Abstract:Objective To compare the clinical efficacy of percutaneous vertebroplasty(PVP)and percutaneous kyphoplasty(PKP)in the treatment of stage Ⅰ and stage Ⅱ Kümmell's disease.Methods The clinical data of patients with stage Ⅰ and stage Ⅱ Kümmell's disease who were treated with PVP(25 cases)and PKP(21 cases)in our hospital from January 2018 to June 2022 were retrospectively analyzed.The basic data,bone cement leakage rate,and incidence of adjacent vertebral fractures were compared.The visual analogue score(VAS)and Oswestry Disability Index(ODI)were used as clinical evaluation indicators.The height of the vertebral anterior edge and the kyphotic angle were measured by imaging examination,and the vertebral compression rate and kyphotic correction rate were calculated.Results Both groups were followed up for 12-20 months.The amount of bone cement injected in the PKP group was(5.50±0.74)ml,and that of the PVP group was(4.80±0.51)ml,P<0.05.There were 2 cases of bone cement leakage in the PKP group and 6 cases in the PVP group,P<0.05.There were 3 cases of adjacent vertebral fractures in the PKP group and 1 case in the PVP group,P<0.05.There was no refracture of the responsible vertebra and displacement of bone cement in both groups at the last follow-up.VAS and ODI in both groups were significantly lower than those before surgery at 1 day,3 months,and 1 year after surgery(all P<0.05).The vertebral compression rate and kyphosis correction rate of the PKP group were better than those of the PVP group 1 day,3 months,and 1 year after surgery(all P<0.05).Conclusions Both PVP and PKP can achieve good clinical outcomes in the short term for the treatment of stage Ⅰ and stage Ⅱ Kümmell disease.PVP has the advantages of shorter operation time and fewer radiation exposures,while PKP has a lower cement leakage rate and better effects in restoring vertebral height and correcting kyphosis,but it may increase the risk of adjacent vertebral fractures.The choice of surgical procedure should be determined based on a comprehensive evaluation of the patient's overall condition,degree of vertebral compression and kyphosis deformity,economic conditions,and surgical willingness.

Abstract:Objective To investigate the incidence of infection and the distribution characteristics of pathogenic bacteria after internal fixation of open limb fractures,in order to provide reference for the development of clinical intervention programs.Methods A total of 410 patients with open limb fractures treated in our hospital from January 2021 to January 2025 were retrospectively selected as the research objects.All patients underwent internal fixation after admission.The incidence of postoperative infection was counted,the distribution characteristics of pathogenic bacteria and drug resistance of main pathogenic bacteria were analyzed,and the clinical data of infected and non-infected patients were compared.Logistic regression equation was used to analyze the influencing factors of infection after internal fixation of open limb fractures.Results A total of 94 cases of infection occurred in 410 patients with open limb fractures;121 strains were isolated,of which 75 strains of Gram-negative bacteria accounted for 61.98%,mainly Escherichia coli and Pseudomonas aeruginosa;38 strains of Gram-positive bacteria accounted for 31.40%,mainly Staphylococcus aureus and coagulase negative Staphylococcus.There were 8 fungal strains,accounting for 6.61%.Among the main Gram-negative bacteria,Escherichia coli had low resistance to imipenem and meropenem,and Pseudomonas aeruginosa had low resistance to imipenem and meropenem.Among the major Gram-positive bacteria,Staphylococcus aureus had relatively low resistance to rifampicin,vancomycin and Teicoplanin,while coagulase-negative Staphylococcus had relatively low resistance to vancomycin and Teicoplanin.There were statistically significant differences in the presence or absence of tension blisters,limb swelling,invasive operations,and whether surgical debridement was thorough between patients with postoperative infection and those without infection(P<0.05).Logistic regression equation analysis showed that tension blisters,limb swelling,invasive operations,and incomplete surgical debridement were all risk factors for infection after internal fixation of open limb fractures(P<0.05).Conclusions There is a relatively high incidence of infection after internal fixation of open limb fractures,mainly caused by Gram-negative bacteria,and there is certain drug resistance.For patients with postoperative infection in clinical practice,antibiotics should be reasonably selected based on the analysis of drug resistance of pathogenic bacteria.

Abstract:Objective To comprehensively evaluate the frailty and function recovery in fragility fractures.Methods A comprehensive literature search was undertaken in PubMed,Web of Science,Embase,and The Cochrane Library,with the aim of identifying observational studies relevant to the association between frailty and functional outcomes in elderly patients with fragility fractures.The search encompassed a chronological range from January 2000 to May 2024.Utilizing a random-effects model that incorporated heterogeneity,the findings were analyzed.Six subgroup analyses were conducted,encompassing country,study design,statistical analyses,follow-up durations,frailty criteria and fragility fracture sites.Results Our review encompassed eighteen distinct studies,with a combined total of 47 054 participants.After adjustment,frail patients exhibited a significantly elevated risk of experiencing limitations in ADL(adjusted OR=1.80,95%CI:1.27-2.56,I2=97%,P=0.001)and ambulation(adjusted OR=1.79,95%CI:1.43-2.24,I2=62%,P<0.001)compared to non-frail counterparts.The subgroup analysis has demonstrated that the association between frailty and both disability(including ADL impairment,poor usual activities,and decreased physical performance)as well as limitations in ambulation were particularly pronounced in studies with a six-month follow-up period.Conclusions The meta-analysis indicates that frailty serves as a notable indicator of diminished functional recovery in older patients following fragility fractures,particularly in investigations with a six-month observation period.Consistent evaluation of frailty throughout the course of treatment has the potential to alleviate lasting functional impairments.

Abstract:Objective To evaluate the effects of virtual reality technology on pain,anxiety,limb function,and heart rate during the treatment and rehabilitation of fracture patients by a Meta-analysis.Methods Cochrane Library,Web of Science,PubMed,Embase,China Knowledge Network,Wanfang,China Biomedical Literature and Weipu databases were systematically searched with a timeframe from the establishment of the library to February 21,2025,and Meta-analysis was performed using RevMan 5.4.Results A total of 10 studies were included in this study,and Meta-analysis was performed on 7 studies involving 886 patients with fractures.The results of Meta-analysis showed that,compared with the control group who received usual care,virtual reality technology improved patients'pain level(SMD=-1.17,95%CI:-2.31--0.03,P=0.04),anxiety(SMD=-1.89,95%CI:-3.14--0.64,P=0.003),and heart rate variability(SMD=-5.98,95%CI:-10.85--1.11,P=0.02).However,the effect was not significant in terms of improving independence of limb function(SMD=-9.19,95%CI:-20.50-2.11,P=0.11).Conclusions Virtual reality technology can effectively alleviate pain levels and anxiety in fracture patients,but it does not demonstrate significant advantages in improving the independence of limb function.

Abstract:Objective To investigate the anatomical boundaries of the peritrochanteric space,its relationship with adjacent tissues,and the characteristics of the surrounding tendon complex using fresh cadaveric specimens,aimed at providing an anatomical basis for localization during hip arthroscopy.Methods Four fresh-frozen adult cadaveric hip specimens were selected.Layer-by-layer dissection was performed to expose the peritrochanteric space.The composition of its medial and lateral walls,as well as its anterior,posterior,superior,and inferior boundaries,was observed.The longitudinal length and transverse width of the space were measured.The transitional boundary between the posterior aspect of the space and the deep gluteal space was investigated in detail.The shortest distance from the lateral edge of the sciatic nerve to the posterior boundary of the peritrochanteric space was measured.Additionally,the morphological characteristics of the fiber connections and the insertion range on the medial aspect of the tensor fasciae latae(TFL)-iliotibial band(ITB)-gluteus maximus complex were observed.Results The peritrochanteric space was a distinct anatomical compartment with defined boundaries.Its posterior boundary consisted the lateral margin of the quadratus femoris insertion and the overlying loose deep fascia,serving as a natural barrier separating the peritrochanteric space from the deep gluteal space.The longitudinal length of the space was(119.5±20.0)mm,and the transverse width was(77.0±7.9)mm.The sciatic nerve was located within the deep gluteal space;the shortest distance from its lateral edge to the posterior boundary of the peritrochanteric space was(28.7±2.4)mm.The TFL,ITB,and gluteus maximus form a continuous tension complex through extensive aponeurotic connections.The insertion range of the gluteus maximus tendon into the ITB posterior to the greater trochanter was broad,extending from superior to the greater trochanter down to inferior to the gluteal tuberosity.Conclusions The peritrochanteric space possesses constant anatomical boundaries and spatial dimensions.The lateral margin of the quadratus femoris insertion and the deep fascia serve as the anatomical dividing line between the peritrochanteric space and the deep gluteal space.Determining the distance between the sciatic nerve and the posterior boundary of the peritrochanteric space provides a safety reference for arthroscopic procedures within the deep gluteal space.Planning the level of ITB release based on the anatomical characteristics of the TFL-ITB-gluteus maximus complex holds promise for improving treatment outcomes for gluteal muscle contracture.

Abstract:Objective To analyze the impact of bone cement distribution patterns on short-term clinical outcomes in patients with osteoporotic vertebral compression fractures(OVCF)undergoing unilateral percutaneous kyphoplasty(PKP).Methods A total of 89 patients with OVCF treated at our hospital between March 2021 and June 2024 were included in this study.Based on the distribution pattern of bone cement,the patients were divided into three groups:Group A(bone cement did not cross the vertebral midline),comprising 33 cases;Group B(bone cement crossed the midline but did not reach the contralateral pedicle),comprising 34 cases;and Group C(bone cement crossed the midline and reached the contralateral pedicle),comprising 22 cases.Perioperative indicators,radiographic parameters,pain visual analogue scale(VAS)scores,Oswestry disability index(ODI)scores,Japanese Orthopaedic Association(JOA)scores were compared among the three groups.Results Group C exhibited a significantly higher volume of bone cement injected and a higher incidence of bone cement leakage compared to Groups A and B(P<0.05).At the 6-month postoperative follow-up,the anterior vertebral height and the ratio of anterior-to-posterior vertebral height in Group C were significantly greater than those in Groups A and B(P<0.05),while the kyphotic Cobb's angle was significantly smaller(P<0.05).Furthermore,Group C demonstrated superior outcomes in terms of VAS scores,ODI scores,and JOA scores compared to the other two groups(P<0.05).Conclusions In unilateral PKP for OVCF,a bone cement distribution pattern that crosses the vertebral midline and reaches the contralateral pedicle offers advantages including superior fracture reduction,better spinal functional outcomes,and more effective pain relief.

Abstract:Objective To explore the effect of rehabilitation training with flossing band on early knee joint function in patients after anterior cruciate ligament reconstruction(ACLR).Methods 52 patients after ACLR in our hospital from January to May 2025 were divided into observation group(n=26)and control group(n=26)by the random number table method.The control group received only routine exercise rehabilitation training,while the observation group was treated with additional flossing band training for 3 months.Visual analogue scale(VAS),Lysholm knee function scores,active range of motion(AROM),thigh circumference,and Hamilton anxiety scale(HAMA)were measured before intervention,and at 1 month,2 months and 3 months after intervention.Results After 1,2,and 3 months intervention,both groups showed decreased VAS and HAMA scores compared to baseline,with the observation group demonstrating significantly lower scores than the control group(P<0.05,P<0.01).During these intervals,knee joint Lysholm scores and AROM measurements increased in both groups,though the observation group exhibited markedly higher scores at 1 and 2 months(P<0.05,P<0.01).Subsequent measurements revealed significant thigh circumference increases of 5 cm and 10 cm above the patella in affected areas for both groups at 2 and 3 months(P<0.05,P<0.01).At 3 months,the observation group's thigh circumference measurements exceeded those of the control group by 5 cm and 10 cm above the patella(P<0.05,P<0.01),while no statistically significant difference was observed between the affected and healthy corresponding thigh regions(P>0.05).Conclusions Rehabilitation training with flossing band can effectively relieve the pain and anxiety symptoms of ACLR patients,improve early knee joint function and active range of motion,prevent and treat quadriceps atrophy,and demonstrate significant clinical value.

Abstract:Objective To compare the clinical effect of two reduction methods for lateral tibial plateau depressed fractures.Methods 78 cases of lateral tibial plateau depressed fractures surgically treated in Department of Orthopaedic Trauma,Norhern Jiangsu People's Hospital,from January 2019 to March 2024 were analyzed retrospectively.According reduction methods all patients were divided into fenestration group and osteotomy group.The general condition,perioperative period,follow-up and imaging measurement data were recorded and compared.Results There were 48 cases in fenestration group and 30 cases in osteotomy group,followed up for 13-71 months(mean 35.0±15.0 months).There were no significant differences in general condition and perioperative indexes between the two groups.There were no significant differences in fracture healing time and Rasmussen function score at each follow-up point between the two groups.2 cases of incision infection occurred in the fenestration group and 4 cases of joint stiffness occurred in the osteotomy group.Visual analogue scales(VAS)score of osteotomy group was higher than that of fenestration group at 3 months after operation(2.4±0.6 vs.2.0±0.7),range of motion(ROM)of knee joint extension and flexion in osteotomy group was significantly lower than that of fenestration group at 3 months after operation and at the last follow-up[(98.7±17.2)° vs.(112.1±10.6)°,(122.3±15.9)° vs.(130.0±9.1)°](P<0.05).The preoperative articular surface collapse degree in the osteotomy group was higher than that in the fenestration group[(12.0±5.0)mm vs.(8.6±4.7)mm],the preoperative Rasmussen imaging score in the osteotomy group was lower than that in the fenestration group(8.7±2.8 vs.11.7±2.7)(P<0.05).There was no significant difference in the articular surface collapse degree and Rasmussen imaging score between the two groups at different postoperative follow-up point.The increase of Rasmuussen imaging scores at the last follow-up in the osteotomy group was significantly higher than that in the fenestration group(7.5±3.7 vs.4.8±3.2)(P<0.05).Conclusions Both subarticular fenestration reduction and intraarticular osteotomy reduction can effectively reduce the depressed fracture of lateral tibial plateau.The pain is lighter and the range of motion is larger after fenestration reduction.Osteotomy group is more suitable for reduction of more severely depressed displacement fracture.

Abstract:Objective To analyze the effect of orthopedic robot-assisted nail placement in treating calcaneal fractures and the impact on serum traumatic stress indicators.Methods A total of 100 patients with calcaneal fractures who were admitted to the Department of Orthopedic Trauma at Taihe Hospital in Shiyan from May 2022 to May 2024 were selected as the study subjects.Using random number table method,they were divided into the observation group and the control group,with 50 cases in each group.The control group underwent surgery via a traditional lateral L-shaped incision,while the observation group underwent Kirschner wire prying/tarsal sinus incision+full-thread headless screw+robot-assisted surgery.The general situation of surgery,fracture reduction effect,and changes in serum traumatic stress indicators[C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)]were recorded.Changes in imaging indices before surgery and at 12 months after surgery were compared between the two groups.Complications were recorded.Results The duration of surgery in the observation group(85.79±8.65)min was longer than that in the control group(65.41±6.72)min,and the frequency of intraoperative fluoroscopy was lower than that in the control group[(36.12±3.74)times vs.(38.18±4.37)times].Fracture healing time and hospital stay[(3.02±0.33)months and(5.62±0.63)days]were shorter than those in the control group[(3.37±0.36)months and(8.79±0.94)days](P<0.05).Intraoperative blood loss and visual analogue scale(VAS)scores on postoperative days 1-3 in the observation group[(21.05±2.23)ml and(2.85±0.31)]were lower than those in the control group[(46.11±4.72)ml and(3.47±0.38)](P<0.05).At 12 months postoperatively,the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot score in the observation group(83.44±8.72)was higher than that in the control group(75.18±7.63)(P<0.05),and the excellent-good rate of fracture reduction in the observation group(96%)was higher than that in the control group(84%)(P<0.05).At 1 week postoperatively,serum CRP,IL-6,and TNF-α levels in the observation group[(9.43±0.96)mg/L,(35.18±3.62)ng/L,(52.15±5.34)pg/ml]were lower than those in the control group[(10.17±1.45)mg/L,(40.75±4.27)ng/L,(54.73±5.67)pg/ml](P<0.05).At 12 months postoperatively,calcaneal length,height,Böhler's angle,and Gissane's angle in the observation group[(77.45±7.89)mm,(40.25±4.18)mm,(26.38±2.72)°,(131.26±13.51)°]were larger than those in the control group[(73.26±7.61)mm,(37.77±3.79)mm,(24.89±2.57)°,(123.88±13.37)°](P<0.05).There was no statistically significant difference in the risk of complications between the two groups(P>0.05).Conclusions Robot-assisted nail placement is effective in treating calcaneal fractures,which can reduce pain,improve the accuracy of localization,promote fracture healing,reduce traumatic stress response,and improve imaging indicators,with good safety.It is worthy of promotion and application in clinical practice.

Abstract:Objective To analyze the diagnosis and treatment of polytraumatized patients with spinal injuries,and clarify the site of initial surgical intervention,optimal timing for surgery,prognostic factors,and ultimately providing references for the treatment of spinal injuries in severely polytraumatized patients.Methods This study collected and analyzed data from polytrauma patients with spinal injuries who were treated between January 2017 and January 2023.Data collected primarily included patient demographics,treatment-related information,clinical scoring systems,imaging parameters,prognosis,etc.Pearson correlation analysis was used to compare the correlation between independent quantitative variables,while Spearman correlation analysis was used to compare the correlation among count data.Logistic regression analysis was conducted to compare the correlation between independent variables and the dependent variable.Kaplan-Meier survival analysis was performed to compare the impact of relevant variables on postoperative survival of patients.A P-value<0.05 was considered statistically significant.Results This study included a total of 60 patients,among whom the number of surgeries and injuries involving extraspinal injuries was significantly higher than those involving spinal injuries(P=0.026 for surgeries,P<0.001 for injuries).Compared to preoperative values,the Cobb's angle significantly decreased postoperatively(P<0.001).The majority of patients underwent their first spinal surgery within 12 hours of admission(60.0%),with hemorrhagic shock being the most common factor delaying surgery(16.7%).The most common type of surgery was posterior thoracic spinal fixation(25.0%).Limb surgery was the most common type of initial surgery(35.0%).There was no significant change in ASIA grade E patients at 90 days post-admission(53.3%),while the number of grade D patients increased significantly(16.7%,P<0.001).In the group with surgery performed within 12 hours,the majority of patients was ASIA grade A(33.3%),while in the group with surgery performed after 48 hours,the majority was ASIA grade E(83.3%)(P<0.001).Among patients undergoing their first spinal surgery,the survival rate at 12-48 hours was significantly better than that of patients operated on within less than 12 hours or more than 48 hours(P=0.047).The survival rate was lowest among patients who experienced postoperative hemorrhagic shock(P<0.001).Only age(B=0.152,P=0.004;B=1.246,P=0.033)and the number of extraspinal surgeries as covariates were significantly associated with patient mortality(R2=0.519).Conclusions Performing spinal surgery either too early or too late can adversely affect patient outcomes.Therefore,it is essential to select the appropriate timing for surgery based on the specific characteristics of each patient.In emergency situations involving polytrauma patients,efforts should be made to minimize the use of combined surgical treatments to prevent the occurrence of a"second hit"phenomenon.Patients who develop hemorrhagic shock postoperatively have the poorest survival outcomes and should take targeted treatment upon admission.

Abstract:Objective To compare the rehabilitation effect of hip joint function of proximal femur bionic nail(PFBN)and proximal femoral nail antirotation(PFNA)internal fixation in the treatment of intertrochanteric femoral fractures(IFF).Methods A total of 108 IFF patients admitted to Huiji District People's Hospital in Zhengzhou City from April 2022 to March 2024 were prospectively selected and divided into PFBN group(54 cases)and PFNA group(54 cases)by random number table method.The PFBN group underwent PFBN internal fixation,while the PFNA group underwent PFNA internal fixation.The perioperative indicators,postoperative recovery,hip joint function(Harris hip score,HHS)before and 3 months after surgery,and postoperative complications were compared between the two groups.Results The operative time in the PFBN group was longer than that in the PFNA group,and the postoperative ground activity time,weight-bearing time,normal walking time,and fracture line disappearance time were all shorter than those in the PFNA group(P<0.05).However,no significant difference was showed in intraoperative bleeding between the two groups(P>0.05);3 months after surgery,all scores of the HHS in the PFBN group were higher than those in the PFNA group(P<0.05);the incidence of postoperative complications in the PFBN group was 7.41%,which was slightly lower than that in the PFNA group12.96%,but with no significant difference(P>0.05).Conclusions PFBN and PFNA internal fixation have high safety in the treatment of IFF patients.However,compared with PFNA internal fixation,PFBN internal fixation can shorten bed rest time,enable faster mobilization,weight-bearing exercise,fracture healing,postoperative recovery and better hip joint function.

Abstract:Objective To investigate the clinical efficacy of minimally invasive treatment for displaced midshaft clavicle fractures in adolescents using retrograde elastic intramedullary nailing fixation.Methods A retrospective analysis was performed on 38 adolescents with displaced midshaft clavicle fractures(overlapping or separated)treated with minimally invasive retrograde elastic intramedullary nailing between January 2023 and April 2024.The cohort included 24 males and 14 females,with 21 left and 17 right clavicle fractures.Causes of injury were:traffic accidents(5 cases),bicycle falls(12 cases)and sports-related falls(21 cases).Radiographs showed transverse fractures in 20 cases,short oblique fractures in 10 and comminuted fractures in 8.The affected and healthy sides were assessed using the Constant-Murley shoulder score at 4 weeks,8 weeks,12 weeks,6 months and 12 months postoperatively.The overall score from the Patient and Observer Scar Assessment Scale was recorded.Radiographs were reviewed to evaluate fracture union,loss of reduction and implant stability.Results All 38 cases were treated minimally invasively using retrograde elastic intramedullary nailing fixation.The follow-up period ranged from 12 to 18 months with a fracture healing time of(6±2)weeks.The Constant-Murley shoulder function scores at 4,8 and 12 weeks were(54.90±4.32),(83.25±16.73)and(97.76±2.13)respectively.Compared with the pre-treatment score of(22.48±4.18),the differences were statistically significant(F=1321.352,P<0.001).At 8 weeks,the Constant-Murley score of the affected side was comparable to that of the contralateral healthy side(P>0.05).The overall Patient and Observer Scar Assessment Scale score was 2.5 and all patients were satisfied with the shoulder appearance.All fractures achieved union.The elastic intramedullary nails were removed 6 to 10 months postoperatively.No complications such as infection,implant failure or re-fracture occurred.Postoperatively,two patients experienced implant irritation at the nail tip and two patients underwent minimal incision with Kirschner wire-assisted reaming prior to fixation due to a narrow intramedullary canal of the clavicle.Conclusions The retrograde elastic intramedullary nailing technique for minimally invasive treatment of displaced midshaft clavicle fractures in adolescents offers advantages including minimal surgical trauma,rapid functional recovery,concealed incisions and few complications.It provides a new surgical option for the minimally invasive management of these fractures in adolescents.

Abstract:Objective To compare the therapeutic effects of the modified sugar tong splint and the conventional sugar tong splints in the treatment of distal radius fractures,and to explore which external fixation method is more suitable for the treatment of distal radius fractures.Methods A total of 90 patients with distal radius fractures,who were admitted to the Department of Orthopedics and Traumatology at Handan Hospital of Traditional Chinese Medicine between September 2022 and August 2024,were selected for this study.Using a random number table method,they were allocated into either the modified sugar tong splint group(Group A)or the conventional sugar tong splint group(Group B),with 45 patients in each group.The fracture types,according to the AO classification,were A2.2,A2.3,and C1.During follow-up,the following data were collected from both groups:the number of complication cases,Mayo wrist function score,Hospital for Special Surgery(HSS)elbow function score,Visual Analogue Scale(VAS)score for pain,as well as radiographic parameters including volar tilt,ulnar inclination,radial height,and fracture healing time.Results The number of patients experiencing shoulder pain in Group A was significantly lower than that in Group B(4 vs.15,P<0.05).At 6 and 12 weeks after closed reduction and plaster cast immobilization,the HSS elbow function scores in Group A were significantly superior to those in Group B(82.38±4.90 vs.73.78±4.28 and 87.94±4.15 vs.83.67±4.41,respectively;P<0.05 for both).However,no statistically significant difference was observed between the two groups at 6 months(P>0.05).Repeated-measures ANOVA indicated that Group A achieved good functional recovery more rapidly(F=43.678,P<0.001).There were no statistically significant differences in the Mayo wrist function scores between the two groups at any time point(6 weeks,12 weeks,or 6 months after closed reduction and plaster cast immobilization)(all P>0.05).Similarly,no significant differences were found between the groups regarding the radiographic parameters(volar tilt,ulnar inclination,radial height)or the number of complications at any follow-up interval(all P>0.05).Conclusions In this study involving elderly patients(≥60 years)with distal radius fractures(AO types A2.2,A2.3,and C1),no significant differences are observed between the two external fixation methods regarding fracture stability or healing time.However,the modified sugar tong splint demonstrates superiority over the conventional sugar tong splint in reducing the incidence of shoulder pain and yielding better elbow function scores.These findings suggests that for eligible patients with similar fracture characteristics,the modified sugar tong splint may represent a preferable external fixation option.

Abstract:Objective To investigate the medium-term outcomes of surgical hip dislocation(SHD)combined with impacted bone grafts and iliac bone flap implantation in the treatment of non-traumatic osteonecrosis of the femoral head(NONFH)and to define the indications for this treatment.Methods A total of 56 cases(62 hips)with non-traumatic osteonecrosis of the femoral head from January 2014 to December 2017 were included in this study.According to the JIC classification,47 hips were classified as JIC type C1,and 15 hips were classified as JIC type C2 at initial diagnosis.All patients underwent SHD surgery combined with impacted bone grafts and iliac bone flap implantation.Preoperative and postoperative clinical outcomes were assessed using the Harris hip score(HHS)to evaluate hip function before and after the operation in all patients.The excellent and good hip function ratio and X-ray imaging evaluation were used as the evaluation indexes of curative effect.Univariate and multivariate logistic regression analyses were performed to identify risk factors affecting the clinical outcome.Kaplan-Meier(K-M)analysis was applied to calculate the survival rate of the femoral head.Results At the last follow-up(59.58±15.06 months),the HHS was 87.50±11.84,which was significantly higher than that before the operation 55.58±8.43.The HHS was excellent for 38 hips,good for 14 hips,fair for 1 hip,and poor for 9 hips.The rate of excellent and good hip function was 83.87%.All nine hips with poor HHS underwent total hip arthroplasty(THA)within 4 years.The collapse situation,according to X-ray,recovered in 22 hips(35.48%),did not progress in 5 hips(8.06%),and developed in 35 hips(56.45%).JIC type C1 and pain duration≤12 months were found to protect patients from THA.There were statistical differences in the survival curves of the C1 and C2 groups of JIC classification(P<0.001),and there were statistical differences in the survival curves of the three groups with pain duration≤6 months,7-12 months,and>12 months(P<0.001).The overall survival rates of JIC type C1 and C2 were 97.9%and 46.5%,respectively.The overall survival rates of patients with pain duration≤6 months,7-12 months,and>12 months were 97.5%,92.9%,and 12.5%,respectively.Conclusions SHD combined with impacted bone grafts and iliac bone flap implantation in the treatment of NONFH had good short-term and mid-term clinical outcomes,especially for patients with retention of the lateral column of the femoral head and hip pain less than 1 year.