To investigate whether adding 1 transverse screw (TS) to the triangular parallel cannulated screw (TPCS) fixation has a mechanical stability advantage for Pauwels type Ⅲ femoral neck fractures by conducting finite element analysis on four internal fixation methods. Based on CT data of a healthy adult male volunteer's femur, three Pauwels type Ⅲ femoral neck fracture models (Pauwels angle 70°, Pauwels angle 80°, and Pauwels angle 70° combined with bone defect) were constructed using Mimics 21.0 software and SolidWorks 2017 software. Four different internal fixation models were built at the same time, including TPCS, TPCS+TS, three cross screws (TCS), and TPCS+medial buttress plate (MBP). The mechanical stability of different models under the same load was compared by finite element analysis. The femoral model established in this study exhibited a maximum stress of 28.62 MPa, with relatively higher stress concentrated in the femoral neck. These findings were comparable to previous studies, indicating that the constructed femoral finite element model was correct. The maximum stress of internal fixation in finite element analysis showed that TCS was the lowest and TPCS+MBP was the highest in Pauwels angle 70° and 80° models, while TPCS+TS was the lowest and TCS was the highest in Pauwels angle 70° combined with bone defect model. The maximum displacement of internal fixation in each fracture model was located at the top of the femoral head, with TCS having the highest maximum displacement of the femur. The maximum stress of fracture surface in finite element analysis showed that TCS was the lowest and TPCS was the highest in the Pauwels angle 70° model, while TPCS+MBP was the lowest and TPCS/TCS were the highest in the Pauwels angle 80° model and the Pauwels angle 70° combined with bone defect model, respectively. The maximum displacement of fracture surfece analysis showed that TPCS+MBP was the lowest and TCS was the highest in Pauwels angle 70° and 80° models, while TPCS+TS was the lowest and TCS was the highest in Pauwels angle 70° combined with bone defect model. For Pauwels type Ⅲ femoral neck fractures, the biomechanical stability of TPCS+TS was superior to that of TPCS alone and TCS, but it has not yet reached the level of TPCS+MBP.

Objective:To investigate whether adding 1 transverse screw (TS) to the triangular parallel cannulated screw (TPCS) fixation has a mechanical stability advantage for Pauwels type Ⅲ femoral neck fractures by conducting finite element analysis on four internal fixation methods. Methods:Based on CT data of a healthy adult male volunteer's femur, three Pauwels type Ⅲ femoral neck fracture models (Pauwels angle 70°, Pauwels angle 80°, and Pauwels angle 70° combined with bone defect) were constructed using Mimics 21.0 software and SolidWorks 2017 software. Four different internal fixation models were built at the same time, including TPCS, TPCS+TS, three cross screws (TCS), and TPCS+medial buttress plate (MBP). The mechanical stability of different models under the same load was compared by finite element analysis. Results:The femoral model established in this study exhibited a maximum stress of 28.62 MPa, with relatively higher stress concentrated in the femoral neck. These findings were comparable to previous studies, indicating that the constructed femoral finite element model was correct. The maximum stress of internal fixation in finite element analysis showed that TCS was the lowest and TPCS+MBP was the highest in Pauwels angle 70° and 80° models, while TPCS+TS was the lowest and TCS was the highest in Pauwels angle 70° combined with bone defect model. The maximum displacement of internal fixation in each fracture model was located at the top of the femoral head, with TCS having the highest maximum displacement of the femur. The maximum stress of fracture surface in finite element analysis showed that TCS was the lowest and TPCS was the highest in the Pauwels angle 70° model, while TPCS+MBP was the lowest and TPCS/TCS were the highest in the Pauwels angle 80° model and the Pauwels angle 70° combined with bone defect model, respectively. The maximum displacement of fracture surfece analysis showed that TPCS+MBP was the lowest and TCS was the highest in Pauwels angle 70° and 80° models, while TPCS+TS was the lowest and TCS was the highest in Pauwels angle 70° combined with bone defect model. Conclusion:For Pauwels type Ⅲ femoral neck fractures, the biomechanical stability of TPCS+TS was superior to that of TPCS alone and TCS, but it has not yet reached the level of TPCS+MBP.

Background:Coronal process fracture and radial head fracture are accompanied by posterior dislocation of the elbow joint, which is called the "terror triad" by Hotchkiss. It consists of the elbow fracture and the medial and lateral collateral ligament injuries of the elbow joint, resulting in severe instability, which is very difficult in clinical treatment as one of the main factors affecting the stability of the elbow joint, coronal process fracture plays a pivotal role in preventing posterior dislocation of the elbow joint. There is no adequate internal fixation for the coronal process fracture fragment with conventional methods, so it has always been a difficult point in clinical treatment. The technique of suture lasso was used in the cases of coronal process fracture of Regan-Morrey type I/II, and the preliminary curative effect was obtained. Objective To explore the operative method and clinical effect of the suture lasso technique in treating Regan-Morrey type I/II coronal process fracture.Methods:From January 2018 to June 2022, the clinical data and follow-up results of 18 patients with coronal process Regan-Morrey type I/II fracture in terror triad of the elbow treated with suture lasso technique were retrospectively analyzed, including 12 males and 6 females. Their ages ranged from 18 to 55 years, with an average age of 32 years. The causes of injuries included 12 cases of traffic injuries, 5 cases of high fall injuries, and 1 case of fall damage. All of them were type I/II according to the Regan-Morrey classification. All the lateral collateral ligaments were injured. All patients were treated through a lateral approach to reduce and fix fractures of the coronal process, radial head, and lateral collateral ligament. After the operation, the elbow joint was set in the functional position for 2 weeks, followed by functional exercise. The outpatients were followed up regularly for 3 weeks, 6 weeks, and 3 months after the operation. The postoperative elbow joint score was evaluated by the MEPS score system.Results:All patients were followed up for 3 to 52 months, with an average of 18 months. Bone union was achieved in all fractures. Elbow joint flexion position (0-30°), extension position (90-125°), with an average range of joint motion being 103.61°; pronation (10-90°), supination (20-90o), with an average rotation range of 142.78°. According to the MEPS Elbow Performance Index, the average postoperative score was 88.89 points (range 65-100 points). Among them, 12 cases were excellent, 3 were good, and 3 were moderate. The excellent and good rate was 83.3%. Three patients developed myositis ossificans. One patient took out the suture anchor due to infection.Conclusion:In the terror triad of the elbow, the clinical effect of the lateral approach of the elbow joint using the suture lasso technique to fix the coronal process fracture of Regan-Morrey I/ II type fracture is satisfactory.

OBJECTIVE:To investigate the effect of internal external fixator assisted O-arm navigation imaging in the treatment of unstable pelvic fractures.METHODS:From May 2019 to November 2019, 15 patients with unstable pelvic fractures were treated by intraoperative O-arm navigation imaging using INFIX technology. There were 6 males and 9 females. The age ranged from 24 to 66 years old. The course of disease ranged from 2 to 14 days. According to Tile classification, there were 1 case of B1 type, 8 cases of B2 type, 3 cases of C1 type, and 3 cases of C2 type. According to Young-Burgess classification, there were 8 cases of LC, 1 case of APC, 4 cases of VS, 2 cases of CM. Preoperative routine pelvic anteroposterior film, entrance position, exit position and pelvic CT three-dimensional reconstruction were performed. Intraoperative O-arm navigation system three-dimensional reconstruction and triplane scanning imaging were used to evaluate the effect of intraoperative reduction. The anterior pelvic ring was fixed with internal external fixator, and the posterior ring was fixed with sacroiliac screw, plate screw or lumbar iliac screw. The operation time, intraoperative bleeding and nail placement were observed and recorded. The quality of fracture reduction was evaluated by Matta standard, and the postoperative function was evaluated by Majeed function score.RESULTS:Wound healing was good in all patients without vascular, nerve and local irritation complications. All the 15 patients were followed up for 10 to 16 months. The fracture reduction was evaluated according to the Matta scoring standard, 9 cases were excellent results, 5 cases were good, and 1 case was medium. The Majeed functional score was 0 to 95 points.CONCLUSION:The built-in external fixator assisted O-arm navigation imaging system in the treatment of unstable pelvic fractures. The reduction effect is evaluated in advance, the operation time is shortened, and the accuracy of internal fixation is improved. The operation is simple, safe and less bleeding. The operation is in line with the principles of minimally invasive medical treatment and precision medical treatment in orthopedics, which is conducive to the recovery of patients' postoperative function and rapid recovery.

BACKGROUND Clinical femoral neck fracture is common. Based on patient age and fracture type, different surgical methods can be selected, including cannulated screw fixation of the femoral neck and artificial total hip joint or semi-hip joint replacement. When patients with femoral neck fracture are treated with cannulated screw fixation, a cannulated screw may be positioned too deep. The excessively deep-placed screw is difficult to remove and causes major trauma to the patient. CASE SUMMARY A patient with poliomyelitis and femoral neck fracture was treated with a cannulated screw that was placed too deep. A self-made auxiliary tool (made of a steel sternal wire) was used to remove the cannulated screw near the pelvic cavity. CONCLUSION The depth of the cannulated screw can be estimated before screw placement using an improved hollow screwdriver with a scale mark, thus improving the safety of screw placement and facilitating clinical use.

Background: To investigate effect of postoperative anti-rotation on the union of intracapsular displaced femoral neck fracture treated with three cannulated screws. Methods: A retrospective analysis was performed on all the intracapsular femoral neck fractures treated in the department of orthopedics of the second Hospital of Shanxi Medical University from July 2015 to December 2018. Fractures of femoral neck were reduced and fixed with three cannulated screws. The patients who wore anti-rotation shoes in the affected side were kept at bed rest for 10-12 weeks after surgery. The results were analyzed.Results: A total of 135 patients were included in the analysis. Six patients (4.4%) were not united. There were 12 cases of avascular necrosis (9.3%). No wound infections, screw breakages was found.Conclusion: Anti-rotation after surgery can significantly reduce the rate of femoral neck fracture nonunion, but not significantly improve the femoral head necrosis

胫腓骨远端开放粉碎性骨折伴胫前后动脉损伤是临床上较为常见的比较严重的开放性损伤.大部分患者由于不能及时就诊、损伤严重或者基层技术水平所限无法获得良好的治疗效果,以至于大部分此类患者被行小腿截肢术或者保肢后遗留下较为严重的并发症.我院2012年8月至2014年12月共收治9例胫腓骨远端开放粉碎性骨折伴胫前后动脉损伤的患者,全部患者均采用可调式外固定架固定同时使用负压封闭引流(VSD)吸引,同时行胫前后动脉血管吻合和周围的软组织处理.9例患者患足全部存活,而且踝关节功能良好,经8个月至2年随访,疗效满意.

股骨干骨折是下肢常见的骨折之一，随着锁式髓内钉在我国的广泛使用，因其能够有效地防止短缩、旋转、侧方移位，固定牢固利于早期关节功能锻炼和负重等优点，目前带锁髓内钉固定已成为治疗新鲜股骨干骨折的首选方法［1，2］，然而随着其使用范围增大，同时由于手术适应证的选择和手术操作以及术后康复训练等原因使锁式髓内钉固定后的骨不连发生率也随之增加［3］。本文着重讨论2013年1月至2015年12月因股骨干骨折行带锁髓内钉固定钢丝环扎术后骨折不愈合来我院就诊的12例患者的不愈合原因分析。

Objective To observe and compare the analgesic efficacy of femoral nerve block (FNB)and sufentanil for positioning patients with fractured hip.Methods Sixty patients scheduled for hip fracture surgery were randomized into three groups.Fifteen minutes before positioning for subarachnoid block,the FNB group received nerve ultrasound guided FNB using 20 ml ropivacaine 0.5% .Five minutes before positioning,the S group received a dose of IV sufentanil 0.15μg/kg,the C group didn't accept any intervention.The visual analog scale(VAS)following positioning (T2 ),OAA /S scale before positioning (T1 ),MAP,HR,SpO2 entering operating room (T0 )and T1 ,T2 ,adverse reactions were recorded.The plasma concentration of noradrenaline(NA)and cortisol(Cor)by T0 and T2 were measured.Results MAP,HR,the level of NA,Cor by T2 in group C increased significantly by comparing with T0 (P <0.05),while there were no obvious change in group F,and the same to group S except NA.The obvious change of SpO2 couldn't be found at each time point in every group(P >0.05).There were no significant differences in MAP,HR,the level of NA,Cor in all instances among the three groups(P >0.05).The OAA /S of S group was higher than the other groups(P <0.05).Compared with group C,group F and S showed markedly lower VAS at T2 (P <0.05),there were no significant differences between the two group.Side effects of group S included respiratory depression in 3 patients,nausea vomiting in 1 and dizzy in 1,no adverse reaction were found in other groups.Conclusions Both FNB and intravenous sufentanil can reduce the pain of positioning patients with fractured hip,showing almost the same analgesic efficacy,FNB can more inhibit stress reaction caused by pain.

Acetabulum four sides bodies as the inner surface of the acetabulum supporting the acetabulum. Which is the medial aspect of the acetabulum supporting the acetabulum, and unicom important structure acetabulum anterior column and acetabulum posterior column, more and more orthopaedic surgeons to realize its importance. The quadrilateral area adjacent to the acetabulum, the real purpose of reset the quadrilateral area in the surgery is to hope that through reset the quadrilateral area to indirect reduc-tion the acetabulum fracture. In this paper, reviewed from Several aspects,such as commonly used surgical approach in the treat-ment of the acetabulum fracture surgery, the reset of the acetabulum quadrilateral area and the new technology of operation, to summarized the status and progress of that the technology of reset the acetabulum quadrilateral area in treatment of the complex acetabular fractures in recent years.

目的：观察骨搬移法治疗胫骨骨髓炎伴大段骨缺损的疗效。方法回顾2010年2月至2013年6月利用骨搬移技术治疗20例胫骨骨髓炎伴大段骨缺损患者。男15例，女5例；年龄16~62岁，平均33岁。20例患者断端切新后骨缺损长度为6~10 cm，平均8 cm。术后定期复查调整力线，鼓励患者完全负重。结果本组20例患者均获得16~40个月（平均22.0个月）随访。16例患者对合端直接愈合（平均12个月），其余4例患者对合端未能直接愈合。经重新切开植骨内固定最终愈合。骨延长长度为6~10 cm（平均8 cm）。外固定架指数为1.5~2个月/ cm。根据 Paley 骨愈合评分标准评定，优14例，良5例，差1例，优良率95％。结论骨搬移技术是治疗胫骨骨髓炎伴大段骨缺损的一种安全有效的方法。

钽是一种稀有高熔点金属,能经受高温和矿物酸的腐蚀,抗蚀能力与玻璃相同,在常温的空气中稳定.正因为钽金属所具有的高熔点、大强度、耐磨损、抗腐蚀等理化特性,因而其被大范围用于飞机、火箭等需要耐热材料以及需要高强度零部件的工业领域.不仅如此,钽金属还具有优良的生物相容性和稳定性,因此钽金属也被制造成各种接骨板以及螺钉用于医学领域.

骨不连即骨折不愈合,是长管状骨骨折术后最主要的并发症之一.目前国内外尚无统一定义,临床诊断中多采用美国FDA定义即骨折术后9个月仍未愈合,且已连续3个月无任何愈合迹象.据文献统计长管状骨骨折术后骨不连发生率为5％～10％[1].随着当前社会的发展,高能量创伤患者屡见不鲜,而四肢长管状骨骨折的发生率更是居高不下.近年来虽然长管状骨骨折从愈合机制、治疗方法、技术水平、植入器械等方面均有长足进步,但骨折术后骨不连仍时有发生,给患者生活、经济、心理带来持久创伤.因此长管状骨骨折术后骨不连的治疗仍是创伤骨科今后亟待研究和解决的主要问题之一.

踝关节骨折在日常生活中非常常见，据统计，在所有踝关节骨折和需要手术治疗的踝关节骨折的病例中，伴有下胫腓韧带联合损伤的比例分别占10%和20%［1］。临床中由于对踝关节下胫腓韧带联合损伤认识的不足，导致诊疗方面存在很多误区。下胫腓韧带损伤常导致距骨外移和踝关节不稳，尸体研究发现：当距骨向侧方移动1 mm 时，胫距关节连接区域减少42%［2］。下胫腓韧带联合损伤会导致踝关节稳定性下降、踝关节疼痛，而治疗不当或漏诊常会导致疼痛、关节活动受限、创伤性关节炎等，给患者带来身体与精神的痛苦与负担。除规范诊断标准、详细体格及影像学检查外，更重要的是通过治疗缓解患者病痛。骨科医师对下胫腓韧带损伤的治疗既有赖于其对骨损伤范围的认识，还有赖于对解剖结构的熟识和损伤机制的认识。本文着重阐述当前下胫腓韧带联合的治疗进展。

骨质疏松症（osteoporosis，OP）是一种全身性骨代谢疾病，它以骨量减少、骨微细结构退化、骨脆性增加、易致骨折为特征［1］，是目前临床的常见病、多发病。 <br>　　阿司匹林在日常生活中用途多，副作用少，且价格便宜，目前内科已推荐老年人常规使用小剂量阿司匹林预防脑梗死发作，前期实验已证实阿司匹林可以提高大鼠骨密度，促进骨质疏松骨折的骨愈合［2-4］，但是并未探讨阿司匹林治疗骨质疏松骨折的最佳剂量。

骨搬移技术是一种治疗骨髓炎所致骨缺损的有效的方式和方法。骨搬移技术的出现以及在全世界的推广和普及经历了一些艰辛的历程，但是由于骨搬移技术有科学的理论支撑同时骨搬移技术取得了让世人瞩目的成绩，因此大家不断的探索研究骨搬移法，不断总结操作的技巧和术后护理的注意事项。

Objective To observe the effect of aspirin on osteoporosis and to explore the effect of different doses or different time of aspirin on adjuvant therapy after osteoporosis in ovariectomized rats. Methods Forty-Two 6-month female wistar rats were randomly divided into two groups: 6 rats in sham-operated (A) group and 36 rats in ovariestomized (OVX) group. The OVX group was divided two groups. Prevention of osteoporosis using aspirin: OVX control group (B), 8.92 mg/kg aspirin group (C), 26.75 mg/kg aspirin group (D). Treatment of osteoposis using aspirin: OVX control group (E), 8.92 mg/kg aspirin group(F), 26.75 mg/kg aspirin group (G). The rats in prevention group were given an intragastric gavage of aspirin after OVX 3 days, while the treatment groups after 12 weeks. Bilateral humerus was collected. Three-point bending eaperiment was performed on the bilateral. The right humerus tested using dual-energy X-ray absorptiometry. Result ①bone mineral (BDM): The BMD in group B was signiifcantly lower than that in group A, C, D. The BMD in group E was signiifcantly lower than that in goup A, F, G (P<0.05). ②Three-point bending lode: The three-point bending lode in the OVX control groups was signiifcantly lower than that aspirin groups (P<0.05). The three-point bending lode in the prevention group was higher than the treatment group of the same dose (P<0.05). Conclusion Aspirin can obviously increase the BMD of ovariectomized osteoporotic mice, and improve the mechanical properties of the bone.

OBJECTIVE:To analyze the non-operation related risk factors of the wound complications by using lateral extensive L-shaped incision for open reduction and internal fixation of calcaneal fractures.METHODS:A retrospective analysis was made on the clinical data of 58 patients with closed calcaneal fractures (63 calcaneus) treated by using lateral intensive L-shaped incision for open reduction and internal fixation between September 2006 and August 2011. There were 52 males (56 calcaneus) and 6 females (7 calcaneus), aged 18 to 64 years (mean, 35 years). The causes of injury included fall injury in 53 cases (58 calcaneus), traffic injury in 5 cases (5 calcaneus). The mean time between injury and operation was 8 days (range, 3-22 days). According to Sanders classification, 4 calcaneus were rated as type II, 31 calcaneus as type III, and 28 calcaneus as type IV. Postoperative complications were observed and graded; 58 patients were divided into complication group (> or = grade 2) and control group (< grade 2). The univariate analysis was used to analyze 18 factors which may lead to wound complications; multi-factor unconditioned logistic regression analysis was done for the factors showing significant difference.RESULTS:According to postoperative wound complications grading, 41 patients (46 calcaneus) were included in the control group, whose incision healed primarily, and 17 patients (17 calcaneus) in the complication group. In 17 patients of the complication group, 14 had skin necrosis or dehiscence, and 3 had superficial infection; they obtained healing after symptomatic treatment. The univariate analysis showed significant differences in combined spinal fracture, diabetes mellitus, and long-term smoking between 2 groups (P < 0.05). The logistic regression analysis revealed that combined spinal fracture was an independent risk factor for wound complications (95% confidence interval: 0.004-0.360, P = 0.004).CONCLUSION:Combined spinal fracture is an independent risk factor for wound complications after open reduction and internal fixation of calcaneal fracture using lateral extensive L-shaped incision.

Objective To observe the effect of oral medication of nitroglycerin(NTG) on bone healing,and to explore the effect of different doses of NTG on adjuvant therapy after osteoporotic fracture operation in ovariectomized rats.Methods Sixty 6-month female wistar rats were randomly divided into two groups: 12 rats in sham-operated(A) group and 48 rats in ovariestomized(OVX) group.Twelve weeks after ovariectomy and gavage,bone mineral density(BMD) of the right femur was tested using dual energy X-ray absorptiometry to confirm the successful establishment of osteoporosis model.Then the right femur fracture model was established.Rats in OVX group were further randomly divided into low dose NTG(B) group,middle dose NTG(C) group,high dose NTG(D) group,and control group(E).All rats in OVX group were given an intragastric gavage of different doses of NTG per day.After 4-week and 8-week gavage,6 rats in each group were randomly selected.BMD of the right femur was tested using dual-energy X-ray absorptiometry.The situation of fracture healing was compared through X-ray imaging.The serum concentration of nitric oxide(NO) was tested using nitric oxide kit.The number,size,and the shape of trabecular in bone callus in each group were observed using HE staining.Results The concentrations of NO in group B,C,and D were higher than that in group E.The healing of fractures in group B and C was better than those in the control group and group D.A larger number of calluses at the trabecular bone were also observed in group B and C.Conclusion Low-dose and medium/dose of NTG can promote the healing of fractures,whereas high doses of NTG cannot promote the healing of fractures.

BACKGROUND: Nitric oxide plays an important role in bone metabolism. However, the effects of different doses of L-arginine, nitric oxide substrate, on the healing of osteoporotic fractures remain unclear. OBJECTIVE: To investigate the influence of different doses of L-arginine on the healing of osteoporotic fractures and blood biochemistry in rats. METHODS: A total of 50 female Wistar rats, aged 6-month-old, were randomly divided into sham-surgery (n=10) and osteoporosis (bilateral ovariectomy, n=40). After osteoporosis model was established, left middle femoral fractures were made in al 50 rats, and the osteoporosis group was further divided into four groups, low, middle and high dose of L-arginine, and control groups. The L-arginine groups were intraperitoneal y injected with 1, 3, and 5 mg/kg L-arginine at the second day fol owing surgery, while the control and sham-surgery groups were injected with the same volume of normal saline. At 8 weeks, the lumbar and cal us bone mineral density, serum nitric oxide, and nitric oxide synthase were detected. Meanwhile, the bone cal us histological examination was conducted. RESULTS AND CONCLUSION: During fracture healing, osteoporosis rats showed a low level of serum nitric oxide and nitric oxide synthase compared with normal fractured rats (P < 0.05). L-arginine can improve the concentration of serum nitric oxide and nitric oxide synthase in osteoporosis rats. Moreover, middle dose of L-arginine can increase the cal us and lumbar spine bone mineral density of osteoporosis rats, so the number and continuity of bone trabecula were enhanced. These findings suggest that middle dose of L-arginine (3 mg/kg) can promote healing process of osteoporotic fractures and improve osteoporosis.