PurposeThe purpose of the study is to compare isolated syndesmotic screw fixation and transplate syndesmotic screw fixation in distal tibiofibular syndesmotic injuries.MethodsIn this retrospective study, 37 patients diagnosed with pronation-external rotation ankle fractures requiring screw fixation were enrolled between July 2023 and December 2024. Nineteen patients underwent isolated syndesmotic screw fixation. Another group of 18 patients received transplate syndesmotic screw fixation. Follow-up was conducted for a minimum duration of 12 months. Radiographic outcomes were assessed using CT scans and x-rays. The CT evaluations included measurements of screw entry point and trajectory, anterior tibiofibular distance, posterior tibiofibular distance, anteroposterior fibular translation, and fibular rotation, conducted within 24 h post-operation and at one year after syndesmotic screw removal. x-ray assessments focused on tibiofibular overlap, tibiofibular clear space, and medial clear space, also evaluated at the same time nodes.ResultsPreoperative and intraoperative data, including age, sex, time from injury to surgery, and mean operating time, were comparable between the two groups (p > 0.05). Significant differences were observed in the screw entry points and trajectories (p < 0.05) between the groups. Postoperative ankle x-rays showed no significant differences in syndesmotic reduction quality between the groups (p > 0.05). However, postoperative immediate CT scans indicated that the transplate syndesmotic screw fixation group experienced a higher incidence of posterior tibiofibular distance widening (p < 0.05). The 12-month postoperative ankle CT scans showed that in both groups, patients with mild ankle malreduction or overtightening of distal tibiofibular syndesmosis almost achieved spontaneous reduction after the removal of the distal tibiofibular syndesmotic screws, while patients with severe malreduction or syndesmotic widening still exhibited persistent distal tibiofibular syndesmotic malreduction.ConclusionsAccording to radiological comparisons, the fibular plate may interfere with screw placement and increase the likelihood of malalignment of the distal tibiofibular syndesmosis.

Department of Orthopedics, Ningbo No.6 Hospital, Ningbo, Zhejiang, 315040, People’s Republic of China Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Published online ■ ■ *Corresponding author. Address: Department of Orthopaedics, Ningbo No. 6 Hospital, 1059 Zhongshan East Road, Ningbo, Zhejiang, 315040, People’s Republic of China. E-mail address: [email protected] (Q. Ying). This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author. http://creativecommons.org/licenses/by-nd/4.0/

Background Ankle fractures are common injuries with substantial implications for patient mobility and quality of life. Traditional imaging methods, while standard, have limitations in detecting subtle fractures and distinguishing them from complex bone structures. The advent of 3D Convolutional Neural Networks (3D-CNNs) offers a promising avenue for enhancing the accuracy and reliability of ankle fracture diagnoses. Methods In this study, we acquired 1,453 high-resolution CT scans and processed them through three distinct 3D-CNN models: 3D-Mobilenet, 3D-Resnet101, and 3D-EfficientNetB7. Our approach involved rigorous preprocessing of images, including normalization and resampling, followed by a comparative evaluation of the models using accuracy, Area Under the Curve (AUC), and recall metrics. Additionally, the integration of Gradient-weighted Class Activation Mapping (Grad-CAM) provided visual interpretability of the models' predictive focus points. Results The 3D-EfficientNetB7 model demonstrated superior performance, achieving an accuracy of 0.91 and an AUC of 0.94 after 20 training epochs. Furthermore, Grad-CAM visualizations aligned closely with expert radiologists' assessments, validating the model's diagnostic precision. Spatial localization techniques further enhanced the interpretability of fracture detection, providing clear visual cues for medical professionals. Conclusions The implementation of 3D-CNNs, particularly the 3D-EfficientNetB7 model, significantly improved the detection and localization of ankle fractures. The use of Grad-CAM has also proved essential in providing transparency to AI-driven diagnostics. Our research supports the integration of 3D-CNNs in clinical settings, potentially revolutionizing the standard of care in fracture diagnosis and paving the way for their application in broader medical imaging tasks.

AIM:This study aimed to evaluate the hypothesis that the utilization of percutaneous screw guides enhances the precision of screw placement in the surgical fixation of talar fractures. METHODS:Computed tomography (CT) scans of ankle joints were obtained from 40 healthy adults and 10 cadaveric specimens between April 2019 and August 2020 at Ningbo No. 6 Hospital. The acquired CT data were imported into Materialise Interactive Medical Image Control System (MIMICS) software for processing. Three-dimensional (3D) digital models of the ankle joints were reconstructed, and relevant anatomical parameters were measured. A percutaneous screw guide (PSG) was designed and fabricated to facilitate accurate screw placement in the posterior talar process. Ten eligible cadaveric ankle joints were selected for further analysis and their 3D models were reconstructed using the MIMICS software. Screw trajectory parameters were then measured and analyzed based on these cadaveric models, forming the model group for comparative analyses. Ten cadaveric specimens were utilized in this study, equally divided into two groups: a guider group (n = 5) and a free-hand group (n = 5). In the guider group, talar posterior process screws were inserted using percutaneous screw guidance. In the free-hand group, screws were inserted into the talar posterior process without guidance. Post-operative CT scans were performed on all specimens. The following parameters were quantitatively compared between the two groups: screw trajectories, entry point distances in specimens with preselected screws, entry point distance trajectories in the 3D model, operation time, frequency of fluoroscopic imaging, and number of drilling attempts. RESULTS:Following the generation of the 3D models from 10 cadavers, a virtual screw was digitally inserted into each model. In the model group, the preselected screw trajectory was oriented towards the medial aspect of the talar neck base, with a cephalad inclination angle (CIA) of 3.1° ± 1.5° in the transverse~plane and a medial diverge angle (MDA) of 12.0° ± 1.4° in the coronal plane. The CIA and MDA of the screw trajectory in the guider group were 2.1° ± 1.7° and 11.2° ± 1.6°, respectively, whereas the CIA and MDA in the free-hand group were 6.0° ± 2.2° and 18.8° ± 1.6°, respectively. Statistical analysis revealed significant differences in both CIA and MDA between the two groups (p < 0.05). Furthermore, the guider group yielded superior outcomes in terms of entry point distance, operation time, fluoroscopic exposure time, and number of drilling attempts compared to the free-hand group (p < 0.05). CONCLUSIONS:Percutaneous screw guidance can improve the accuracy and safety of the posterior process of the talar screws, which can be feasible for percutaneous fixation. Further studies are required to confirm the efficacy and clinical outcomes of percutaneous screw guidance.

Background Ankle fractures are prevalent injuries that necessitate precise diagnostic tools. Traditional diagnostic methods have limitations that can be addressed using machine learning techniques, with the potential to improve accuracy and expedite diagnoses. Methods We trained various deep learning architectures, notably the Adapted ResNet50 with SENet capabilities, to identify ankle fractures using a curated dataset of radiographic images. Model performance was evaluated using common metrics like accuracy, precision, and recall. Additionally, Grad-CAM visualizations were employed to interpret model decisions. Results The Adapted ResNet50 with SENet capabilities consistently outperformed other models, achieving an accuracy of 93%, AUC of 95%, and recall of 92%. Grad-CAM visualizations provided insights into areas of the radiographs that the model deemed significant in its decisions. Conclusions The Adapted ResNet50 model enhanced with SENet capabilities demonstrated superior performance in detecting ankle fractures, offering a promising tool to complement traditional diagnostic methods. However, continuous refinement and expert validation are essential to ensure optimal application in clinical settings.

OBJECTIVE:To investigate the clinical effect of orthopedic robot combined with Starr pelvic reduction frame in the treatment of Tile type C pelvic ring fracture.METHODS:From October 2019 to May 2021, 14 patients with type C pelvic ring fracture were treated with robotic combined with Starr pelvic reduction frame, including 9 males and 5 females. The age ranged from 33 to 69 years. All the 14 patients had fresh closed fractures without femur, tibia and fibula fracture. Surgery was completed from 4 to 7 d after hospital admission. During the operation, the X-ray carbon bed was used, the pelvic ring was reduced by Starr pelvis reduction frame, and pelvic ring fracture was treated by orthopedic robot. Operation time, bleeding volume, fluoroscopy times of single screw placement, fracture reduction quality, affected limb function and complications were observed. Radiological reduction was evaluated using Matta scoring standard, and clinical efficacy was evaluated by Majeed pelvic function scoring system at the final follow-up.RESULTS:All of 14 patients successfully completed the operation, the operation time was 84 to 141 min, the bleeding volume was 20 to 50 ml, and the fluoroscopy times of single screw insertion was 4 to 9 times. All of 14 patients were followed up for 12 to 24 months. The healing time was 3 to 7 months. No complications such as fracture of internal fixation, screw loosening, infection and nerve injury were found. According to the evaluation criteria of Matta imaging reduction, 9 cases were excellent, 4 cases were good, and 1 case was fair. At the final follow-up, Majeed pelvic function scoring system was used:10 cases were excellent, 4 cases were good.CONCLUSION:The treatment of type C pelvic ring fracture with robotic combined Starr pelvis reduction frame is simple, time-saving, less trauma, less complications and effective.

ObjectiveTo describe unilateral transforaminal lumbar interbody fusion (TLIF) via a modified hemilateral spinous process-splitting (MHSPS) approach and determine its effectiveness.MethodsSixty-five consecutive patients with the lumbar degenerative disease who underwent MHSPS TLIF between August 2020 and July 2021 were retrospectively analyzed. Japanese Orthopedic Association (JOA) score and visual analog scale (VAS) scores for back and leg pain were evaluated before surgery and at the last follow-up. Postoperative paraspinal muscle atrophy was evaluated on axial T2-weighted magnetic resonance imaging.ResultsMean JOA score increased from 13.6 ± 3.21 before surgery to 24.72 ± 3.34 at last follow-up (p < 0.001). The mean recovery rate was 68.2% ± 5.68%. Clinical outcome was excellent in 22, good in 35, and fair in 8 patients. The VAS score for low back pain was significantly lower at the last follow-up than before surgery (1.18 ± 0.99 vs. 3.09 ± 1.35; p < 0.001). The VAS score for leg pain was also significantly lower at the last follow-up than before surgery (1.13 ± 0.91 vs. 6.61 ± 1.23; p < 0.001). The mean paraspinal muscle atrophy rate did not significantly differ between the symptomatic side (6% ± 3.8%) and asymptomatic side (4.8% ± 3.3%) at last follow -up (p = 0.071).ConclusionMHSPS TLIF is an effective minimally invasive surgical treatment for selected types of degenerative lumbar disease. This technique can achieve effective spinal decompression and interbody fusion. Its advantages include direct and adequate visualization, vast surgical working space, short operation time, and minimal muscle injury.

Background Posterior malleolus fractures are known to be associated with ankle instability. The complexities involved in obtaining precise laboratory-based spatial pressure measurements of the ankle highlight the significance of exploring the biomechanical implications of these fractures. Methods Finite element analysis was utilized to examine the stress distribution across the contact surface of the ankle joint, both in its natural state and under varied sagittal fracture line angles. The study aimed to identify stress concentration zones and understand the influence of sagittal angles on stress distribution. Results Three distinct stress concentration zones were identified on the ankle's contact surface: the anterolateral tibia, the anteromedial tibia, and the fracture line. The most significant stress was observed at the fracture line when a fracture occurs. Stress at the fracture line notably spikes as the sagittal angle decreases, which can potentially compromise ankle stability. Larger sagittal angles exhibited only minor stress variations at the contact surface's three vertices. It was inferred that sagittal angles below 60° might pose risks to ankle stability. Conclusions The research underscores the potential implications of fractures on the stress profile of the ankle joint, emphasizing the role of the contact surface in ensuring stability. The identification of three zones of stress concentration and the influence of sagittal angles on stress distribution offers a valuable reference for therapeutic decision-making. Further, the study reinforces the importance of evaluating sagittal fracture angles, suggesting that angles below 60° may compromise ankle stability.

目的 观察经腋窝入路微型钢板螺钉内固定治疗Ideberg Ⅰ、Ⅱ型肩胛骨骨折的临床疗效.方法 回顾性分析自2020-03-2021-06经腋窝入路内固定治疗的9例Ideberg Ⅰ～Ⅱ型肩胛骨骨折,于腋窝中心作纵形切口长8～10 cm,逐层切开后在背阔肌肌腱的前方进一步显露,手指触摸肱骨头,在肱骨头表面可触及腋神经,使用深拉钩顿性分离并用橡皮筋保护,切开关节囊直视下复位骨折端,5例采用2枚直径3.0 mm空心钉固定,2例采用单纯微型锁定钢板固定,2例采用微型锁定钢板联合空心钉内固定.结果 9例均获得随访,随访时间6～22个月,平均14个月.所有患者均获得骨性愈合,骨折愈合时间为(11.0±1.5)周.末次随访时肩关节功能Hardegger评分:优5例,良3例,差1例.功能评分为差的1例术后出现腋神经损伤症状,术后10个月症状缓解,残留三角肌萎缩,肌力4级.1例用骨膜剥离子顿性分离时损伤肩胛下动脉,术中予以结扎.结论 经腋窝入路微型钢板螺钉内固定治疗Ideberg Ⅰ、Ⅱ型肩胛骨骨折可取得较为满意的临床疗效,与Judet入路及后方外侧微创直切口相比具有出血量少、恢复快、切口隐蔽等优点.

Objective:To investigate the efficacy of treatment of Sanders Ⅱ & Ⅲ calcaneal fractures with an absorbable stick plus Kirschner wire through the tarsal sinus incision.Methods:From July 2017 to May 2020, 37 patients with 42 Sanders Ⅱ & Ⅲ calcaneal fractures were treated with an absorbable stick plus Kirschner wire through the tarsal sinus incision at The Third Ward of Department of Traumatic Orthopeadics, The Sixth Hospital of Ningbo. There were 25 males and 12 females, with an age of (48.2±5.6) years (from 20 to 69 years). The fractures were at the left side in 12 cases, at the right side in 20 and at bilateral sides in 5. By Sanders classification, 20 fractures were type Ⅱ and 22 ones type Ⅲ. Fracture union time and complications were recorded. Their B?hler and Gissane angles were compared between preoperation, postoperation and the last follow-up. The range of motion of the subtalar joint was evaluated by the Morrey method at 6 months postoperation. The functional recovery was evaluated by the American Society of Foot and Ankle Surgery (AOFAS) ankle-hindfoot score at 12 months postoperation.Results:The 37 patients were followed up for (15.2±2.7) months (from 13 to 18 months). There were no such complications as incision skin necrosis, Kirschner wire deformation, loss of fracture reduction or Kirschner wire infection. The anatomical morphology of the calcaneus was restored satisfactorily in the 37 patients. At preoperation, postoperation and the last follow-up, the B?hler angles were 13.3°±1.6°, 32.5°±5.5° and 32.7°±5.4° and the Gissane angles 78.3°±6.7°, 127.2°±6.7° and 128.0°±6.4°, respectively, showing significant differences between the preoperative and postoperative values ( P<0.05) but no significant differences between postoperation and the last follow-up ( P>0.05). The range of motion of the subtalar joint at 6 months postoperation was slightly limited in 25 cases and moderately limited in 12 cases, giving a rate of moderate and above limitation of 32.4% (12/37). By the AOFAS ankle-hindfoot score at 12 months postoperation, 12 cases were excellent, 21 ones good and 4 ones fair, giving a good to excellent rate of 89.2% (33/37). Conclusion:Treatment with an absorbable stick plus Kirschner wire through the tarsal sinus incision may lead to fine clinical efficacy for Sanders Ⅱ & Ⅲ calcaneal fractures.

Objective Surgical treatment for Schatzker type II tibial plateau fractures remains challenging and requires high‐quality research. The aim of the study is to compare the “windowing” and “open book” techniques for the treatment of Schatzker type II tibial plateau fractures. Methods In this prospective study, all patients with Schatzker type II tibial plateau fractures between January 2014 and December 2017 were managed by open reduction and internal fixation using an anterolateral incision approach. “Windowing” group included 78 patients (53 men and 25 women), with an average age of 57.7 ± 13.5 years, who underwent the “windowing” technique, in which the procedure was performed through a small cortical window against the depressed zone of the lateral plateau. The “open book” group included 80 patients (56 men and 24 women), with an average age of 54.8 ± 12.4 years, who underwent the technique. The clinical outcomes included the Rasmussen classification of knee function and grading of post‐traumatic arthritis. The radiographic outcome (x‐ray and computed tomography [CT]) was the reduction quality of the lateral plateau based on the modified Rasmussen radiological assessment. The patient‐reported outcome was visual analogue scale (VAS) scores. Results The mean follow‐up time for the158 patients was 32 months (range, 24–42 months). The time elapsed from injury to surgery in “windowing” group and “open book” group were 3.7 ± 1.2 (range, 1–10 days) and 3.5 ± 1.4 days (range, 1–11 days), respectively, with no significant difference between the groups (P > 0.05). The operation times did not differ significantly between the “windowing” group (61.0 ± 8.3 min, range, 45–120 min) and the “open book” group (61.2 ± 10.4 min, range, 40–123 min) (P > 0.05). After surgery, CT revealed five (6.4%) and 15 (18.8%) cases of articular depression in the “windowing” and “open book” groups, respectively. Significant differences were observed in the articular depression of tibial plateau fractures between the groups (P < 0.05). However, condylar widening or valgus/varus did not differ significantly between the groups. Furthermore, no significant differences in knee function were observed during follow‐up (P > 0.05). VAS scores were similar between the groups at 24 months after surgery (P > 0.05). There were significant differences in the number of severe post‐traumatic arthritis (grades 2 and 3) cases between the groups (P < 0.05). Conclusions The “windowing” and “open book” techniques are both effective for the treatment of Schatzker type II tibial plateau fractures. However, the “windowing” technique provides better reduction quality, leading to a satisfactory prognosis.

Objective Valgus‐impacted femoral neck fractures with or without posterior tilt of the femoral head are very common and full of pitfalls in clinical practice, which may lead to femoral neck shortening (FNS) and avascular necrosis (AVN). The study tries to introduce a novel technical trick aiming at anatomical reduction of valgus‐impacted femoral neck fracture with minimally invasive procedure, and summarize the clinical prognosis in case series. Methods In this retrospective study, 24 patients (seven men and 17 women) with valgus‐impacted femoral neck fractures between May 2017 and July 2020 were managed by “in‐out‐in” percutaneous reduction technique (percutaneous reduction group). Another 24 cases (10 men and 14 women) suffering the fractures underwent in situ fixation were enrolled as control group for function comparison (in situ fixation group). All patients were followed up for 24–42 months. The clinical outcomes included complications after operations (χ2 test) and Harris Hip Score (HHS) for hip function (unpaired t test) in the two groups. The radiographic outcomes were evaluated by collodiaphyseal angle, posterior tilt angle, and FNS before the operation and during the follow‐up in the percutaneous reduction group (unpaired t test). Results Patients' preoperative data, including age, sex, affected side, fracture types, and medical history, were similar between the two groups, respectively (p > 0.05). After surgery, the mean HHS at 6, 12, and 24 months were all better in the percutaneous reduction group (76 ± 6.72, 85.34 ± 6.33 and 90.54 ± 5.81) than that in the in situ fixation group (70.86 ± 6.91, 80 ± 6.11 and 84.1 ± 7.82), respectively (p < 0.05). One patient suffered fixation failure with screws retreat and one patient suffered AVN in the percutaneous reduction group. In the in situ fixation group, AVN occurred in two patients at last follow‐up. There was no significant difference in complication amounts between the two groups (p > 0.05). In the percutaneous reduction group, collodiaphyseal angle, posterior tilt angle, and amount of FNS were significantly different between preoperative cases and immediately postoperative cases (p < 0.05). However, there was no statistical difference of the measurements among postoperative cases at different time points (within 24 h, 6 months, and 2 years postoperatively) (p > 0.05). Conclusions Our experience of the technique and the case series show that “in‐out‐in” percutaneous reduction technique for treatment of valgus‐impacted femoral neck fracture with or without posterior tilt of the femoral head is safe and effective for achieving successful bone union and satisfactory function.

Purpose: The study described a novel surgical treatment of Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture and patient outcomes at intermediate period follow-up. Methods: All patients from January 2015 to December 2017 with tri-malleolar fracture of which posterior malleolar fractures were Haraguchi type 1, were surgically treated in this prospective study. Lateral and medial malleolar fractures were managed by open reduction and internal fixation through dual incision approaches. 36 cases of Haraguchi type 1 posterior malleolar fractures were randomly performed by percutaneous posteroanterior screw fixation with the aid of medial exposure (group 1). And 40 cases were performed by percutaneous anteroposterior screw fixation (group 2). Clinical outcomes, radiographic outcomes and patient-reported outcomes were recorded. Results: Seventy-six patients with mean follow-up of 30 months were included. There were no significant differences in the mean operation time (81.0 ± 11.3 vs. 77.2 ± 12.4), ankle function at different periods of follow-up, range of motions and visual analog scale (VAS) at 24 months between the two groups ( p > 0.05). However, the rate of severe post-traumatic arthritis (Grade 2 and 3) and the rate of step-off rather than gap in radiological evaluation were lower in group 1 than that in group 2 ( p < 0.05). Conclusion: Using our surgical technique, more patients had good outcome with a lower rate of severe post-traumatic arthritis, compared with the group of percutaneous anteroposterior screw fixation. Percutaneous posteroanterior screw fixation can be a convenient and reliable alternative in treating Haraguchi type 1 posterior malleolar fracture.

Background. Osteoporotic thoracolumbar compression fractures have become a great social burden due to the aging tendency of population. This study is aimed at comparing the clinical and radiological outcomes of percutaneous kyphoplasty with or without pedicle screw fixation in patients with osteoporotic thoracolumbar fractures. Hypothesis. There is a difference in clinical outcomes between percutaneous kyphoplasty with pedicle screw fixation and percutaneous kyphoplasty. Methods. This retrospective study included 87 patients who received percutaneous kyphoplasty with or without pedicle screw fixation between October 2015 and October 2017 at Ningbo No.6 Hospital and were followed for 2 years. A total of 40 patients received percutaneous kyphoplasty with pedicle screw fixation (PKPF group), and the other 47 patients had percutaneous kyphoplasty only (PKP group). The outcomes were measured using the visual analogue scale (VAS), Oswestry Disability Index (ODI), Cobb angle (CA), and anterior vertebra height rate (AVHr), which were calculated at preoperative admission and each follow-up visit. Complications including postoperative back pain, refracture, and fixation failure were collected from medical records. Results. There was no significant difference in baseline characteristics or preoperative data between the two groups ( p < 0.05 ) but significantly better improvements in VAS, ODI, CA, and AVHr at 12- and 24-month follow-up visits in the PKPF group compared with those of the PKP group. 23 (48.9%) patients in the PKP group had complications, whereas only 5 (12.5%) patients in the PKPF group presented complications including 2 postoperative back pain and 1 fixation failure ( p = 0.04 ). Conclusions. PKPF obtained longer correction and better improvement in VAS, ODI, and CA in patients with osteoporotic thoracolumbar vertebral fractures than PKP.

To explore the computed tomography (CT) imaging characteristics and BPF algorithm fine lung CT image efficiency for the diagnosis of pelvic fracture patients and assist clinicians to carry out the disease care and treatment, CT images based on optimized back-projection filtering (BPF) algorithm were utilized to diagnose postoperative reduction of pelvic fractures and penetrating lung infection caused by long-term bed rest. A total of 100 patients with pelvic fracture were selected and all of them underwent pelvic fracture surgery and were rolled into conventional CT diagnosis group (conventional group) and BPF algorithm optimized CT image diagnosis group (BPF group). One group used conventional CT images to guide pelvic reduction and detect lung infections, and the other used BPF algorithm to optimize the images. The results showed that the BPF group was superior to the conventional CT group in both image clarity and shadow area, and the peak signal-to-noise ratio (PSNR) was significantly better than that of the conventional group ( P < 0.05 ). Nine more cases were detected in the algorithm group than in the conventional group, and the incidence of complications was 48% in the conventional group and 28% in the BPF group, with a statistical difference of 20% between the two groups ( P < 0.05 ). In addition, the satisfaction of returning patients was 96% in the BPF group and 77% in the conventional group ( P < 0.05 ). The diagnosis of pulmonary infection was more obvious in the BPF group, indicating that BPF optimization of the CT image was suitable for clinical diagnosis and had a practical application value.

Posttraumatic infections can occur in orthopedic trauma patients, especially in open fractures. Rapid and accurate identification of pathogens in orthopedic trauma is important for clinical diagnosis and antimicrobial treatment. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been successfully used for first-line identification of pathogens grown on culture plates. However, for direct analysis of liquid clinical specimens, pre-purification of the sample is necessary. Herein, we investigated the feasibility of coupling Fc-MBL@Fe3O4 enrichment with MALDI-TOF MS profiling in the identification of pathogens in liquid-cultured samples. This method is successfully used for the identification of pathogens in a patient with an open-leg fracture obtained at sea. Pathogens were enriched by Fc-MBL@Fe3O4 from briefly pre-cultured liquid media and identified by MALDI-TOF MS. We identified an opportunistic pathogen, Vibrio alginolyticus, which is uncommon in clinical orthopedic trauma infection but exists widely in the sea. Therefore, combining Fc-MBL@Fe3O4 enrichment and MALDI-TOF MS profiling has great potential for direct identification of microbes in clinical samples.

Glucocorticoid-induced osteoporosis is the commonest form of drug-induced osteoporosis. Histone deacetylase 6 (HDAC6) is involved in the differentiation from mesenchymal stem cells to osteoblasts. However, the role of ricolinostat (ACY-1215, HDAC6 inhibitor) in the dexamethasone (Dex)-induced proliferation and differentiation of preosteoblasts remains to be elucidated. The protein expression and mRNA expression levels of HDAC6, osteopontin (OPN), runt-related transcription factor 2 (Runx2), osterix (Osx), collagen I (COL1A1) and glucocorticoid receptor (GR) in MC3T3-E1 cells were analyzed by western blot analysis and reverse transcription-quantitative PCR analysis. The cell viability was detected by CCK-8 assay. The alkaline phosphatase (ALP) activity and capacity of mineralization was determined by ALP assay kit and alizarin red staining. HDAC6 expression was increased in patient serum and Dex-induced MC3T3-E1 cells at a certain concentration range; 1 mu M Dex was selected for further experimentation. Cell viability was decreased after Dex induction and restored following ACY-1215 treatment. The ALP activity and capability for mineralization was decreased when MC3T3-E1 cells were induced by 1 mu M Dex and was gradually improved by the treatment of ACY-1215 at 1, 5 and 10 mM. The expression of OPN, Runx2, Osx and COL1A1 was similar, with the changes of capability for mineralization. Furthermore, GR expression was increased in Dex-induced MC3T3-E1 cells. ACY-1215 promoted the GR expression in MC3T3-E1 cells from 1-5 mM while GR receptor expression was increased with 10 mM ACY-1215 treatment. In conclusion, ACY-1215 reversed the Dex-induced suppression of proliferation and differentiation of MC3T3-E1 cells.

Purpose: The purpose of this study was to clinically compare the single-incision and dual-incision approaches for the treatment of distal tibial and fibular fractures. Methods: In total, 93 patients were enrolled, and the mean follow-up was 15 months (range 12–19 months). The patients treated for open reduction and internal fixation were randomly classified into two groups based on the approach used: 45 patients were treated using the single-incision approach (group 1) and 48 patients were treated using the dual-incision approach (group 2). In these two groups, operation time, discharge time, postoperative complications, and ankle function evaluations (Olerud–Molander Ankle Score) were compared between the two groups. Results: There were no significant differences in the mean operation time (98.2 ± 18.5 vs. 103.6 ± 19.3), discharge time (11.1 ± 3.9 vs. 12.5 ± 5.7), overall surgical complication rates (9/45 vs. 15/48), or ankle function between the two groups ( p > 0.05). However, the rate of soft tissue-related complications, such as skin slough, infection, nonunion, and delayed union, was significantly lower in group 1 (5/45) than in group 2 (14/48) ( p < 0.05). Conclusion: The two incision approaches were found to have similar clinical outcomes. However, with regard to soft tissue conservation, the single-incision approach was superior to the dual-incision and maybe a reliable alternative.

目的 探究以“小切口+保护外侧骨瓣+可吸收钉”手术治疗外侧关节面塌陷为主的跟骨骨折手术效果.方法 2010年1月-2014年1月宁波市第六医院收治的37例(41足)跟骨外侧关节面塌陷为主的骨折患者,术前影像学检查(X线或CT)确诊后,进行小切口掀开外侧骨瓣手术,可吸收钉或克氏针内固定术;骨质疏松、粉碎、关节面塌陷严重等予以一期植骨,术中影像学检查骨折达到或者近似解剖复位.术后进行随访和回顾性分析.纳入研究的临床数据包括:患者年龄、性别、有无其他基础疾病和吸烟史、是否伴有其他复合伤、损伤因素、Sander分型、手术时间、术中出血、手术并发症、骨折临床愈合和功能恢复情况.术后随访复查患者影像学愈合情况、有无感染、骨不愈、内置物失效,患足功能评估采用美国足踝骨科协会(American orthopedic foot&ankle society,AOFAS)的评分系统.结果 37例患者术后随访12～38个月,平均随访时间18个月.SandersⅡ、Ⅲ、Ⅳ型术前、术后Bohler角和Gis-sane角差异具有统计学意义(均P＜0.05),术后均较术前高;患者手术切口均一期愈合,未出现切口感染、坏死等,AOFAS评分平均84.8分,总的优良率为87.8％ (36/41).结论 小切口保护跟骨外侧壁骨瓣+可吸收钉治疗外侧关节面塌陷为主的跟骨骨折,缩短手术时间、手术创伤小、降低术后并发症,最大程度的保护跟骨外侧组织结构;同样,可应用于不适合应用跟骨外侧广泛切口内固定的患者,为治疗跟骨骨折提供新的思路.

目的 观察鲑鱼降钙素结合钙剂对骨质疏松患者血清骨代谢标志物的影响.方法 选取136例骨质疏松患者,分为观察组和对照组,各68例.对照组给予碳酸钙治疗,观察组在对照组基础上给予鲑鱼降钙素治疗.观察骨代谢标志物:β-胶原片段(β-CTX)、25羟基维生素D(25OHVitD)、骨钙素(BGP)、甲状旁腺激素(PTH)及骨特异性碱性磷酸酶(BNALP);骨密度指标:股骨颈、Ward氏三角区和腰椎L1～4的骨密度.结果 两组治疗后β-CTX、25OHVitD、BGP、PTH、BNALP、股骨颈、Ward氏三角区和腰椎L1-4的骨密度均较治疗前明显改善(均P＜0.05),且两组治疗后p-CTx、25OHVitD、BGP、PTH、BNALP、股骨颈、Ward氏三角区和腰椎L1～4的骨密度差异均有统计学意义(均P＜0.05).结论 鲑鱼降钙素结合钙剂可使骨质疏松患者的血清骨代谢标志物明显改善,提高患者骨密度.