95(25.14, 36.70) N·m, and the median bending moment was 4.38(3.16, 5.15) rad. The median bending moment of model 5 was 13.66(7.99, 25.62) N·m, and the median bending moment was 3.50(3.32, 3.56) rad. The median bending moment of model 6 was 24.60(9.33, 29.37) N·m, and the median bending moment was 3.90(3.69, 4.10) rad. The median bending moment of model 7 was 41.14(0.16, 41.30) N·m, and the median bending moment was 5.50(5.50, 7.05) rad. The mechanical properties of model 1 were better than those of the other six models.Conclusion:The simplified mechanical model and its mechanical calculation analysis based on the lever reconstruction balance theory can be used to preliminarily reveal the mechanical characteristics of femoral intertrochanteric fractures after internal fixation. The internal fixation methods of the medial support and lateral wall of femoral intertrochanteric fracture reconstruction can improve the initial stability of the weight bearing after internal fixation of femoral intertrochanteric fractures and have guiding significance for the functional rehabilitation of early postoperative weight bearing.

Intertrochanteric femoral fracture occurs frequently in elderly osteoporotic patients, with high disability and mortality, for which surgical treatment is necessary. Common surgical modalities for intertrochanteric femoral fracture include intramedullary and extramedullary internal fixation systems, but neither can avoid the complications like internal fixation cut-out or internal fixation cut-through of the femoral head after surgery. The tip-apex distance theory was once considered to be of great significance in avoiding internal fixation cut-out, with the mainstream view was that screw cut-out could be avoided to the maximum extent when the tip-apex distance was ≤25 mm. However, internal fixation that meets the criteria of the tip-apex distance theory may also show cut-out and "Z-effect" in clinical practice, which lacks a reasonable explanation. Based on the lever balance reconstruction theory and the buttress-stretch effect, the author re-understands the value of the tip-apex distance theory in guiding treatment of intertrochanteric femoral fracture, hoping to propose an enlightenment for the treatment of intertrochanteric femoral fracture.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

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.

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.

Collum femoris preserving (CFP) is a surgical approach that emphasizes bone preservation, which can improve the stress distribution of the proximal femur, especially for young and active patients. Although the conventional CFP prosthesis has excellent short-term and medium-term clinical outcomes, and bone stock preservation is better than traditional total hip arthroplasty, it has not shown a higher prosthetic survival rate, which limits the broad application of CFP prosthesis. Compared with the conventional total hip prosthesis stem, the conventional CFP prosthesis improved the compressive stress transfer mechanism by retaining the femoral neck and moving the reconstruction fulcrum inward, neglecting the mechanical reconstruction of tensile stress transfer. Based on the theory of lever reconstruction balance, the bionic collum femoris preserving (BCFP) stem achieves the medial migration of the fulcrum based on preserving the femoral neck and proximal femoral bone and reconstructs the tension stress transmission mechanism through tension screws to reduce the stress shielding effect and improve the stress distribution. In addition to enhancing the initial stability of the prosthesis, the bionic fixation of the prosthesis is realized. Traditional total hip prosthesis and CFP prosthesis are plagued by long-term complications such as aseptic loosening and periprosthetic fractures. The innovative design of the BCFP prosthesis is expected to break new ground in addressing the longevity of the hip prosthesis.

Early internal fixation for intertrochanteric fracture of the femur can improve the quality of patients′ life and reduce disability and mortality. In the past, treatment of intertrochanteric fracture of the femur had some problems, such as head and neck screw cut-out, hip varus deformity, nail withdrawal, femoral neck shortening, and internal fixator fracture, etc., for which no reasonable explanation could be provided. The "lateral wall" theory has been recognized by most scholars and used to guide the development and clinical application of internal fixation, which has not entirely avoided the occurrence of the complications mentioned above. A correct understanding of the mechanics of the lateral wall of the proximal femur helps choose a reasonable internal fixation method for the treatment of intertrochanteric fracture of the femur to reduce the incidence of complications. The author firstly discusses the lateral wall measuring and fixation strengthening methods, reasonably explore the reasons for postoperative complications according to the theory of lever-pivot balance, and proposes that the proximal femoral bionic nail (PFBN) is an ideal choice for the treatment of intertrochanteric fracture of the femur.

Objective:To study the reason for failed fixation with dynamic hip screws (DHS) and the indications for DHS fixation in the treatment of intertrochanteric fracture based on the lever-balance-reconstruction theory.Methods:A retrospective analysis was performed of the data of 32 patients with intertrochanteric fracture who had been treated by DHS fixation at Department of Orthopaedic Trauma, Peking University People's Hospital from January 1999 to December 2019. There were 22 males and 10 females, aged from 34 to 91 years (average, 67.7 years). By the AO classification, 15 fractures were type 31-A1, 13 ones type 31-A2, and 4 ones type 31-A3. According to the lever-balance-reconstruction theory, after the position of postoperative fulcrum was determined depending on the relationship between fracture line and internal fixation, the medial and lateral force arms were measured after internal fixation. The 32 patients were divided into 2 groups according to the position of fulcrum after internal fixation. In group A of 13 patients, the fulcrum was located in or within the center of the medullary cavity; in group B of 19 patients, the fulcrum was located outside the center of the medullary cavity. The incidence of internal fixation failure was compared between the 2 groups.Results:Internal fixation failure occurred in 15 of the 32 patients: cutting out of the head and neck screws without penetration in 2 cases, screw withdrawal in 8 cases, hip varus deformity in 10 cases, and femoral neck shortening in 15 cases. The 2 groups were comparable because there were no statistically significant differences in their preoperative general data or types of internal fixation between them except AO classification ( P>0.05). The length of medial force arm (power arm) averaged 51.12 mm (from 39.4 to 57.9 mm) and the length of lateral force arm (resistance arm) 23.37 mm (from 15.1 to 31.0 mm) in group A where 3 patients experienced internal fixation failure after operation; the length of medial force arm (power arm) averaged 63.71 mm (from 52.3 to 74.5 mm) and the length of lateral force arm (resistance arm) 9.94 mm (from 3.1 to 18.3 mm) in group B where 12 patients experienced internal fixation failure after operation. There was a significant difference between the 2 groups in internal fixation failure ( P=0.036). Conclusions:In the DHS fixation of intertrochanteric fracture, the postoperative fixation failure is associated with the fulcrum position after reconstruction. DHS is only indicated for intertrochanteric fractures whose fracture line (post-reconstruction fulcrum) is near and inside the center of the medullary cavity, but not for those whose fracture line (post-reconstruction fulcrum) is outside the medullary cavity.