BACKGROUND:For elderly patients with traumatic hip fractures,the related factors of prognosis are very complex,and the integrity of the lateral wall is one of the influencing factors.It is of important clinical value to understand the effect of lateral wall injury on the prognosis of femoral intertrochanteric fracture. OBJECTIVE:To evaluate the relationship between the integrity of the lateral wall and hip functional recovery and other outcomes in patients with femoral intertrochanteric fractures. METHODS:Totally 82 patients with femoral intertrochanteric fractures were screened and all patients received proximal femoral nail antirotation fixation.According to the thickness of the lateral wall,the patients were divided into the lateral wall intact group(n=31)and lateral wall risk group(n=51).The perioperative indexes,weight-bearing time,fracture healing time,hip joint function and range of motion,postoperative pain and complications were compared between the two groups. RESULTS AND CONCLUSION:(1)The time of hospitalization and the number of fluoroscopies during operation in the lateral wall intact group were significantly lower than those in the lateral wall risk group(P<0.05),but there was no significant difference in other perioperative indexes.(2)Both groups were able to get down to the ground early after surgery and finally complete weight-bearing,but in the lateral wall risk group,the time of fracture healing was longer;the time of complete weight-bearing was significantly delayed;the Harris score of the last follow-up was lower;the range of motion of hip extension and flexion and neck trunk angle on the affected side were smaller(P<0.05).(3)There was no significant difference in the incidence of postoperative complications between the two groups,but the overall incidence of complications in the lateral wall intact group was significantly lower(P<0.05).(4)In summary,after internal fixation of proximal femoral nail antirotation,patients with the intact lateral wall had a relatively better prognosis than those with risk lateral wall.

Objective:To delineate the histomorphological disparities of subchondral bone between hemophilic arthritis (HA) and osteoarthritis (OA) and to explore the mechanisms underpinning aberrant bone remodeling in HA.Methods:Fifteen male HA patients, aged 32.60±7.58 years (range 22-45), who underwent total knee arthroplasty at the Second Affiliated Hospital of Anhui Medical University from January 2021 to June 2023, were included. All patients had hemophilia A and tested negative for coagulation factor VIII antibodies. Simultaneously, fifteen male OA patients, aged 75.67±5.09 years (range 71-87), also underwent arthroplasty. Tibial plateau bones were extracted for micro-CT, which assessed morphological parameters. Histological changes in the subchondral bone plate (SBP) and trabecular bone were evaluated with HE and Safranin O-Fast Green staining. TRAP staining determined osteoclast differentiation levels, and VEGF-A and Osterix immunohistochemistry gauged angiogenesis and osteoblast differentiation.Results:Micro-CT revealed that HA patients had a BV/TV of 25.14%±0.70% (medial) and 22.31%±0.53% (lateral), Conn.D. of 4.20±0.10 1/mm 3 (medial) and 3.27±0.08 1/mm 3 (lateral), BMD of 0.288±0.006 g/cm 3 (medial) and 0.285±0.004 g/cm 3 (lateral), Tb.Th of 0.257±0.008 mm (medial) and 0.206±0.008 mm (lateral), Tb.N of 0.984±0.043 1/mm (medial) and 0.908±0.026 1/mm (lateral), and Tb.Sp of 0.683±0.008 mm (medial) and 0.808±0.010 mm (lateral). These parameters were significantly lower than those in the OA group except for Tb.Sp, which was higher ( P<0.001). Histological staining indicated that the HA group's SBP thickness was 177.43±6.42 μm (medial) and 117.96±5.08 μm (lateral) with significant differences observed ( P<0.001). TRAP staining showed that TRAP + osteoclasts accounted for 33.4%±3.1% (medial) and 25.1%±2.3% (lateral) in HA subchondral bone, again significantly different ( P<0.001). Immunohistochemical staining revealed VEGFA + cells at 34.1%±5.9% (medial) and 25.9%±3.7% (lateral), and Osterix + cells at 14.6%±1.4% (medial) and 5.8%±1.1% (lateral) in HA patients, differing significantly from the OA group ( P<0.001). Conclusion:The HA group exhibited more extensive subchondral bone destruction, thinner trabeculae, a nearly absent tidemark, higher osteoclast differentiation, increased angiogenesis, and reduced osteoblast differentiation, indicating severe osteoporosis, despite thicker SBP. These findings suggest that targeting abnormal bone remodeling and angiogenesis in HA could retard its progression and provide therapeutic benefits.

Objective:To investigate the application of combined distractor in the treatment of refractory distal radius fractures.Methods:From March 2018 to February 2020, the data of 32 patients with refractory distal radius fractures treated with combined distractor-assisted reduction were retrospectively analyzed. The propensity score matching method was used to establish a non-distractor group according to 1∶1 matching, with a total of 32 patients. In the distractor group, there were 15 males and 17 females, age 54.9 ±15.8 years (range, 18-77). According to AO classification, 3 cases were A3, 3 cases were B3, 16 cases were C2, 10 cases were C3. In the non-distractor group, there were 12 males and 20 females, age 59.7±14.8 years, 4 cases were A3, 5 cases were B3, 12 cases were C2 and 11 cases were C3. Main measures: surgical time, radial height, palm inclination, ulnar deviation, range of motion of the wrist, visual analogue scale (VAS), and functional assessment using disability of arm, shoulder and hand (DASH) and modified Mayo wrist score (MMWS).Results:A total of 64 patients were included in this study, and all patients successfully completed the operation and were followed up for 12-54 months, with an average of 17.8 months. The operative time of the distractor group was 91.2±14.6 min, which was significantly lower than that of the non-distractor group 137.6±27.3 min, and the difference was statistically significant ( t=8.48, P<0.001); the radial height in the distractor group 11.5±1.4 mm was significantly higher than that in the non-distractor group 10.6±1.3 mm, and the difference was statistically significant ( t=2.59, P=0.012). At the last follow-up, there were no statistically significant differences in the palm inclination 7.9°±4.4° vs. 7.5°±3.5°, ulnar deviation 23.3°±5.7° vs. 22.3°±4.5°, wrist flexion 63.2°±15.3° vs. 62.6°±11.1°, dorsiflexion 63.5°±10.7° vs. 62.4°±15.2°, pronation 69.2°±11.8° vs. 67.0°±11.0°, supination 73.1°±10.4° vs. 72.0°±8.7°, VAS 0.8±0.5 points vs. 0.9±0.7 points, DASH score 12.9±6.6 points vs. 13.4±7.0 points amd MMWS 84.1±5.8 points vs. 83.5±6.2 points ( P>0.05). One patient in the distractor group had symptoms of extensor muscle irritation, and the symptoms disappeared after the internal fixation was removed; 2 patients in the non-spreader group developed carpal tunnel syndrome, which improved after incision and decompression treatment. Conclusion:For refractory distal radius fractures, the use of combined distractor can achieve better radius height recovery and shorten the operation time, and has a satisfactory postoperative effect.

Objective:To analyze retrospectively the risk factors for pulmonary infection after traumatic cervical spinal cord injury.Methods:The 154 patients with a cervical spinal cord injury studied included 120 with a pulmonary infection and 34 uninfected controls. Regressions were evaluated using data on their genders, ages, the cause of injury, affected segments, the neurological level of the injury (NLI), and the presence of a vertebral fracture or dislocation.Results:Age, complete injury, NLI at C 1 to C 4, and an injury-to-treatment time of more than 8 hours were found to be independent risk factors for secondary pulmonary infection. Conclusion:Elderly spinal cord injury patients, with a complete injury, an NLI between C 1 and C 4 or an injury-to-treatment time of more than 8 hours have a higher risk of pulmonary infection.

Objective:To explore the short-term therapeutic outcomes of femoral neck fractures fixated by Femoral Neck System (FNS).Methods:A retrospective analysis was conducted of the 16 patients with femoral neck fracture who had been admitted to the Department of Traumatology & Orthopedics, The Second Affiliated Hospital to Anhui Medical University from January to December 2019. They were 6 males and 10 females, aged from 24 to 69 years (average, 47.5 years). According to the Garden Classification, there were 3 cases of type Ⅱ, 7 cases of type Ⅲ, and 6 cases of type Ⅳ. All the 16 patients were fixated with FNS. Recorded were operation time, frequency of intraoperative fluoroscopy, intraoperative blood loss, quality of postoperative fracture reduction, hospital stay, fracture healing time, and efficacy and complications at the last follow-up.Results:The 16 patients were followed up for 5 to 16 months after operation (average, 9.3 months). According to the Garden indexes, fracture reduction was evaluated as satisfactory in all the 16 patients. The operation time in this group ranged from 25 to 115 min with an average of 41.5 min, the frequency of intraoperative fluoroscopy from 14 to 47 times with an average of 26 times, the intraoperative blood loss from 35 to 210 mL with an average of 76 mL, the hospital stay from 3 to 9 days with an average of 4.6 days, and the fracture healing time from 3 to 6 months with an average of 4.5 months. By the Harris hip scores at the last follow-up, the function of the affected hip was rated as excellent in 10 cases, good in 5 and fair in one. Follow-ups revealed no complications like infection or implant loosening.Conclusions:The FNS is a new type of simple, reliable, safe and minimally invasive internal fixation for the treatment of femoral neck fractures. The plate, bolt, anti-rotation screws and locking screws in FNS can be inserted through a single minimally invasive incision, leading to reliable fixation, limited irritation to the lateral muscular soft tissues, and fine short-term outcomes.

Objective:To evaluate the trauma center model in general hospitals for patients with severe trauma.Methods:The data of 1,248 patients with severe trauma (ISS≥16) were retrospectively analyzed who had been admitted to the trauma centers in 6 Chinese general hospitals from January 2019 through June 2020. They were 987 males and 261 females with an age of 50.4 years ± 15.4 years. Their injuries were caused by a traffic accident in 622 cases, falling from a height in 357 cases, a knife in 62 cases, and others (like a heavy object and fall) in 207 cases. Upon admission, their injury severity scores (ISS) were 24.9±8.5 and their Glasgow coma scores (GCS) 12.6±3.6. They were all treated in a scientific and standard manner by a multidisciplinary team at the trauma center of their specific general hospital. Recorded were deaths within 30 days after admission, 30-day mortality and causes of death.Results:All the patients were treated effectively. 101 deaths occurred within 30 days after admission, yielding a 30-day mortality of 8.1%. The main causes of death were severe craniocerebral injury in 56 cases, hemorrhagic shock in 26 cases, multi-organ failure in 11 cases and others in 8 cases.Conclusions:Establishment of trauma centers in China can make up for the disadvantage of over-division of clinical specialties in large general hospitals which has led to insufficient care for patients with severe trauma and multiple injuries. The trauma centers in general hospitals may be a feasible model to be popularized in treatment of patients with severe trauma and multiple injuries.

The unilateral biportal endoscopic technique is defined as posterior unilateral of two small incision with established percutaneous observation channel and endoscopic observation channel in monitoring field. The operation tools were placed within the channel for each operation inside and outside vertebral canal. The characteristics of dual channel intervention make this technology different from coaxial endoscopic technology. This technique has a clear vision for flexible and convenient operation with the advantages of relatively simple surgical instrument requirements. In recent years, the use of unilateral dual channel endoscopic surgery in treating spinal diseases was gradually increasing, especially in the removal of nucleus including lumbar intervertebral disc protrusion and lumbar spinal stenosis disease decompression, and in endoscopic space-occupying lesions such as vertebral fusion and spinal canal between inside and outside. It was also applied in cervical and thoracic diseases with good clinical effects. Its advantages include less surgical trauma and faster recovery process. In addition, it has a large surgical field of vision under the microscope for easy identification of structures and surgery and with relatively gentle learning curve. Thus, it is conducive to beginners' mastery. However, complications such as nerve injury and postoperative lower limb numbness are still frequently reported. Some factors have to be considered, including insufficient understanding of the new technology, the local anatomy of the dual-channel endoscope, the operation of the spinal canal under the microscope. The successful application of the technique in treating various lumbar diseases needs understanding the operation process of the technique and local anatomy under the microscope.

Objective:To develop a unilateral biportal endoscopic technique and investigate the clinical efficacy of unilateral biportal endoscopic technique in the treatment of lumbar disc herniation and lumbar spinal stenosis.Methods:Between July 2018 and June 2019, 60 patients with lumbar disc herniation or spinal stenosis were treated by unilateral biportal endoscopic technique. According to the inclusion and exclusion criteria, 51 patients were included in the study. There were 25 cases of prolapsed lumbar disc herniation, 26 cases of degenerative lumbar spinal stenosis, all of which were treated with posterior lumbar decompression by unilateral biportal endoscopic laminectomy, and contralateral stealth decompression by unilateral approach was performed on the patients with bilateral stenosis. Endoscopic interbody fusion and percutaneous pedicle screw fixation were performed in 5 patients with instability. Operation time, length of incision, hospital stay and complications were recorded. Visual analogue scale (VAS) for low back pain and leg pain, Oswestry dysfunction index (ODI) and the modified Macnab scale were used to evaluate the clinical efficacy.Results:All operations were completed successfully, and no cases were transferred to open surgery. The operative time was 70.29±19.55 min (44-151 min), while the length of incision was 1.79±0.34 cm (1.4-3.0 cm). Postoperative CT suggested complete decompression with intact contralateral structure. All patients got out of bed 1-3 d after surgery, and the postoperative hospital stay was 3.49±2.76 d (1-14 d). The postoperative follow-up time was 13.59±2.80 months (10-21 months). Forty-six patients returned to work or normal activities within 3 weeks and 5 patients with interbody fusion returned to normal activities within 4 weeks. According to the modified Macnab criteria, the final outcome was excellent in 43 cases, good in 6 cases, and fair in 2 cases. There were 3 cases of dural sac tear during operation and 2 cases of transient numbness of lower limbs after surgery and they all recovered after conservative treatment. The VAS score of low back pain of 26 patients with lumbar spinal stenosis was reduced from 6.69±1.44 before surgery to 3.27±1.43 at postoperative 1 month, 2.69±1.57 at postoperative 3 months, 2.31±1.16 at postoperative 6 months and 2.23±1.28 at the last follow-up, respectively, and the difference was statistically significant ( F=128.534, P<0.005). The VAS scoreof leg pain was reduced from 6.77±1.34 before surgery to 3.27±1.37 at postoperative 1 month, 2.88±1.48 at postoperative 3 months, 2.85±1.52 at postoperative 6 months and 2.54±1.53 at the last follow-up, and the difference was statistically significant ( F=146.951, P<0.005). The ODI score was reduced from 64.18%±8.23% before surgery to 37.53%±4.45% at postoperative 1 month, 27.51%±3.83% at postoperative 3 months, 19.91%±5.27% at postoperative 6 months and 6.84%±2.74% at the last follow-up, and the difference was statistically significant ( F=783.966, P<0.005). The VAS score of low back pain of 25 patients with lumbar disc herniation was reduced from 5.60±1.38 before surgery to 3.04±1.54 at postoperative 1 month, 2.84±1.75 at postoperative 3 months, 3.12±1.86 at postoperative 6 months and 3.44±1.69 at the last follow-up, respectively, and the difference was statistically significant ( F=22.357, P<0.005). The VAS scoreof leg pain was reduced from 5.48±1.45 before surgery to 2.88±1.64 at postoperative 1 month, 2.52±1.83 at postoperative 3 months, 2.76±1.83 at postoperative 6 months and 3.00±1.92 at the last follow-up, and the difference was statistically significant ( F=29.445, P<0.005). The ODI score was reduced from 53.59%±6.87% before surgery to 32.46%±3.78% at postoperative 1 month, 23.39%±2.78% at postoperative 3 months, 16.49%±3.49% at postoperative 6 months and 7.23%±3.15% at the last follow-up, and the difference was statistically significant ( F=790.985, P<0.005). Conclusion:Unilateral biportal endoscopic technique has the advantages of clear and wide field of vision, large operating space, relatively simple surgical instrument need and convenient and flexible operation procedure. It has excellent clinical effects in the treatment of lumbar disc herniation and lumbar spinal stenosis.

Objective:To compare of the efficacy of Steinman pin-assisted and manual reduction for the treatment of distal femoral fracture with anterograde intramedullary nail.Methods:From January 2014 to August 2018, data of 54 patients with distal femoral fracture were retrospectively analyzed. According to the fracture reduction methods, patients were divided into two groups: bare-handed reduction group and Steinman pin-assisted reduction group (referred to Steinman pin group). There were 16 males and 10 females in bare-handed reduction group, with age of 37.5±9.2 years (range, 21-59 years). According to AO/OTA classification, 16 cases were type 32-A, 7 type 32-B, 3 type 32-C. There were 19 males and 9 females in Steinman pin reduction group, with age of 36.4±9.8 years (range, 18-55 years). According to AO/OTA classification, 19 cases were type 32-A, 7 type 32-B, 2 type 32-C. The reduction time, fluoroscopy times, intraoperative blood loss, fracture healing time, and knee joint function score of American hospital for special surgery (HSS) were compared between the two groups.Results:The amount of blood loss during operation was 142.78±29.76 ml in the bare-handed group, and 94.81±17.71 ml in the Steinman pin group. The reduction time of fracture was 14.19±2.50 min in the bare-handed group and 5.02±1.69 min in the Steinman pin group. The times of fluoroscopy during reduction was 12.56 ±2.01 in the bare-handed group and 5.01±1.51 in the Steinman pin group. There were significant differences in the above indexes ( t=12.19, 4.02, 5.47; all P < 0.05). All 54 patients were followed up for 12-51 months, with an average of 23.4 months. All the fractures healed, and there was no delayed union or nonunion. The healing time was 7.01±1.15 months in the bare-handed group and 5.99±0.97 months in the Steinman pin group. There were no significant difference. The HSS score of knee joint function was 23.7±4.1 before operation, 61.3±4.5 at 1 month after operation, 70.2±4.2 at 2 months after operation, 78.9±5.9 at 3 months after operation, 87.9±4.6 at 6 months after operation, and 93.1±5.8 at 12 months after operation, in the bare-handed group. Meanwhile, in the Steinman pin group, 22.5±3.8 before operation, 62.2±5.1 at 1 month after operation, 69.1±4.7 at 2 months after operation, 79.2±4.3 at 3 months after operation, 88.6±5.3 at 6 months after operation, and 92.3±6.1 at 12 months after operation. There were no significant difference between the two groups ( t=1.113, 0.689, 0.908, 0.212, 0.519, 0.494, P > 0.05). There were significant differences between the two groups at each time point before and after operation ( F=716.42, 815.52, P < 0.001). There were no complications such as injection point infection, vascular and nerve injury, failure of internal fixation and so on. Conclusion:Both groups had good functional recovery after operation. However, compared with bare-handed reduction, Steinman pin groupreduction has less intraoperative blood loss, shorter reduction time and less fluoroscopy times, which is a safer reduction method.

Objective: To explore the clinical efficacy of plate fixation via the lateral transverse incisions and double-window approaches for the treatment of intra-articular calcaneal fractures. Methods: A retrospective analysis was performed on the data of 21 intra-articular calcaneal fractures (22 feet) which had been treated at Department of Orthopaedics, The Second Affiliated Hospital to Anhui Medical University from May 2014 to April 2016. There were 19 males and 2 females, aged from 20 to 60 years (average, 38.3 years). The fracture affected 13 left feet and 9 right feet. According to the Sanders classification, 10 feet were type Ⅱ, 11 type Ⅲ and one type Ⅳ. They were treated by plate fixation via the lateral transverse incisions and double-window approaches. Early complications within 3 months after operation, the length, width, height, Böhler angle and Gissane angle of the calcaneus one year after operation, functional recovery of the affected feet at the last follow-up, and complications were recorded. Results: The 21 patients were followed up for 21 to 44 months (mean, 36.7 months). Incisions were all healed at the first postoperative stage with no serious skin or soft tissue complications like superficial infection, deep infection or wound dehiscence. At the early stage, one patient suffered epidermal necrosis at the margin of incision, which was cured after dressing change. None of the patients developed subtalar arthritis by the last follow-up. The preoperative length, width, height, Böhler angle and Gissane angle of the calcaneus (respectively, 68.6±1.2 mm, 46.7±0.8 mm, 39.1±2.0 mm, 5.4°±12.1° and 104.3°±10.2°) were significantly improved to 71.7±1.6 mm, 48.8±2.0 mm, 32.8±1.3 mm, 29.2°±6.8°, and 120.8°±6.2° one year after operation(P<0.05). At the last follow-up, their AOFAS ankle-hind foot scores averaged 92.7 points (from 73 to 98 points); 17 feet were rated as excellent, 3 as good and 2 as moderate, giving an excellent and good rate of 90.1%. Conclusion Plate fixation via the lateral transverse incisions and double-window approaches can reduce incidences of postoperative soft tissue complications and subtalar arthritis, leading to good clinical results in the treatment of intra-articular calcaneal fractures.