Background: Clavicle fractures, frequently associated with sports and trauma, are prevalent injuries in the upper extremity. Surgical repair, a common intervention, aims to restore skeletal stability and facilitate functional recovery. The role of neural protection, particularly concerning the supraclavicular nerve, in clavicle fracture surgery remains an area of interest. The purpose of this study was to compare operative time, bleeding, postoperative hospitalization, postoperative pain, numbness, and upper extremity function between clavicle plastic surgery patients using supraclavicular nerve preservation and supraclavicular nerve sacrifice techniques. Methods: A retrospective cohort study spanning January 2021 to January 2023 involved patients with midshaft clavicle fractures treated with dynamic compression plates or locking plates at Xi'an People's Hospital (Xi'an Fourth Hospital). Patient data were extracted, and surgical outcomes were meticulously recorded. Parameters such as operative time, estimated blood loss, post-operative hospitalization duration, Visual Analog Scale (VAS) scores, Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score, and the occurrence of numbness were among the comprehensive outcomes analyzed. Results: Among the 241 eligible patients, the study categorized them into Supraclavicular Nerve Preservation (SNP) and Supraclavicular Nerve Sacrificing (SNS) groups. Baseline analysis revealed comparable demographic and injury-related characteristics. Surgical outcomes analysis demonstrated no significant difference in operative time between the SNP and SNS groups (64.28 ± 16.07 vs. 67.50 ± 17.53, p = 0.19). Strikingly, the SNP group exhibited significantly lower blood loss during surgery compared to the SNS group (28.43 ± 13.35 vs. 36.51 ± 16.54, p < 0.01). No substantial difference in post-operative hospitalization duration was noted between the two groups (3.07 ± 1.07 vs. 3.23 ± 41.06, p = 0.32). Evaluation of postoperative numbness consistently favored the SNP group at 1 month (94.1% vs. 8.1%, p < 0.01), 3 months (95.6% vs. 10.4%, p < 0.01), 6 months (98.5% vs. 11.6%, p < 0.01), and 1 year postoperatively (98.5% vs. 13.3%, p < 0.01). Conclusion: This study suggests that the Supraclavicular Nerve Preservation approach, while equivalent in operative efficiency, offers advantages in reducing blood loss (p < 0.01) and minimizing postoperative numbness (all p < 0.01). These findings contribute valuable evidence to the discourse on optimal clavicle fracture management, emphasizing the importance of nerve preservation in surgical interventions. Further research is warranted to validate and extend these findings for broader clinical implications.

This long-term study protocol aims to compare the clinical outcomes of patients with severe lower limb trauma undergoing orthoplastic and orthopedic surgeries, focusing on their physical and psychological status. Patients with lower limb injuries and open fractures have been recruited since October 2019 and will be followed up until October 2024. The patients will be divided into two groups: (1) Orthoplastic group, where single-stage debridement, fixation, and soft tissue repair will be performed, and (2) Orthopedic group, where soft tissue repair will be done in a delayed-stage. The follow-up period will be one year, during which clinical data, limb function recovery, psychological scores, and health-related quality of life (HRQOL) will be evaluated to assess postoperative recovery and clinical outcomes. Additional clinical data, such as socio-demographic information, baseline features, Enneking score, Visual Analogue Scale (VAS) score, two-point discrimination score, and blood test parameters will also be collected. The 36-Item Short Form Health Survey (SF-36) will be used to evaluate HRQOL, while the Post-traumatic Stress Disorder Checklist (PCL) will assess the severity of self-reported post-traumatic stress disorder. The results of this study will provide valuable insights into prognostically relevant targets and contribute to improving the management and outcomes of patients with lower limb injuries and open fractures, who often face challenges related to limb disability and potential amputation postoperatively, significantly impacting their psychological and physical well-being.

Rationale: Incidence of lunate fractures is very low, less than 1% of all fractures. Lunate fractures generally come from high-energy injuries, often combined with other wrist fractures. Simple lunate fractures can be fixed with screws or Kirschner wires. However, Comminuted lunate fractures are difficult to reduce and fixe by conventional methods. Patient concerns: Here we report a 42-year-old male construction worker who was crushed by an excavator bucket and presented with comminuted lunate fracture combined with distal radius fracture and scaphoid fracture. Diagnoses: Comminuted lunate fracture, distal radius fracture, and scaphoid fracture. Interventions: The posterior approach was used to reconstruct the radial lunate bone with polymethylmethacrylate cement, and cannulated screws were used to fix the scaphoid and distal radius fractures. Outcomes: At the 3rd month after surgery, the movement of the right wrist joint improved. At the sixth month after surgery, the patient returned to the building site and began working at the same intensity as before the injury. Lessons: Although the incidence of comminuted lunate fractures is very low, they occur sometimes. For comminuted lunate fractures, early identification and intervention can preserve most of the function of the wrist joint.

穿支皮瓣是在传统轴型皮瓣基础上发展而来,以穿支血管供血,仅包括皮肤与浅筋膜组织的一种新型皮瓣,由于改变了深筋膜血管网是皮瓣赖以生存的传统观点,使皮瓣设计和形成更具灵活性和多样性 [ 1, 2, 3] 。2012年唐举玉 [ 4] 在国际上首次提出的特殊形式穿支皮瓣是应用传统穿支皮瓣的"微创与美学"理念、根据受区修复要求对皮瓣供区的一级源血管及其分支和相应供养的组织（皮肤、筋膜、肌肉、骨组织）进行优化设计、无创解剖、分割和重组,根据受区创面重建需要切取不同组织块（嵌合）或相同组织块（分叶）,然后再削薄、组装、拼接成与受区创面内容、形状及血液循环重建要求相匹配的新型皮瓣。特殊形式穿支皮瓣是传统穿支皮瓣的衍生和发展,是穿支皮瓣的更高形式,丰富了穿支皮瓣的内涵,扩大了穿支皮瓣的适应证 [ 5, 6, 7, 8, 9, 10, 11, 12, 13] 。

OBJECTIVE:This study aimed to retrospectively analyze clinical data of a series of patients with severe open fractures of extremities (Gustilo IIIb or IIIc), who achieved a satisfactory outcome through radical orthoplastic surgery, so as to provide a reference for determining the treatment of severe open fractures of extremities.METHODS:The clinical data of 41 consecutive patients with severe open fracture (Gustilo IIIb or IIIc) of the limb, who underwent successful surgical debridement, fixation, and soft tissue reconstruction in one stage between January 2008 and January 2019, were retrospectively reviewed. Postoperative indicators, including infection rate and union time, were acquired by a regular follow-up and analyzed.RESULTS:The mean (±SD) age of the patients was 38 ± 16 years. A total of 90 open fractures and severe soft tissue damages were analyzed. The soft tissue cover was achieved within 72 h. The overall rate of infection was 14.6% (6/41). Sex and the Mangled Extremity Severity Score were associated with infection. The median union time of 40 patients (one amputation) was 32 weeks.CONCLUSION:The overall rate of infection exhibited a lower tendency in this study compared with previous studies on high-grade open fractures following a two-stage orthopedic approach. The consequence of infection rate and union time was similar to that in previous studies. These results indicated that the single-stage radical orthoplastic treatment was an effective and reliable option for reconstructing severe open fractures.

Objective This study aimed to present the use of flow-through free anterolateral thigh (ALT) flap for the reconstruction of severe limb injury. Patients and Methods Four patients (2 male and 2 female subjects), with an average age of 26 (9-39) years, were included. These injuries referred to upper and lower limbs, including bone, soft tissue, nerve, and arterial segments. Two patients experienced large soft tissue defects in the lower limb and were repaired by double flow-through ALT flaps. The sizes of damaged soft tissues in the remaining 2 patients were 14 x 10 cm(2)and 21 x 13 cm(2), respectively. Three patients had bone fractures, in which one of them experienced bone shortening during operation. The arterial injury was observed in 2 patients and the lengths of defects were 5 and 12 cm, respectively. Flow-through free ALT flap was applied for all 4 patients. Results Patients were followed up for 18 months. All the flaps have survived successfully without any vascular crisis or infection. All incision wounds were under primary healing stage, without any severe complications. The flaps showed better appearance, color, texture, and satisfactory sensation. All patients had satisfactory functional recovery of their injured limbs. Conclusions The flow-through free ALT flap assists in overcoming complex traumatic injuries with severe soft tissue and arterial defects in the limbs. This flow-through ALT flap can be an effective alternative for reconstruction of severe limb injury.

Objective:To analyze the therapeutic effect of medial gastrocnemius muscle flap transfer combined with induced membrane technique in repairing anterior medial Gustilo-Anderson type ⅢB injury of the middle and upper tibia accompanied by bone defect.Methods:A retrospective case series study was conducted to analyze 21 patients with anterior medial Gustilo-Anderson type ⅢB injury of middle and upper tibia accompanied by bone defectanterior medial tibial fractures admitted to Xijing Hospital，Air Force Military Medical University from April 2017 to January 2019. There were 15 males and 6 females，with the age of （38.6 ± 7.6）years （range，18-66 years）. After admission，all patients had bone defect repair and fixation and soft tissue defect repair using membrane induction technique in the first stage. The area of soft tissue defect ranged from 8.0 cm × 6.0 cm to 16.0 cm × 12.0 cm. The length of tibial defect was （5.5 ± 1.8） cm （ranged，3.5-11.0 cm）. The size of metastasis of medial gastrocnemius flap ranged from 12.0 cm × 8.0 cm to 22.0 cm × 13.0 cm. The survival rate of muscle flap was observed. One week after the wound was stabilized，skin grafting on the surface of muscle flap was performed at second stage. The graft survival was observed. The induced membrane technique was used to reconstruct bone defects at third stage. The infection index，lower extremity functional scale （LEFS） and Mazur ankle function score were compared before and at the last follow-up. The fracture healing and related complications were observed，and the lower limb function was evaluated by Johner-Wruhs scoring system at the last follow-up.Results:All patients were followed up for 11-26 months ［（18.4 ± 5.1） months］. The muscle flap transferred survived in all patients at first stage. The skin graft survived at second stage，and the wound healing time was 1-4 weeks ［（3.1 ± 0.5）weeks］. After the surgery at third stage，the healing time of bone fracture was （8.2 ± 0.7）months （range，6-10 months）. A significantly lowered level of infection was observed at the last follow-up compared to that before operation （ P < 0.01）. The LEFS and Mazur ankle function scores of the affected limb were （52.2 ±8.9）points and （75.2 ± 13.1）points at the last follow-up，significantly higher than those before operation ［（36.0 ± 5.6）points，（53.7 ± 14.6）points］ （ P < 0.01）. The soft tissue defect was repaired satisfactorily，and the broken ends of bone defects were healed at the last follow-up. Delayed bone union occurred in 3 patients，but no infection，osteomyelitis，foot drop or other complications occurred. According to Johner- Wruhs score，18 patients were rated as excellent，2 patients as good，1 patient as fair and 0 patient as poor，with the excellent and good rate of 95%. Conclusion:For patients with anterior medial Gustilo-Anderson type ⅢB injury of the middle and upper tibia accompanied by bone defect，transfer of medial gastrocnemius head muscle flap combined with induced membrane technique can effectively repair the injured limb，reduce infection and restore partial function of the lower limb，indicating that the procedure is an effective treatment strategy with satisfactory clinical results.

Abstract Orthoplastic treatment based on the collaboration of orthopedic and plastic surgeons in an “orthoplastic” central unit has been recommended by the British Association of Plastic Reconstructive and Aesthetic Surgery. However, this approach is not used worldwide especially in most developing countries. Based on the aggressive orthoplastic management, orthoplastic experience with Chinese characteristics has been carried out in last 10 years. The clinical data of 41 consecutive patients with severe open fracture (Gustilo IIIb or IIIc) of the limb, who underwent successful surgical debridement, fixation, and soft tissue reconstruction in one stage between January 2008 and April 2019, were retrospectively reviewed. Postoperative indicators, including infection rate and union time, were acquired by a regular follow-up and analyzed. The mean (±SD) age of the patients was 38±16 years. The soft tissue cover was achieved within 72 h. The overall rate of infection was 14.6% (6/41). Sex and the Mangled Extremity Severity Score were associated with infection. The median union time of 40 patients (one amputation) was 32 weeks. The overall rate of infection exhibited a lower tendency in this study. These results indicated that the single-stage radical orthoplastic treatment was an effective and reliable option for reconstructing severe open fractures.

Severe open fractures of the lower limb are often accompanied by bone defect, soft tissue defect and vascular injury, which greatly endangers safety of the lower limb. Limb salvage treatment is a difficult problem in orthopedic trauma. Now the main problems of limb salvage treatment in China are the lack of professional regional treatment system, ambiguity in the timing of debridement and the qualification of debridement doctor and delayed soft tissue coverage. As a result, the majority of patients cannot achieve satisfactory recovery of limb function. The concept of Orthoplastics was first advocated in the publication of guidelines for the treatment of open fractures in lower limbs by British Orthopaedic Association. There are significant advantages of Orthoplastic strategies, such as less frequency of operation, less healing time of the fracture, lower infection rate and other complications. This strategy brings us new direction for the treatment of severe open fractures of the lower limb. The authors mainly analyze the problems in treatment of severe open fractures of the lower limb, introduce the new concept of orthoplastics, improve the understanding of treatment of severe open fractures of the lower limb in Orthopaedic surgeons, so as to provide references for improving the treatment effect.

伴有严重软组织损伤的开放性骨折,保肢治疗挑战巨大.国内传统治疗模式是骨折修复技术与软组织修复技术的简单叠加或重复实施.长期的实践表明该治疗模式需对患者施行多次手术,不仅增加了患者及其家庭的经济负担,更重要的是并不利于伤肢功能的恢复. Orthoplastic(骨整形)理念是将肢体骨与软组织创伤作为一个整体,由创伤骨科和整形外科医生一起有计划、有次序地高效完成骨与软组织的同期修复;其在严重开放性骨折的保肢疗效方面显著优于传统治疗.结合我国临床实际情况推广该理念并加以提升,对于提高严重开放性骨折的治疗水平具有重要意义和积极的推动作用.

目的:足踝部特殊的解剖结构使其在手术或创伤打击之后易发骨髓炎,本文介绍了足踝部慢性骨髓炎的治疗策略及治疗结果.方法:回顾性分析2010年1月到2015年12月于我科治疗的足踝部慢性骨髓炎患者的临床特点及治疗结果,纳入患者术后随访至少2年,有糖尿病或免疫缺陷者被排除在研究之外.骨髓炎的病因,原发部位,致病菌,是否累及临近关节及骨髓炎复发情况被纳入评估,所有患者术前均进行SPECT/CT检查,用以评估骨髓炎感染的范围以及是否累及临近关节.手术治疗策略包括彻底的病灶清除,去除死腔以及累及关节时进行关节融合等.结果:足踝部慢性骨髓炎最常见的病因是创伤后的开放骨折或脱位,占所有患者的70％.耐甲氧西林金黄色葡萄球菌和铜绿假单胞菌是最常见的致病病原体.在45％的患者中,骨髓炎侵犯邻近关节,所有累及关节患者均进行了关节融合术.平均住院天数为16.5天.20例患者中18例无复发.结论:足踝部慢性骨髓炎发生邻近关节侵犯时,在进行彻底的病灶清除和去除死腔后,进行关节融合可获得良好疗效.

Objective To explore the therapeutic feasibility of uterus transplantation for uterine infertility .Methods Retrospective analysis was performed for the diagnosis ,treatment and pregnancy course of the first domestic case of uterus transplantation and the relevant literature reviewed .The recipient was a 22-year-old woman with a congenital absence of uterus and vagina .Previously she underwent vaginal reconstruction and the donor was her mother . The specific procedures included donor/recipient screening , ethical argumentation ,assisted reproductive technology of obtaining frozen embryos , Vinci robot-assisted uterine procurement ,orthotopic replacement & fixation of retrieved uterus , revascularization;immunoregulation &monitoring of transplanted uterine recipient , assisted reproductive technology after transplantation and gestational management .Results The durations of donor and recipient surgeries were 360 and 530 min respectively .No complications of recipient or donor occurred during the perioperative period .First menstruation occurred at 40 days post-transplantation and regularly thereafter .Pregnancy occurred after embryo transfer at 31 months post-transplantation .No rejection episodes occurred after transplantation or during gestation .Caesarean delivery occurred near gestational week 34 .The boy weighed 2000 grams at birth and the mother remained well . Conclusions In conjunctions with literature review , uterine infertility may be treated by modified uterus transplantation .And a new path is paved for healthy pregnancy of women with uterine infertility .

The purpose of this study was to verify the effect of cordycepin on ovariectomized osteopenic rats. Fifty Wistar female rats used were divided into 5 groups: (1) sham-operation rats (control), (2) ovariectomized (OVX) rats with osteopenia, and (3) OVX’d rats with osteopenia treated with cordycepin (5 mg, 10 mg, and 20 mg) for 8 weeks. After the rats were treated orally with cordycepin, serum alkaline phosphatase (ALP), tartrate resistant acid phosphatase (TRAP), serum osteocalcin (OC), homocysteine (HCY) , C-terminal crosslinked telopeptides of collagen type I (CTX) level, and oxidative stress were examined, respectively. The femoral neck was used for mechanical compression testing. At the same time, we further investigated the effect of cordycepin in vitro assay. The beneficial effects of cordycepin on improvement of osteoporosis in rats were attributable mainly to decrease ALP activity, TRAP activity, and CTX level. At the same time, cordycepin also increases the OC level in ovariectomized osteopenic rats. The histological examination clearly showed that dietary cordycepin can prevent bone loss caused by estrogen deficiency. These experimental results suggest that complement cordycepin is protective after ovariectomized osteopenic in specific way.