Through in vivo experiments on full-thickness skin wounds in Sprague-Dawley (SD) rats treated with three repair methods-dual-laser, single-laser, and surgical suture-the dual-laser skin repair system was further refined. By employing immunofluorescence staining of fibroblasts and ELISA-based analysis of gene expression levels of fibroblast-related factors, the mechanism underlying the regulation of fibroblast factor secretion was revealed. It was observed that aggregated fibroblast secretion occurred in the wound area within 4-5 days after dual-laser treatment, followed by complete wound closure within 5-7 days and no collagen fibrosis within 21 days. The dual beam laser energy, while maintaining the same total output with single beam, was effectively partitioned and precisely controlled between the two beams to avoid localized high energy delivery and consequent additional thermal damage. This configuration enabled broad-area photothermal irradiation, substantially altering the wall-like structure of the dermal base and disrupted collagen on both sides of the wound rather than only the bottom of wound. These results validate the effectiveness of the dual-laser approach in enhancing healing speed and suppressing collagen fibrosis in live tissue. The study contributes to the methodology system for rapid skin wound repair, achieving accelerated healing while mitigating potential collagen fibrosis. Furthermore, the findings offer valuable insights for laser fusion techniques in other biological tissues.

OBJECTIVE:The global aging population has led to a significant increase in hip fractures among elderly patients, posing substantial clinical challenges. While early surgical intervention is widely advocated, its impact on postoperative complications and mortality in super-aged (≥ 80 years) hip fracture patients remains controversial. This study aimed to evaluate the association between early surgery and clinical outcomes in this population. METHODS:We conducted a retrospective cohort study of patients aged ≥ 80 years who underwent hip fracture surgery at a single-center orthopedic trauma center between January 2018 and November 2021. Participants were stratified into early surgery (≤ 48 h post-admission) and non-early surgery groups. Propensity score matching (PSM) was employed to control for confounding variables. Primary outcomes included 30-day, 90-day, 1-year, and 2-year mortality rates. Secondary outcomes encompassed perioperative transfusion rates, postoperative complications, hospital length of stay (LOS), and hospitalization costs. RESULTS:After PSM, a total of 300 patients were included. Compared with the non-early surgery group, the early surgery group had lower 1-year (11.6% vs. 28.0%, p < 0.001) and 2-year (36.0% vs. 50.7%, p = 0.010) postoperative mortality rates, a lower perioperative blood transfusion rate (32.7% vs. 53.3%, p < 0.001), lower incidences of postoperative pneumonia (15.3% vs. 29.3%, p = 0.004) and delirium (14.0% vs. 36.0%, p < 0.001), a shorter length of stay [8.6 days (7.5, 11.2) vs. 11.6 days (9.7, 14.9), p < 0.001], and lower hospitalization expenses [54,336 ¥ (48,965, 64,532) vs. 61,616 ¥ (50,758, 74,484), p = 0.001]. The serum albumin level at discharge in the early surgery group was higher (33.4 (31.6, 35.4) vs. 32.6 (30.7, 34.9), p = 0.039). Kaplan-Meier survival curve analysis showed that the all-cause mortality rate in the non-early surgery group increased (Log Rank p = 0.0066). Multivariate Cox analysis showed that age, BMI, admission hemoglobin, and non-early surgery were risk factors for 2-year mortality. CONCLUSION:Early surgical intervention for hip fractures in super-aged patients is associated with improved survival, reduced complications, and better resource utilization. These findings support the implementation of protocols to minimize preoperative delays in this vulnerable population.

Nanozymes, a class of nanomaterials with intrinsic enzyme-mimetic properties, have emerged as promising therapeutic platforms for bone regeneration due to their low cost, high stability, and multifunctionality. This review provides mechanistic insights and translational perspectives on how nanozymes act as microenvironmental "remodelers" to enhance bone repair. Representative systems-including cerium oxide (CeO2), manganese-based (Mn3O4/MnO2), and Prussian blue (PBNPs)-exert therapeutic effects by scavenging ROS, promoting M2 macrophage polarization, restoring mitochondrial function, suppressing the NLRP3/NF-κB signaling axis, and clearing deleterious metabolites such as lactate. We systematically discuss immune regulation, metabolic intervention, and their synergistic crosstalk, highlighting their capacity for spatiotemporal coordination of angiogenesis and antimicrobial defense. Finally, we outline future directions, including enhancing catalytic specificity, improving in vivo stability, addressing biosafety and pharmacokinetics, developing intelligent nanozyme designs, and establishing clinically relevant evaluation models to accelerate translation into effective bone therapies.

Diabetic patients exhibit higher tendon injury incidence, with elevated risks of healing failure and re-rupture than healthy individuals, posing major clinical challenges. Tendon stem/progenitor cells (TSPCs) are crucial for tendon homeostasis maintenance, and their senescence underlies regenerative impairment. In this study, diabetic rat Achilles tendon-derived TSPCs (dTSPCs) were identified to exhibit accelerated cellular senescence and dysfunction. Mechanistically, the excessive activation of the Ras/MAPK axis, which mediates mitochondrial dysregulation and elevated reactive oxygen species (ROS) production, was a key driver of dTSPCs senescence and impaired diabetic tendon regenerative capacity. Accordingly, we developed a nanocomposite hydrogel system loaded with Ganoderma lucidum polysaccharides (GLPs), consists of a ROS-responsive PVA-TSPBA hydrogel encapsulating GLPs@ZIF-8 nanoparticles (GZPT). In vitro, GZPT effectively suppressed Ca²⁺ influx, thereby inhibiting aberrant Ras/MAPK axis activation mediated mitochondrial dysfunction and ROS overproduction, ultimately attenuating dTSPCs senescence and dysfunction. In vivo, GZPT enables sustained and precisely controlled release of GLPs, promoting structural regeneration and functional restoration of diabetic tendon defects by mitigating the prosenescent oxidative stress niche. These findings demonstrate that GZPT effectively enhances the functionality of senescent dTSPCs and facilitates diabetic tendon regeneration, suggesting that GZPT represents a promising clinical strategy for improving tendon structural and functional regeneration in diabetic patients.

With population aging, hip fractures in elderly patients are a major medical problem. The impact of intraoperative hypotension (IOH) on adverse postoperative outcomes such as complications and mortality remains controversial. This study aimed to clarify this relationship for clinical guidance. A retrospective analysis was performed on patients over 65 years of age who had hip fracture surgery from July 2019 to Dec 2023. Patients were divided into IOH and No IOH groups. Propensity score matching (PSM) was used to reduce confounding factors. The primary outcome measures included postoperative complications (were grouped as one to two complications and three or more complications) and postoperative mortality. The secondary outcome measures included specific complications and length of hospital stay (LOS). After PSM, 546 patients were included. The IOH group had a higher proportion of patients with three or more postoperative complications (3.0

Objective:To investigate the efficacy and safety of emergency administration of tranexamic acid (TXA) in reducing perioperative blood loss and blood transfusion rate in elderly patients with intertrochanteric femoral fractures. Methods:A retrospective analysis was conducted on the clinical data of 102 elderly patients with intertrochanteric femoral fractures who were admitted between October 2023 and May 2025 and met the selection criteria. Patients were divided into two groups based on whether TXA was administered in the emergency department: the TXA group (patients received a single intravenous infusion of 1 g TXA immediately upon emergency admission, n=50) and the control group (no TXA was used in the emergency department, n=52). There was no significant difference in baseline data between the two groups ( P>0.05), including age, gender, body mass index, American Society of Anesthesiologists (ASA) classification, AO/Orthopaedic Trauma Association (AO/OTA) fracture classification, underlying comorbidities, prothrombin time, activated partial thromboplastin time, fibrin degradation products, D-dimer, bone mineral density T-score, time from injury to admission, time from admission to surgery, hemoglobin (HB), and hematocrit (HCT) levels at emergency admission. The following parameters were collected and analyzed statistically: changes in HB and HCT on the day before surgery (compared with values at emergency admission); hidden blood loss (HBL) on the day before surgery; total blood loss (TBL) on postoperative day 1, day 3, and during the entire perioperative period; in-hospital blood transfusion rate; and incidence of complications such as thrombosis. Results:There was no significant difference in operation time between the two groups ( P>0.05). All patients were followed up 3-12 months (mean, 6.6 months). On the day before surgery, the decreases in HB and HCT in the TXA group were significantly lower than those in the control group ( P<0.05). The HBL on the day before surgery and perioperative TBL in the TXA group were significantly lower than those in the control group ( P<0.05), whereas there was no significant difference in TBL on postoperative day 1 or day 3 between the two groups ( P>0.05). The in-hospital blood transfusion rate in the TXA group (34.0%) was significantly lower than that in the control group (55.8%, P<0.05). During hospitalization and follow-up, no complication such as deep vein thrombosis of the lower extremities, pulmonary embolism, surgical site infection, or allergic reactions occurred in either group. Intermuscular venous thrombosis occurred in 4 patients (8.0%) in the TXA group and 5 patients (9.6%) in the control group, with no significant difference in incidence between the two groups ( P>0.05). Conclusion:Elderly patients with intertrochanteric femoral fractures experience significant blood loss due to initial trauma. Emergency administration of TXA can reduce trauma-induced preoperative HBL, perioperative TBL, and in-hospital blood transfusion rate without increasing the incidence of thromboembolic events, thus proving safe and effective.

In recent years, considerable progress has been made in the specific development and practice of enhanced recovery after surgery (ERAS) for geriatric hip fracture domestically and internationally. By synthesizing domestic and international research reports, this article analyzes the current status of key development areas of ERAS for geriatric hip fracture and puts forward future prospects. The main contents include the crises and opportunities of geriatric hip fracture against the backdrop of deep aging, the specific implementation of team and model construction in the application of ERAS concept to geriatric hip fracture management, the benefits and effect evaluation of recent studies, as well as the opportunities and innovative pathways brought by the development of big data and artificial intelligence for the future development of ERAS in this field.

Sarcopenia is a prevalent issue among older patients with hip fracture and is a risk factor for poor clinical outcomes. Computed tomography (CT)-derived muscle density and areawere reported to predict the prognosis of fracture patients. This study aimed to assess the efficacy of these CT-based muscle parameters in predicting 1-year mortality in the oldest-old patients with hip fracture (≥ 80 years). A retrospective study was conducted on 324 hip fracture patients aged ≥ 80 years from 2018 to 2022. The cross-sectional area (CSA) and Hounsfield units (HU) of periarticular hip muscles were measured from CT images. The primary outcome was 1-year mortality. A multivariate logistic regression model was constructed, and its performance was assessed using ROC analysis, calibration curves, and Hosmer-Lemeshow testing. A nomogram was developed for model visualization and early clinical application. The 1-year mortality rate in this cohort was 13.0

The effective repair of tendon injuries represents a significant challenge in the selection of an appropriate regeneration strategy. Meanwhile, umbilical cord-derived mesenchymal stem cells (UC-MSCs) have been employed in the treatment of a range of diseases due to a number of advantageous characteristics, including low immunogenicity, high proliferation and differentiation potential, extensive availability, ease of large-scale production, absence of ethical constraints, and immunomodulatory functions. It has demonstrated considerable clinical application potential and offer a promising avenue for the treatment of tendon injuries. The core strategies may be broadly classified into three categories: direct stem cell injection, transplantation of biological scaffolds with tissue engineering technology, and the use of stem cell-derived products. This review will provide an in-depth analysis of the pathophysiological mechanisms of tendon repair, describe the unique properties of UC-MSCs, and systematically evaluate the advantages and limitations of these treatment strategies, aiming to provide a solid theoretical basis and scientific guidance for the biological research and clinical application of UC-MSCs in the field of tendon repair. The translational potential of this article: Given the low immunogenicity, good biosafety, and strong differentiation potential possessed by UC-MSCs, it is expected to provide a both safe and effective therapeutic option for tendon injuries through certain processing measures, such as combining UC-MSCs with biomaterials or extracting their products. In addition, the extraction process of UC-MSCs is simple and non-invasive, which makes it easy to realize clinical mass production. Therefore, the use of UC-MSCs for tendon repair is significant for clinical translation of tendon injury treatment.

Background: Unstable proximal humeral fractures (PHFs) often require augmentation to prevent fixation failure, with fibular allograft (FA) being a common but limited option due to graft availability and intraoperative challenges. The spine cage (SC) (Xinrong Medical Instrument, Suzhou, China) offers a standardized alternative, although its comparative efficacy remains understudied. This study biomechanically and clinically evaluated SC vs. FA to assess their relative advantages. Methods: Using a case of postoperative varus malunion for digital simulation, we osteotomized 20 synthetic humeri to create unstable PHF models, which were then randomized to SC or FA groups for biomechanical evaluation of axial stiffness and cyclic loading-to-failure characteristics. In the clinical study, 65 patients with PHFs were grouped by augmentation strut type, with outcomes assessed through radiological measures (humeral head height and neck-shaft angle) and clinical evaluations (visual analog scale score, Constant-Murley Score, American Shoulder and Elbow Surgeons score, and range of motion). Results: The SC group showed higher axial stiffness and cyclic loading tolerance vs. FA. Interfragmentary displacement diverged significantly at 15,000 cycles. Among 65 patients (mean follow-up: 31.2 months), no intergroup differences were found in humeral head height, neck-shaft angle, Constant-Murley Score, American Shoulder and Elbow Surgeons, visual analog scale, or complications. Conclusion: Our findings demonstrate that SC provides superior biomechanical stability while achieving comparable clinical outcomes to FA. Additionally, SC circumvents the limitations associated with FA, including supply shortages and the challenges inherent to shoulder arthroplasty, suggesting its potential as a viable clinical alternative.

BACKGROUND:Emerging economies, represented by BRICS countries (Brazil, China, India, Russian Federation and South Africa), have a substantial impact on the global rehabilitation needs. However, the rehabilitation needs of BRICS countries remain unascertained. This study aimed to explore the rehabilitation needs of the BRICS countries from 1990 to 2021 and predict the trend of rehabilitation needs. METHODS:Relevant data pertaining to eight condition categories (encompassing 27 individual conditions) requiring rehabilitation were retrieved from the Global Burden of Disease Study 2021. The joinpoint regression models were employed to calculate average annual percentage changes to quantify trends in age-standardized rates. The autoregressive integrated moving average models were used to predict rehabilitation needs until 2036. RESULTS:The number of prevalent cases of total conditions requiring rehabilitation increased from 634 million (95% uncertainty interval [UI] 608-664) in 1990 to 1.093 billion (95% UI 1.056-1.135) in 2021, an increase of 72.2%. The years lived with disability counts of total conditions increased from 79 million (95% UI 60-101) in 1990 to 147 million (95% UI 112-189) in 2021, an increase of 85.6%. Since 1990, the age-standardized prevalence rates of total rehabilitation needs have been decreasing in all BRICS countries. The number of people needing rehabilitation will continue to grow, with 1.469 billion people in BRICS countries requiring rehabilitation services by 2036. The highest contribution to the need for rehabilitation in BRICS countries was musculoskeletal disorders with about 676 million people (95% UI 630-716) across eight condition categories, and hearing loss with 232 million people (95% UI 205-260) among 27 individual conditions. CONCLUSIONS:The need for rehabilitation in BRICS countries has increased substantially over the past 32 years and will continue to increase until 2036. Although the rehabilitation needs are based on modeled estimates from the Global Burden of Disease Study 2021, we strongly recommend that rehabilitation services targeting these needs, particularly for musculoskeletal disorders and hearing loss within sensory impairments, be integrated into primary care systems.

Abstract Over the past decades, managing tendon disorders has remained a great clinical challenge. Due to the limited endogenous healing ability of tendons, current clinical approaches often result in unsatisfactory repair. Therapies based on mesenchymal stem cells (MSCs) are promising for treating various tendon disorders; however, recent clinical trials have shown that the therapeutic benefits of exogenous MSC transplantation are still unsatisfactory. Alternatively, harnessing endogenous tendon stem/progenitor cells (TSPCs) has emerged as a promising strategy to initiate tenogenesis and restore tendon homeostasis, which can overcome the limitations of exogenous MSCs transplantation, such as low utilization rate, uncontrollable cell fate, and high costs. Meanwhile, efforts in decoding heterogeneity of TSPCs, advances in material science, and regenerative medicine have enabled precise modulation of the TSPC niche and cellular responses through the tailored design of biomaterials. Biomaterials with tailored properties, such as hydrogels, scaffolds and decellularized tendon matrix, can provide physical or chemical cues that activate endogenous TSPCs for regeneration. Moreover, drug delivery systems mediated by biomaterials like nanoparticles, hydrogels, and microneedles can directly or indirectly promote tenogenic potential of TSPCs. This review provides an updated overview of the specific markers and functions associated with various TSPC subpopulations, highlighting their roles in tendon physiology and pathology. Additionally, we summarize current biomaterial‐based strategies for modulating cellular responses of endogenous TSPCs, including activating normal tenogenic potential, inhibiting pathological differentiation, senescence and apoptosis, and improving the TSPC niche. Lastly, we present future perspectives that emphasize the need for a more comprehensive understanding and targeted modulation of TSPCs and their microenvironment. In summary, this review provides key insights into the rational design of next‐generation biomaterials aimed at TSPC modulation with the ultimate goal of advancing clinical therapies for tendon disorders.

Objective:To compare the short-term effectiveness between Gamma 3 intramedullary nails and Gamma 3 U-Blade system in the treatment of osteoporotic intertrochanteric fractures in the elderly. Methods:A retrospective analysis was conducted on the clinical data of 124 elderly patients with osteoporotic intertrochanteric fractures, who were admitted between February 2020 and February 2023 and met the selection criteria. The fractures were fixed with Gamma 3 intramedullary nails in 65 patients (control group) and Gamma 3 U-Blade systems in 59 patients (UB group). The differences between the two groups were not significant in age, gender, body mass index, American Society of Anesthesiologists (ASA) classification, bone mineral density, time from injury to operation, fracture classification, and affected side ( P>0.05). The operation time, intraoperative blood loss, hospital stay, and fracture healing time were recorded; the tip-apex distance, fracture reduction quality, and lag screw position were evaluated on X-ray films at immediate after operation; the lag screw sliding distance and change value of neck-shaft angle were measured on X-ray films at last follow-up. Harris hip score at 1 year after operation and the occurrence of internal fixation-related complications were compared between the two groups. Results:The operation time, intraoperative blood loss, and hospital stay in the UB group increased compared to the control group, but the differences were not significant ( P>0.05). All patients in both groups were followed up 12-24 months (mean, 17.1 months). At 12 months after operation, there was no significant difference in the Harris hip score between the two groups ( P<0.05). Radiological examination showed that there was no significant difference between the two groups ( P>0.05) in terms of tip-apex distance, fracture reduction quality, and lag screw position. Fractures healed in both groups, and there was no significant difference in healing time ( P>0.05). At last follow-up, the change value of neck-shaft angle and lag screw sliding distance in the UB group were significantly lower than those in the control group ( P<0.05). During follow-up, no related complications occurred in the UB group, while 6 cases (9.2%) in the control group experienced complications, and the difference in the incidence was significant ( P<0.05). Conclusion:For the osteoporotic intertrochanteric fractures in the elderly, the Gamma 3 U-Blade system fixation can achieve good short-term effectiveness, with better imaging results compared to Gamma 3 intramedullary nails fixation.

A dual-beam laser system was developed for closing skin wounds and investigated the healing performance of these wounds after welding using five different laser scanning paths with increasing sparsity. The five paths included Peano, Circle, Jagged, Airwave, and Surgical suture needle point paths. These paths exhibited symmetrical structures along the incision, with decreasing sparsity in the aforementioned order. Total Energy density is 102.96 J/cm2 with the interspace between beams is 0.1865 mm. Soldering time is 300 s and effective fusion area is 0.2625 mm2. Macroscopic morphology and biomechanical strength of skin samples under different laser scanning paths were evaluated using metallographic microscopy and high-precision electronic push-pull force gauge measurements. HE staining was employed to characterize the influence of laser scanning paths on microscopic tissue structure of samples, while Masson staining represented the degree of collagen damage under different scanning paths. Fluorescence spectroscopy was used to analyze energy transfer between tyrosine and phenylalanine, Fourier transform near-infrared spectroscopy demonstrated collagen molecular structural changes, and Raman spectroscopy further analyzed peptide chain folding mechanisms. Finally, Sirius Red staining was utilized to analyze fibrosis tendency in wound healing by examining distribution and content of type I and III collagens after welding with different laser scanning paths. The final results showed that dual-beam laser welding of skin incisions under Jagged path conditions can achieve stable biomechanical strength, fine microstructural texture, and full-thickness fusion. The functionality of tyrosine remains unaffected by laser energy damage, primarily due to the reconstruction of acylamide III band accompanied by the formation of new peptide chains. The ratio between collagen I and collagen III in welded area is close to 0.6, with a rich presence of type III collagen around the denatured region of collagen, contributing in high elasticity and reduced tendency for scar formation during later stages of healing process.

Tendon stem/progenitor cell (TSPC) senescence contributes to age-related tendon degeneration, yet the molecular mechanisms underlying this process remain poorly understood. In present study, we investigated the role of High-Mobility Group A2 (HMGA2) in TSPCs senescence. During the tendon aging, we showed that HMGA2 expression decreases with age. In senescent TSPCs, HMGA2 overexpression significantly delayed TSPCs senescence. Additionally, overexpression of HMGA2 restored the age-related dysfunction of migration, tenogenic differentiation, and mitophagy. HMGA2 also suppressed the senescence-associated secretory phenotype (SASP), downregulating inflammatory cytokines such as IL-1β, IL-6, and TGF-β. Furthermore, we suggested that the PI3K-AKT signaling pathway is activated in senescent TSPCs, and HMGA2 overexpression could inhibit the PI3K-AKT signaling pathway activation, which demonstrates that HMGA2 might attenuate senescence and age-related dysfunction of TSPCs through the repression of PI3K-AKT signaling pathway. Our findings collectively indicated the crucial involvement of HMGA2 in TSPCs senescence regulation and suggested a novel target for preventing tendon aging.

PURPOSE:We aimed to analyse the global, regional, and national burdens of hip fractures in older adults from 1990 to 2021, with projections to 2050, on the basis of data from the GBD 2021 study. METHODS:We employed a joinpoint model to analyse trends in the burden of hip fractures from 1990‒2021. The estimated annual percentage change (EAPC) was used to quantify temporal trends over this period. We evaluated the relationship between the social development index and the burden of hip fracture in elderly people and conducted a health inequality analysis. Additionally, we applied Long-short Term Memory (LSTM) networks to forecast burden trends of hip fractures up to 2050. RESULTS:The global age-standardized incidence rate (ASIR) for hip fractures in older adults rose from 781.56 per 100,000 in 1990 to 948.81 in 2021. The 2021 age-standardized prevalence rate (ASPR) was 1,894.07, and the age-standardized YLD rate (ASDR) was 173.52. From 1990 to 2021, the incidence and prevalence increased by 168.71 % and 173.07 %, respectively, while the burden of DALYs decreased. Future trends were projected via the LSTM. The burden and risk factors for hip fractures varied significantly by sex, country, and region. Population and aging are primary contributors to the rising incidence of elderly hip fractures, with falls being the leading direct cause. CONCLUSION:From 1990 to 2021, the global burden of hip fractures in the elderly population, especially among older women, steadily increased. Population ageing highlights the urgent need for targeted public health interventions and resource allocation, including early diagnosis, effective prevention strategies, and region-specific management approaches.

OBJECTIVES:To investigate the role of a tendon-derived stem cell (TDSC) sheet in tendon-bone healing within an extra-articular bone tunnel rat model. METHODS:Sprague-Dawley rats were randomly assigned to experimental and control groups. The superficial flexor tendon, with or without a TDSC sheet, was transplanted into a 1.0-mm diameter bone tunnel in the proximal tibia. The impact of the TDSC sheet on tendon-bone healing was assessed through radiological analysis, histological staining, and biomechanical testing. RESULTS:The TDSC sheet significantly enhanced tendon-bone healing, as evidenced by higher tunnel bone mineral density and bone volume/total volume at 4 weeks post-operation. Hematoxylin-eosin staining revealed that the TDSC sheet promoted the alignment of perpendicular collagen fibers connecting the tendon to the bone, along with Sharpey's fibers and new bone formation at the tendon-bone junction at both 4 and 8 weeks. Additionally, Masson's staining demonstrated that the tendon-bone interface was filled with abundant collagen fibers, with a significantly higher proportion of collagen fiber area in the TDSC sheet group compared to the control group at both 4 and 8 weeks. CONCLUSION:The TDSC sheet may enhance tendon-bone healing in the early stages, providing a potential therapeutic approach to accelerate tendon-bone remodeling.

Purpose::To assess the relationship between dislocation and functional outcomes in supination-external rotation (SER) ankle fractures.Methods::A retrospective case series study was performed on patients with ankle fractures treated surgically at a large trauma center from January 2015 to December 2021. The inclusion criteria were young and middle-aged patients of 18 - 65 years with SER ankle fractures that can be classified by Lauge-Hansen classification and underwent surgery at our trauma center. Exclusion criteria were serious life-threatening diseases, open fractures, fractures delayed for more than 3 weeks, fracture sites ≥ 2, etc. Then patients were divided into dislocation and no-dislocation groups. Patient demographics, injury characteristics, surgery-related outcomes, and postoperative functional outcomes were collected and analyzed. The functional outcomes of SER ankle fractures were assessed postoperatively at 1-year face-to-face follow-up using the foot and ankle outcome score (FAOS) and American Orthopedic Foot and Ankle Society ankle hindfoot score and by 2 experienced orthopedic physicians. Relevant data were analyzed using SPSS version 22.0 by Chi-square or t-test. Results::During the study period, there were 371 ankle fractures. Among them, 190 (51.2%) were SER patterns with 69 (36.3%) combined with dislocations. Compared with the no-dislocation group, the dislocation group showed no statistically significant differences in gender, age composition, fracture type, diabetes, or smoking history, preoperative waiting time, operation time, and length of hospital stay (all p > 0.05), but a significantly higher Lauge-Hansen injury grade ( p < 0.001) and syndesmotic screw fixation rate ( p = 0.033). Moreover, the functional recovery was poorer, revealing a significantly lower FAOS in the sport/rec scale ( p < 0.001). Subgroup analysis showed that among SER IV ankle fracture patients, FAOS was much lower in pain ( p = 0.042) and sport/rec scales ( p < 0.001) for those with dislocations. American Orthopedic Foot and Ankle Society ankle hindfoot score revealed no significant difference between dislocation and no-dislocation patients. Conclusion::Dislocation in SER ankle fractures suggests more severe injury and negatively affects functional recovery, mainly manifested as more pain and poorer motor function, especially in SER IV ankle cases.

Sarcopenia is prevalent in older adults with hip fracture and is associated with poor postoperative outcomes. This study aimed to evaluate the prognostic value of sarcopenia index (SI) and creatinine–cystatin C ratio (CCR) in predicting postoperative mortality in older patients with hip fracture. A retrospective study was conducted on 485 older adults (aged ≥ 65 years) with hip fracture treated at Zhongda Hospital between January 2018 and December 2022. SI and CCR were calculated using serum creatinine and cystatin C. The primary outcome was all-cause mortality at 1, 3, and 12 months. Among the 485 patients, 46 (9.5

Objective:This review summarized the first 10-year progresses and controversies in the concept of anteromedial cortical support reduction, to provide references for further study and clinical applications. Methods:Relevant domestic and foreign literature on cortical support reduction was extensively reviewed to summarize the definition of positive, neutral, and negative support, anteromedial cortices at the inferior corner, intraoperative technical tips for fracture reduction, radiographic assessment at different periods, comparison between positive versus neutral and medial versus anterior support, and the clinical efficacy of Chang reduction quality criteria (CRQC) and postoperative stability score. Results:Anteromedial cortical support reduction was only focused on the cortex of anteromedial inferior corner, with no concern the status of lateral wall or lesser trochanter. Anteromedial cortex was seldom involved by fracture comminution, it was thicker, denser, and stronger, and was the key for mechanical buttress of the head-neck fragment to share compression load. Positive, neutral, and negative support were also called "extramedullary, anatomic, and intramedullary reduction", respectively. There was hardly seen parallel cortical apposition, but characterized by some kinds of head-neck rotation, for example 10°-15° flexed rotation for positive cortical contact and support. Due to intraoperative compression and postoperative impaction, the status of cortical support may be changed at different time of radiographic examination. The positive medial cortex support was more reliable with less reduction loss than its neutral counterpart, and the anterior cortex contact was more predictive than the medial cortex for final results. As incorporation the bearing of cortex apposition and using a 4-point score, CRQC demonstrated more efficacy and was gradually accepted and applied in the evaluation of trochanteric fracture reduction quality. Postoperative stability score (8 points) provided a assessment tool for early weight-bearing in safety to prevent mechanical failure. Conclusion:Anteromedial cortical support reduction is a key point for stability reconstruction in the treatment of trochanteric femur fractures. Evidence has definitely shown that non-negative (positive and neutral) is superior to negative (loss of cortical support). There is a tendency that positive cortex support is superior to neutral, but high quality study with large sample size is needed for a clear conclusion.