Abstract:Objective To determine the optimal placement of volar plates for distal radius fractures using 3D printing technology.Methods DICOM data from 20 patients(10 males and 10 females aged 18-56 years,40.6 years on average)who underwent CT scans of the wrist(10 left side and 10 right)at Jinshan Hospital of Fudan U-niversity from Apr.2022 to Mar.2023 were retrospectively collected.Using Mimics 21.0 software,we segmented and reconstructed 3D models for 3D printing of distal radius models.After simulating surgery,intraoperative images were obtained via C-arm fluoroscopy,evaluated by three experienced surgeons,and analyzed in Mimics 21.0.Point A was defined as the proximal insertion of the brachioradialis tendon,and point B was located 2.0 cm proximal to point A.Perpendicular lines were drawn from points A and B to the radial axis and extended to the ulnar border,yielding intersection points C and D.We measured the lengths of segments AC and BD,as well as the intersections of the ra-dial edge of the volar plate with AC and BD(points E and F),and calculated the ratios AE/AC and BF/BD.Re-sults The mean length of segment AE was(9.93±3.36)mm,and AC was(72.07±6.91)mm.For segment BF,the mean length was(11.25±2.75)mm,and BD was(61.44±6.39)mm.The mean ratios of AE/AC and BF/BD were 0.14±0.04 and 0.18±0.03,respectively.Conclusion This study employs surgical simulation to de-termine the optimal diaphyseal position for volar plating of distal radius fractures,which yields quantitative data and provides guidance for precise plate placement in clinical practice.

Abstract:Objective To investigate the role of lithium carbonate(LC)in alleviating sepsis-induced acute lung injuries(ALI)by suppressing gasdermin D(GSDMD)-mediated pyroptosis.Methods In vitro experiments were first conducted to assess the effect of LC on interleukin-1β(IL-1β)levels in lipopolysaccharide(LPS)-stimu-lated monocytes.Subsequently,70 male C57BL/6 mice(20-25 g,6-8 weeks old)were randomly assigned to control group(n=10),sepsis group(LPS group,17 mg/kg LPS intraperitoneal injection,n=30),and sepsis+LC group(LPS+LC group,LPS+20 mg/kg LC via gavage,n=20).The 6-d survival outcomes of rates were recorded.Lung inflammatory cell infiltration was evaluated through HE staining and lung injury scoring.Serum levels of IL-1β,TNF-α,and IL-6 were measured by ELISA.Pulmonary pyroptosis and inflammation were assessed via qRT-PCR a-nalysis of IL-6,TNF-α,GSDMD,and CXCL15 mRNA expression.Results In vitro,LC significantly suppressed LPS-induced IL-1β secretion in monocytes(ng/mL,0.91±0.13 vs.1.35±0.11,P<0.001)in a concentration-dependent manner.In vivo,the LPS+LC group exhibited significantly higher 6-d survival than the LPS group(50.0%vs.23.3%,P=0.04).Reduced lung injury scores by HE stain(0.67±0.09 vs.0.51±0.06,P=0.04),de-creased pulmonary levels of TNF-α,IL-6,IL-1β,and CXCL15,and downregulated GSDMD expression were observed in the LPS+LC group(all P<0.05).Conclusion LC mitigates pyroptosis and inflammation in sepsis-induced ALI by inhibiting the GSDMD/IL-1β pathway,thereby improving survival.These findings support its potential as a therapeutic agent for sepsis-associated ALI.

Abstract:Objective To develop a machine learning model for predicting wound infection in snakebite pa-tients,aiding clinicians in early risk identification.Methods Clinical data of snakebite patients treated at three medical facilities(West China Hospital,West China Tian Fu Hospital,Chengdu Shang Jin Nan Fu Hospital)be-tween Jan.2020 and Sep.2022 were retrospectively analyzed.Patients were categorized into infected(n=115)and non-infected(n=408)groups based on wound infection outcomes.There were291 males and232 females,aged50-68 years,median 59 years.The dataset was randomly split into training and validation sets at a 7∶3 ratio.Eleven machine learning models,such as logistic regression(LR),decision tree,etc.,were developed to predict the infection risk,with their performance evaluated using ROC curves to select the optimal model.SHapley Additive exPlanations was used to rank predictor variable importance and visually explain the model,identifying key factors influencing out-comes.Results LASSO regression identified six significant predictors of wound infection,i.e.,white blood cell count(WBC),platelet count(PLT),neutrophil-to-lymphocyte ratio(NLR),presence of blisters,antibiotic usage,and timing of antivenom administration.Among the 11 machine learning models evaluated,LR demonstrated the best performance,with an AUC of 0.858(95%CI:0.808-0.907)in the training set and 0.855(95%CI:0.789-0.921)in the validation set,indicating stable and reliable predictive ability.Conclusion WBC,PLT,NLR,presence of blisters,antibiotic administration,and timing of antivenom administration are independent risk factors for wound in-fection following snakebites.Among the 11 machine learning models assessed,LR exhibits superior performance,making it a promising tool for clinical decision-making.

Abstract:Field surgery serves as the cornerstone of military medicine,and field surgical capabilities cen-tered on"damage control resuscitation and surgery"are important in reducing the mortality rate of combat casualties and maintaining combat effectiveness.In Russia-Ukraine conflict,characterized by large-scale,prolonged,and sym-metrical engagements,battlefield injuries exhibit features of complexity,mass casualties,and severity,posing disrup-tive challenges to field surgical capabilities.The traditional chain of care——"Tactical Combat Casualty Care(TC-CC)-rapid aeromedical evacuation-damage control surgery"——derived from military operations in Iraq and Af-ghanistan,is no longer fully applicable to future battlefields.TCCC must transition into prolonged casualty care,rapid aeromedical evacuation is compelled to shift toward a combined ground and air evacuation,and damage control sur-gery capabilities are constrained by mobility limitations.Enhancing field surgical capabilities requires establishing a comprehensive military-civilian collaborative system for combat casualty care,developing safe,standardized,and effi-cient combat casualty management capabilities,and adapting damage control surgery skills to meet the demands of future battlefield surgical resuscitation.

Abstract:Skin wound healing is a complex process.Various factors,such as bacterial infection and comor-bid chronic diseases,can interfere with the wound healing process and form refractory wounds,or even cause serious consequences such as sepsis and amputation.Curcumin is a natural compound extracted from the rhizome of turmer-ic.A large number of studies have shown that it has pharmacological effects such as hemostasis,anti-inflammatory,proliferative remodeling,anti-infection,and antioxidant in wound repair.This article reviews the therapeutic effects and possible mechanisms of curcumin in different stages of skin wound treatment,to lay a foundation for the further development and use of curcumin in wounds.

Abstract:Open globe injury(OGI)is a major cause of vision loss worldwide.In disaster or battlefield en-vironments,the incidence of OGI is high,characterized by complex conditions,difficulties in treatment,and poor prognosis.Currently,due to varying levels of treatment capacity for OGI across military and civilian medical institu-tions at different levels,issues persist including improper battlefield management,incomplete injury assessment,and non-standardized evacuation and treatment procedures.There is a lack of relevant treatment guidelines and consen-sus.In response,the Army Ophthalmology Specialty Alliance and the Editorial Board of the Journal of Traumatic Surgery have organized experts to develop the Expert Consensus on Early Management of OGI,with the aim of impro-ving the level of OGI care in basic medical units within and outside the military.

Abstract:Health-related quality of life(HRQL)following trauma assesses the impact of trauma on pa-tients'quality of life,including physiological,psychological,social and other fields.It not only reflects the current survival status of trauma patients,but also is an important indicator to evaluate the treatment effectiveness.This pa-per reviews the level of HRQL of trauma patients,assessment tools and influencing factors.At present,the level of HRQL in post-traumatic patients is low,which is affected by age,gender,education level,mental psychology,injury site,injury mechanism,injury severity,etc.The existing assessment tools lack uniformity and specificity.It is rec-ommended that clinical staff should increase their attention to HRQL of post-traumatic patients,and mean while se-lect and develop better HRQL assessment tools that are consistent with the domestic cultural context,to improve the assessment accuracy of HRQL and provide rehabilitation support for trauma patients.

Abstract:The cornerstone of effective trauma first aid resides in the synergistic collaboration between pre-hospital emergency care and in-hospital treatment,coupled with the concerted efforts of multidisciplinary medical professionals.Consequently,the integrated trauma first aid model has emerged as a theoretical matter of considerable practical significance within the realm of trauma first aid.This manuscript analyzes the inherent challenges within the conventional trauma first aid model in China,proposing an innovative integrated sequential medical model.The expo-sition systematically delineates the conceptual framework,substantive content,procedural intricacies,and systemic composition of the sequential medical model.It is suggested that an integrated trauma center be established to foster a multidimensional trauma discipline that amalgamates monitoring,prevention,diagnosis,treatment,and rehabilita-tion,leading to the development of a trauma discipline.Moreover,it constructs an intelligent trauma first aid system tailored for pre-hospital and in-hospital settings with intelligent information construction.Additionally,it supports the development of intelligent health city data and addresses other forefront scientific inquiries with comprehensive trau-ma data.

Abstract:Objective To compare the biomechanical properties of full-threaded vs.half-threaded hollow nail combined with femoral neck system(FNS)in managing Pauwels type III femoral neck fractures among young and middle-aged patients by finite element(FE)analysis.Methods A healthy 28-year-old female volunteer was enrolled,who underwent 64-slice spiral CT scan to obtain the femoral imaging data and establish a femoral neck frac-ture model(Pauwels angle set at 70°).Three internal fixation models were constructed in SolidWorks 2021,respec-tively group A(single FNS),group B(FNS+half-threaded hollow nail),and group C(FNS+full-threaded hollow nail).The assembled models were imported into FE analysis software,where a vertical load of 1000 N was applied to simulate the single-leg standing posture.Von-Mises stress peak values and displacement measurements were re-corded for the femur,proximal bone fragments,and internal fixation devices.Results The femur model in group C exhibited the lowest peak stress of 93.883 MPa with uniform distribution,showing no significant stress concentra-tion.The proximal fracture fragment demonstrated the lowest peak stress(24.764 MPa)and displacement value(1.483 mm)among all groups.Regarding the internal fixation devices,group C recorded the highest peak stress(431.45 MPa),while group A had the lowest(273.04 MPa).Both the femur and fracture fragments showed mini-mal overall displacement in group C,measuring 1.592 mm and 1.483 mm,respectively.Conclusion The fixation of Pauwels type III femoral neck fractures with FNS combined with full-threaded hollow nail has better biomechanical stability,more reasonable stress distribution and less fracture displacement,which can be used as the preferred inter-nal fixation for this type of fracture.

Abstract:Modern warfare,characterized by high-energy weapons,results in complex,multiple combat inju-ries that need rapid surgical resuscitation in austere environments.This review analyzes the critical bottlenecks hin-dering the development of surgical resuscitation capabilities within the Chinese Army and proposes systematic gener-ation pathways to address these challenges.The concept of surgical resuscitation is defined as the integration of dam-age control surgeries and physiological resuscitation.A comprehensive overview of core surgical skills for injuries to the head,chest,abdomen,and extremities is provided.Four primary bottlenecks are identified:(1)the inherent con-flict between the mobility of medical teams and their mission load capacity;(2)the discrepancy between peacetime sub-specialized training and the need for generalist surgeons in combat;(3)the degradation of fundamental surgical skills using basic instruments("cold weapons")due to reliance on energy platforms;and(4)the widespread lack of experience in open-cavity surgeries due to the prevalence of minimally invasive techniques.To overcome these di-lemmas,a two-tiered generation path is proposed.The foundational level involves adopting standardized trauma train-ing(e.g.,ATLS,China Trauma Care Training®)and fostering deep military-civilian integration with regional trau-ma centers.The innovative level focuses on building multi-dimensional,combat-oriented capabilities through manda-tory cross-specialty training,reinforcement of basic surgical techniques,a renewed focus on open surgery proficiency,development of diverse learning platforms,and a shift towards realistic,capability-testing combat drills.This review provides a strategic framework and practical approaches to systematically enhancing the surgical resuscitation capa-bility of the Chinese military surgeons,ensuring readiness for future combat medical support missions.

Abstract:Objective To compare the clinical efficacy of elderly osteoporotic vertebral compression frac-tures(OVCF)by percutaneous curved vertebroplasty(PCVP)or titanium mesh cement filling.Methods A retro-spective study was conducted on clinical data of 123 elderly OVCF patients admitted to our hospital from Aug.2022 to Sep.2023.Among them,70 were male and 53 were female,aged 65-84 years,with an average age of 77.0 years.Fracture sites were 64 cases of lumbar vertebrae and 59 thoracic vertebrae,and AO classification defined 71 cases of type A1 and 52 type A2.The causes of injuries were 50 road traffic accidents,38 falls,24 falls from heights,and 11 others.According to the surgeries they received,patients were divided into either group A(60 cases,PCVP)or group B(63 cases,titanium mesh bone cement filling).The function by Oswestry dysfunction index(ODI),visual analogue scale(VAS),perioperative indicators,imaging indicators(Cobb angle,anterior vertebral height ratio)and complications were compared between the two groups.Results Compared with group A,group B showed less a-mount of injected bone cement(mL,5.4±0.3 vs.9.2±0.6)and intraoperative fluoroscopy(times,7.8±1.8 vs.12.9±2.5),and shorter operation time(min,26.9±2.2 vs.37.6±3.5)(all P<0.05).Compared with before op-eration,both the VAS and ODI decreased at postoperative 2 days and 3 months in two groups(all P<0.05),moreo-ver,both scores were much lower in group B(all P<0.05).At 3 months after operation,the Cobb angle decreased and the anterior vertebral height ratio increased in both groups,and comparison between the two groups revealed bet-ter results in group B(Cobb angle:11.6°±2.5°vs.16.8°±2.9°;anterior vertebral height ratio:38.9%±2.3%vs.33.6%±3.1%,both P<0.05).The incidence of complications in group B was 4.8%,much lower than the 16.7%in group A(P<0.05).Conclusion Compared with PCVP,titanium mesh bone cement filling is more effective in the treatment of elderly OVCF patients,which can better promote postoperative recovery,improve imaging indicators,and reduce pain and incidence of complications.

Abstract:As China enters an aging society,the incidence of femoral intertrochanteric fractures is increasing annually.Surgical treatment is the best option and has always been a focus and hot topic in orthopedic trauma.This manuscript draws on the author's own clinical experience and worldwide literature and guidelines to conduct a retro-spective analysis on the surgical efficacy of intertrochanteric fractures and related influencing factors,such as bone quality,fracture classification,fracture reduction,internal fixator selection,surgical techniques,and perioperative management.It aims to provide a comprehensive and in-depth understanding of the diagnosis and treatment of such fractures and to improve the management outcomes.

Abstract:Objective To analyze the characteristics of radial head fractures by medical image analysis and fracture mapping,and to provide reference for clinical diagnosis and treatment of these injuries.Methods A retro-spective study was conducted on 130 cases of adult radial head fractures treated in the Department of Orthopedics Trauma of the First Affiliated Hospital of Air Force Medical University from Jan.2021 to Jun.2023.Among them,70 were males and 60 were females;the median age was 36.4 years,range 18-60 years;61 cases involved the left side and 69 the right;82 cases were due to falls,18 to high-level falls,25 to road traffic injuries,and 5 to others.Based on preoperative plain films and CT images,the fracture morphology was observed and classified according to the fracture morphology and injury mechanism.Mimics 21.0 image processing software was used to reconstruct the 3D fracture model of the radial head.The position of the radial head in the neutral forearm position was divided into four quadrants(anterior lateral quadrant:AL;posterior lateral quadrant:PL;anterior medial quadrant:AM;pos-terior medial quadrant:PM).Observation,measurement and plotting of the fracture blocks and fracture lines were conducted.Through reconstruction,virtual reduction and image superposition,the fracture map was established to observe the distribution of fracture blocks and the shape of fracture lines.Results According to Mason classifica-tion,there were 10 cases of type I,78 type Ⅱ,27 type Ⅲ,and 15 type IV.While based on the injury mechanisms,there were 54 cases of vertical(direct)injuries to the elbow joint,30 lateral deviation injuries,18 posterior and me-dial rotational injuries,and 28 posterior and lateral rotational injuries.According to the fracture morphology,radial head fractures presented as separate ones or combined with other parts.The former were divided into fractures of the radial head that involve the joint surface(87 cases,mainly affecting the AL+PL,AM+PL and AM+AL+PL)and fractures of the radial neck(radial head tilt in 24 cases,mainly anterior tilt displacement);the latter were divided into elbow dislocation with radius head fractures and ulna coronoid process fractures(terrible triad of the elbow,8 cases,mainly affecting the AL+AM),transolecranon olecranon fractures and dislocation of the radius head,and pos-teromedial rotation injury with radius head fracture and dislocation(together 7 cases,mostly affecting the AL+AM+PL).Conclusion The cases of separate radial head fractures involve a wide range of radial heads,while radius head fractures associated with terrible triad of the elbow and those with olecranon dislocation mostly involve the AL+AM,and moreover,are relatively combined with comminuted fractures and significantly increased risk of transverse displacement.The assessment of radial head fractures should be based on Mason classification,elbow joint injury mechanisms and the fracture morphology.

Abstract:To analyze and compare the disease burden and risk factors of road traffic injuries(RTI)in Chi-na and several Asian countries from 1990 to 2021,and to predict future trends.Methods Data from the Global Burden of Disease(GBD)2021 database on the prevalence,incidence,and disability-adjusted life years(DALY)of RTI were extracted for the global population,China,India,Pakistan,and Malaysia,stratified by gender.The esti-mated annual percentage change(EAPC)was used to assess trends.Joinpoint regression and Bayesian age-period-cohort(BAPC)models were employed for analysis and prediction.Results From 1990 to 2021,the incidence and DALY of global RTI were decreasing.The EAPC in the incidence rate was-1.6(95%CI:-1.61 to-1.51),and in the DALY rate was-1.4(95%CI:-1.56 to-1.29),both indicating a downward trend.At the national level,China and Malaysia showed a general decline in overall burden.In India,the age-standardized incidence rate(ASIR)re-bounded between 2015 and 2021(APC=0.22%,P<0.001),while Pakistan exhibited significant increases in the incidence rate and DALY rate,with the EAPCs being 0.41%and 1.16%,respectively.In terms of gender differ-ences,the ASIR and age-standardized disability-adjusted life year rate(ASDR)of males were generally 2-3 times higher than those of females across different countries.In India,cultural factors led to lower early exposure risks for females,but the gender gap has been gradually narrowed since 2015.The Bayesian model predicts that by 2030,the burden of RTI will continue to decline in most regions globally.However,India is expected to see a short-term in-crease in ASIR(with a 2.7%increase in males),and Malaysia may experience a 22.6%rise in ASDR due to popu-lation aging.The analysis of risk factors indicated that occupational injuries were the primary risk,with Pakistan ex-hibiting a high attributable DALY rate of 519.75 per 100,000 population.Exposure to low temperatures was identi-fied as a protective factor,while exposure to high temperatures was considered a risk factor.Conclusion The over-all burden of global RTI declined year by year,but in some areas,the burden of RTI still needs to be continuously monitored due to economic,policy and demographic factors.China should summarize and learn from the experience and lessons of various countries,promote the transformation of public transport models,pay attention to the allocation of safety while the economy is growing rapidly,and pay attention to policy interventions for gender specificity and population aging,so as to further reduce the burden of future RTI.

Abstract:Objective To compare the efficacy of proximal femoral nail antirotation(PFNA)combined with an anterolateral reconstruction plate and the InterTAN intramedullary nailing in the treatment of elderly patients with AO/OTA A3.3 intertrochanteric fractures of the femur.Methods This retrospective analysis was conducted on clinical data of patients with AO/OTA A3.3 intertrochanteric femoral fractures treated with either PFNA com-bined with lateral wall reconstruction or InterTAN at our department from Jan.2018 to Dec.2023.A total of 81 pa-tients,37 males and 44 females,aged 60-81(mean 72.5)years,were enrolled.The injury causes were road traffic accidents in 47 cases,and falls in 34 cases.According to the treatment they received,patients were divided into lat-eral wall reconstruction group(36 cases)and InterTAN group(45 cases).In the former,there were 16 males and 20 females of 60-81(mean 73.2)years,who received PFNA fixation with lateral wall reconstruction(17 left side and 19 right).In the latter,there were 21 males and 24 females of 61-78(mean 71.9)years,who received Inter-TAN intramedullary nail fixation(24 left side and 21 right).Comparisons between the two groups included opera-tion time,intraoperative blood loss,off-bed activity time,full weight-bearing time,fracture healing time,tip-apex dis-tance(TAD),Harris hip score(HHS)and Parker-Palmer mobility score(PPMS)at 12 months postoperatively,and complications within 1 year after surgery.Results The lateral wall reconstruction group exhibited a longer op-erative time(min,101.7±16.7 vs.89.3±12.5)and more intraoperative blood loss(mL,123.5±18.2 vs.112.1±21.8),compared to the InterTAN group.However,it demonstrated significant advantages in postoperative recovery parameters:earlier off-bed activities(d,14.3±1.2 vs.18.6±1.3)and weight-bearing(week,13.6±3.4 vs.15.5±3.5),faster fracture healing(week,11.8±1.2 vs.12.7±1.1),and higher HHS(91.6±7.5 vs.84.3±8.8)and PPMS(8.5±1.7 vs.7.4±1.7)at 12 months,all revealing statistically significant differences(P<0.05).Both groups showed progressive shortening of femoral neck length at 2 and 12 months postoperatively compared to immedi-ate postoperative measurements(2 d).Notably,the lateral wall reconstruction group demonstrated significantly shor-ter femoral neck dimensions at both follow-up intervals(mm,43.8±2.1 vs.44.6±1.0 at 2 months;42.6±1.9 vs.43.7±0.9 at 12 months)compared to the InterTAN group(P<0.05).Conclusion Compared with InterTAN fixa-tion alone,the use of PFNA and lateral wall reconstruction plate for the treatment of A3.3 femoral trochanteric frac-tures results in earlier weight-bearing exercise,quicker fracture healing,and better hip joint functional recovery.

Abstract:Objective To explore the clinical characteristics and standardized management of animal-in-flicted injuries with severe rabies exposure.Methods A retrospective analysis was conducted on 105 cases from the Animal-Inflicted Injury Clinic,Guangxi University of Chinese Medicine Affiliated International Zhuang Medicine Hospital between Jan.2020 and Dec.2022.Statistical analysis was performed on the following parameters:species of injury-causing animals,gender and age of the injured patients,wound location,wound management methods,time intervals between exposure and medical consultation,vaccination status,surgical treatment,infection status,and post-traumatic stress disorder in children and adolescents.Results Among the 105 cases of animal-inflicted injuries with severe rabies exposure who received standardized management,there were 45 males(42.9%)and 60 females(57.1%),with a male-to-female ratio of 0.75∶1.The primary affected population was concentrated in individuals under 15 years of age,accounting for 43.8%.Upper limbs were the most common injury sites(51.4%),and the dogs were the most prevalent injury-causing animals(62.9%).The rabies vaccination rate was 100%,and 89.4%(76/85)of those requiring passive immunization agreed to receive human rabies immunoglobulin.A total of 33 ca-ses(31.4%)underwent surgical wound management,including 32 cases of debridement and suturing and 1 case of medical adhesive closure.Three cases(2.9%)developed infections.Among children and adolescents with severe rabies exposure animal-inflicted injuries,9(22.5%,95%CI:9.8%-35.2%)showed potential PTSD.Conclusion The emergency department of a general hospital can efficiently complete post-exposure prophylaxis for rabies by es-tablishing standardized procedures for animal-inflicted injury management,standardizing wound treatment,and ensu-ring timely full-course rabies vaccination and passive immunizing agent administration.Meanwhile,as a high-risk group for such injuries,children and adolescents warrant attention regarding their risk of developing PTSD.

Abstract:Objective To analyze the bibliometric characteristics of highly-cited literature(citation fre-quency>20)published in the Journal of Traumatic Surgery from 1999 to 2023 and to explore research hotspots and trends in the field of traumatic surgery.Methods Literature published in the Journal of Traumatic Surgery over the past from 1999 to 2023 was retrieved from the China National Knowledge Infrastructure(CNKI).Papers with cita-tion frequencies>20 were selected as the study subjects.Bibliographic information was exported in RefWorks for-mat;duplicates and non-research papers like conference abstracts,letters to the editor,etc.,were manually exclu-ded.Data on publication year,sub-discipline,column,author affiliations,and citation frequency were extracted,yield-ing 389 eligible papers.Bibliometric analysis was performed using the VOSviewer and CiteSpace software,covering publication timeline,author/institutional collaboration networks,research domain distribution,and keyword co-occur-rence.Results For the 389 highly-cited literature,the annual publication volume showed a fluctuating upward trend,with the peak of 36 highly-cited papers published in 2019.Leading contributing institutions were Army Medi-cal University(34 articles),General Hospital of PLA(12 articles),Tongji Hospital,Tongji Medical College of Hua-zhong University of Science and Technology(6 articles),etc..The major research focus was bone and joint injuries(126 articles,32.4%),and the high-frequency keywords included"internal fixation"(76 occurrences),"multiple injuries"(28 occurrences),and"geriatric trauma"(35 occurrences).Conclusion Highly-cited literature in the Journal of Traumatic Surgery reflects distinct disciplinary characteristics,with research hotspots closely aligned with clinical needs.Management of bone injuries,multiple traumas,and geriatric trauma patients represents the current priorities in traumatic surgery research.

Abstract:Objective To investigate the clinical efficacy of preoperative burr hole drainage in managing trauma patients with traumatic cerebral hernia.Methods A retrospective analysis was conducted on 40 traumatic brain injury(TBI)patients with brain herniation admitted to our department from Jan.2019 to Jan.2023.Among them,there were 27 males and 13 females,aged 18-71 years,with a mean age of 47.4 years.After admission,all pa-tients were implanted with intracranial pressure(ICP)probes.According to their willingness,patients were divided into the conventional group(routine dehydration drugs before craniotomy,n=16)and pre-decompression group(e-mergency bedside burr hole drainage in addition to routine dehydration drugs before craniotomy,n=24).General data,GCS and ICP on admission were comparable between the two groups.Statistical analysis was conducted on re-lated perioperative(craniotomy)variables,including pre-and post-operative ICP,postoperative degree of pupil re-traction,incidence of large-scale cerebral infarction,procedure-related bleeding,and postoperative infection,as well as outcomes by Glasgow outcome scale(GOS)score.Results Compared to the conventional group,patients in the pre-decompression group demonstrated significantly lower ICP(mmHg)both before(25.3±5.0 vs.36.6±5.5)and after(18.5±4.7 vs.23.9±5.8)craniotomy(both P<0.01),much better pupil retraction after craniotomy(P<0.05),and much lower incidence of traumatic large-scale cerebral infarction(6 cases,25%vs.9 cases,56.3%,P<0.05);while the incidence of procedure-related bleeding(1 case vs.0 case)and postoperative infec-tion(1 case vs.1 case)revealed no significant difference(all P>0.05).Moreover,the 6-month GOS was much higher in the pre-decompression group than in the conventional treatment group(P<0.05).Conclusion For se-vere TBI patients with brain herniation,burr hole drainage before craniotomy can significantly alleviate intracranial hypertension before and after craniotomy,prevent postoperative massive cerebral infarction,and improve the prognosis of the patients.The procedure is safe and reliable,without increased procedure-related bleeding or postoperative in-fection.As a result,burr hole drainage can be an effective method for pre-decompression to prolong the golden hour for such patients,and is worthy of further clinical promotion.

Abstract:Objective To identify the risk factors for delayed displacement after surgeries for multiple rib fractures to develop better surgical strategies and to improve patient outcomes.Methods A retrospective analysis was conducted on 105 patients who underwent open reduction and internal fixation for multiple rib fractures at Tian-jin Hospital from Jan.2021 to Dec.2023,during which a total of 347 patients received rib fractures,with 39 pa-tients excluded for a single rib with>3 fracture sites,12 patients excluded for rib cartilage fractures,35 patients ex-cluded for bilateral rib fractures,and 156 patients excluded for fractures involving the 1st-2nd or 11th-12th ribs.There were 70 males and 35 females,with the mean age of 60.4 years(range,35-95 years).According to whether delayed displacement occurred after surgery,patients were divided into non-displacement group(46 cases)and displacement group(59 cases).Data collected included demographic information,mechanisms of injury,number and type of rib fractures,and surgical details,etc..Univariate and multivariate logistic regression analyses were used to identify in-dependent risk factors for delayed displacement of multiple rib fractures after surgery.Results Among the 105 pa-tients with multiple rib fractures,59 experienced delayed displacement postoperatively,with an incidence of 56.2%.The displacement group showed significantly more rib fracture sites[8(6,10)vs.7(5,9)],more non-displaced rib sites before surgery[4(3,6)vs.3(2,4)],and more single ribs with two fracture sites[3(1,4)vs.1(0,3)](all P<0.05),but much less single ribs with one fracture site[2(1,4)vs.3(2,5),P<0.05].The displacement group also showed a much lower rate of total fixation rate[53.9%(42.9%,66.7%)vs.66.7%(50.0%,80.0%,P<0.05]and significantly more single ribs with two fracture sites not fully fixed[2(1,3)vs.1(0,2),P<0.05].Risk factors for delayed displacement included the number of single ribs with two fracture sites,the number of single ribs with two fracture sites not fully fixed,total fracture sites,overall fixation rate,and the number of non-displaced fractures.Multivariate logistic regression analysis showed that the number of non-displaced fractures was an inde-pendent risk factor for delayed displacement of multiple rib fractures(OR:1.676,95%CI:1.135-2.477).Conclu-sion The number of non-displaced fractures is an independent risk factor for delayed displacement of multiple rib fractures.During surgical intervention for multiple rib fractures,attention should be paid to non-displaced rib frac-tures in terms of number and fixation sufficiency,to prevent delayed displacement postoperatively and improve pa-tient outcomes.

Abstract:Objective To explore the clinical characteristics,diagnosis and treatment features of laryngotra-cheal rupture caused by trauma,and to improve the understanding and management ability of this injury.Methods A retrospective analysis was conducted on the clinical data of 49 patients with laryngotracheal rupture admitted to Tangdu Hospital of Air Force Medical University from Jan.2015 to Dec.2024.The cervical injury conditions,ima-ging data,treatment measures and prognosis were analyzed.Results A total of 49 patients were included in this study,with ages ranging from 6 to 87 years and an average age of 46.1 years.There were 33 males and 16 females.The causes of injury were 6 cases of strangulation,9 cases of blunt impact injury,and 34 cases of incised wound.Ac-cording to the trauma type,there were 11 cases of closed laryngotracheal rupture and 38 cases of open laryngotrache-al rupture.All patients were complicated with cervical and mediastinal emphysema and bilateral pulmonary inflam-mation.Among the 11 patients with closed laryngotracheal rupture,8 cases had tracheal transection,9 cases had dyspnea,and all the 9 patients underwent emergency tracheotomy;2 cases had hemorrhagic anemia,and both re-ceived blood transfusion therapy;4 cases received T-tube placement during operation to support the collapsed air-way;7 cases had recurrent laryngeal nerve injury;1 case underwent partial resection of the unilateral vocal cord due to postoperative bilateral vocal cord paralysis and then successfully extubated;1 case achieved normal breathing after bronchoscopic balloon dilatation for tracheal anastomotic scar formation.Finally,10 cases were extubated,while 1 case failed to be extubated due to re-transection of the tracheal and esophageal anastomoses,complicated by infection and granulation tissue formation.Among 38 patients with open laryngotracheal rupture,21 cases had laryngeal tran-section,9 cases had dyspnea,and all the 9 patients underwent emergency tracheotomy;14 cases had hemorrhagic a-nemia,and all received blood transfusion therapy;4 cases received T-tube or finger cot placement during operation to support the collapsed airway;4 cases had recurrent laryngeal nerve injury.Finally,36 cases were extubated,1 case died of severe pulmonary infection complicated by tracheoesophageal fistula,and 1 case was lost to follow-up.Conclusion Laryngotracheal rupture has a wide age range.Open laryngotracheal rupture is more common than closed type,and incised wound is the main cause of injury.In closed laryngotracheal rupture,tracheal rupture is more common,and the incidence rates of dyspnea,airway collapse and recurrent laryngeal nerve injury are high.In open laryngotracheal rupture,laryngeal rupture is more common,and the incidence rate of hemorrhagic anemia is high.Pa-tients with laryngotracheal rupture complicated by esophageal rupture,scar formation or severe pulmonary infection have a poor prognosis.