Background Preoperative assessment of distal Achilles tendon stump length is important for surgical planning in acute Achilles tendon rupture (AATR). However, whether routine magnetic resonance imaging (MRI) is necessary for all patients remains controversial. This study evaluated the value of physical examination (PE), ultrasonography (US), and MRI in assessing the effective length of the distal Achilles tendon (ELDAT). Methods This retrospective diagnostic study included 247 patients with AATR who underwent open repair between June 2020 and July 2021. Preoperative PE, US, and MRI measurements of ELDAT were compared with intraoperative length (IL), which represented the clinically repairable distal tendon stump available for fixation. Insufficient distal stump length was defined as IL < 2 cm. Diagnostic performance metrics were calculated. An exploratory threshold of PE > 3 cm was evaluated for its potential rule-out utility. Results Among 247 patients, 10 (4.0%) demonstrated insufficient distal stump length intraoperatively. PE systematically underestimated ELDAT compared with IL [mean difference (MD), − 0.46 cm; p < 0.001], whereas US overestimated stump length (MD, 0.22 cm; p < 0.001). MRI showed the smallest measurement bias and no significant difference from IL (MD, 0.06 cm; p = 0.262). MRI demonstrated the highest overall diagnostic performance, while PE showed comparable negative predictive value (98.7%). Notably, no patient with PE-measured ELDAT > 3 cm had IL < 2 cm. Application of this exploratory threshold yielded a sensitivity and negative predictive value of 100% and could potentially avoid MRI examinations in 79.8% of patients in this cohort. Conclusions PE serves as a simple clinical tool to screen for insufficient ELDAT. A PE-measured ELDAT > 3 cm can be used as a preliminary threshold to avoid unnecessary MRI scans.

Background The optimal rehabilitation strategy after acute Achilles tendon rupture (AATR) repair remains controversial. Although early weight-bearing (EWB) may promote functional recovery, the clinical implementation of such protocols is currently limited by a lack of objective criteria to guide progression. This study evaluated the safety and effectiveness of an ultrasound-guided early weight-bearing (USEWB) protocol following open repair of AATR. Methods This retrospective cohort study included 64 patients who underwent open repair for AATR between March 2025 and September 2025. Patients were divided into a USEWB group (n = 31) or a conventional rehabilitation (CR) group (n = 33) according to the postoperative rehabilitation protocol. Functional outcomes were evaluated at 2, 4, 6, 8, 12, and 16 weeks postoperatively. The calf circumference difference (CCD), Achilles tendon resting angle (ATRA), Achilles Tendon Rupture Score (ATRS), and postoperative complications were subjected to statistical analysis. Linear mixed-effects models were used for longitudinal analysis. Results In both the ITT and PP populations, USEWB significantly accelerated early functional recovery, demonstrating higher ATRS scores at 4, 8 and 12 weeks and smaller CCD at 8, 12, and 16 weeks postoperatively compared with CR. In the PP population, USEWB exhibited a significantly lower ATRA at 8 weeks postoperatively (p = 0.017). No significant differences were observed in complication rates between groups. Conclusion USEWB after open AATR repair appears to accelerate early functional recovery without increasing the risk of tendon elongation or postoperative complications. This strategy may provide a practical approach for individualized rehabilitation after Achilles tendon repair.

Background: To stabilize posterior pelvic ring injuries with a transiliac-transsacral (TITS) screw percutaneously, it is crucial to determine the adequate entry point as an initial procedure. Here, we propose a universal method for specifying the entry point for the TITS screw under fluoroscopic guidance. Methods: Through analyzing 239 pelvic computed tomography (CT) images retrospectively, we determined the entry point for the TITS screw at the midpoint between the anterosuperior and posteroinferior corners of the respective vertebra in the strict midsagittal CT plane. Virtual surgical procedures were performed to verify the feasibility of using the midpoint as the entry point and to evaluate the accuracy of screw placement. Clinical surgical procedures with our proposed method of determining the entry point on the lateral fluoroscopic view were performed to validate the safety and accuracy of screw placement. Then, the efficacy of this method was evaluated compared to the previously applied method. Results: In the virtual surgical procedures, a total of 148 S1 TITS screws were securely placed in all pelvises with normal sacra, while 239 S2 TITS screws were securely placed in all pelvises regardless of dysmorphism. In clinical surgical procedures, 27 S1 screws and 15 S2 screws were securely placed in 41 pelvises, with 39 screws (92.9%) classified as grade 1 and 3 screws (7.1%) classified as grade 2. The rate of excellent or good functional outcomes was 100%. Compared to the previous method, our proposed method revealed superior efficacy regarding surgical duration (p < 0.001), fluoroscopic shots (p < 0.001), and guidewire attempts (p < 0.001). Conclusions: On the lateral fluoroscopic view, the midpoint between the anterosuperior and posteroinferior corners of the respective vertebra can consistently serve as the entry point for the TITS screw, applicable to S1 and S2 screws in a normal sacrum, as well as to the S2 screw in a dysmorphic sacrum.

Background Atherosclerosis (AS) is a chronic inflammatory vascular disease that can lead to severe cardiovascular events. Ferroptosis and autophagy have been increasingly recognized for their significant roles in AS; however, few clinically translatable hub genes that connect these processes in atherosclerotic lesions have been identified. There is an urgent need for novel diagnostic and therapeutic targets to improve the early detection and intervention of AS.Methods We downloaded AS-related datasets from the Gene Expression Omnibus (GEO) database. Common genes were identified using Limma and Weighted Gene Coexpression Network Analysis (WGCNA). We assessed ferroptosis and autophagy marker expression in AS mouse coronary tissues using immunohistochemistry (IHC) and immunofluorescence (IF). Hub genes were identified by intersecting common genes with known ferroptosis- and autophagy-related gene sets. Gene Set Enrichment Analysis (GSEA), receiver operating characteristic (ROC) curves, and 10-fold cross-validation repeated five times were performed to explore the potential roles and diagnostic capabilities of these hub genes. Immune cell infiltration analysis was performed using CIBERSORT, and Spearman's correlation analysis was subsequently performed to evaluate the associations between the identified hub genes and the relative abundance of immune cells. Finally, hub gene expression was validated in AS mouse coronary tissues using IHC and IF.Results Limma and WGCNA identified 104 common genes. IHC and IF analyses in AS mice confirmed the activation of ferroptosis and inhibition of autophagy in the coronary tissue. Intersecting common genes with pathway-specific genes identified three pivotal hub genes: CALCOCO2, TXNRD1, and SELENBP1. ROC analysis and 10-fold cross-validation repeated five times indicated excellent diagnostic efficacy for these genes. Immune infiltration analysis revealed significant alterations in immune cell populations in AS patients, and correlation analysis further demonstrated that CALCOCO2, TXNRD1, and SELENBP1 were significantly associated with multiple immune cell types, directly linking these hub genes to the atherosclerotic immune microenvironment. Consistent with patient data, IHC/IF validation showed significantly lower expression of the hub genes in AS mouse coronary tissues compared to controls.Conclusions CALCOCO2, TXNRD1, and SELENBP1 represent a novel panel of diagnostic biomarkers uniquely positioned at the intersection of ferroptosis and autophagy in AS. The robust diagnostic performance of these hub genes, as demonstrated by ROC analysis and cross-validation, was further consolidated by IHC/IF validation showing their consistently downregulated expression in AS mouse models. Furthermore, these hub genes are significantly correlated with multiple immune cell populations, directly linking them to the atherosclerotic immune microenvironment and reinforcing their role as immune modulators in AS pathogenesis. Beyond diagnosis, these hub genes illuminate clinically actionable therapeutic targets: restoring their expression or function may simultaneously correct autophagy dysfunction and suppress ferroptosis, offering a dual-mechanism intervention strategy for atherosclerotic cardiovascular disease. Our findings provide a molecular framework for precision medicine approaches targeting ferroptosis-autophagy crosstalk and immune dysregulation in AS.

A modified Scarf osteotomy can not only correct hallux valgus deformity but also relieve lateral metatarsalgia by lowering the head of the first metatarsal. This effect is achieved by inclining the longitudinal osteotomy plane from dorsomedial to plantar-lateral. However, with the increase in the inclined angle, the correction ability for the intermetatarsal angle will weaken, which is critical for hallux valgus correction. The balance between intermetatarsal angle correction(IMAC) and the lowering of the first metatarsal head is crucial for good clinical benefits, and the inclined angle determines the balance. We built 11 three-dimensional models with weight-bearing CT of hallux valgus patients. Then, we simulated scarf osteotomy with different inclined longitudinal osteotomies and explored the exact mathematical relationship between the four variables: lateral displacements of the plantar fragment(LDPF), inclination of the longitudinal osteotomy plane༈ILOP༉, intermetatarsal angle, and plantar displacement of the metatarsal head༈PDMH༉. The degree of IMAC and the PDMH increased with the LDPF. With the increase in the inclination of ILOP, when LDPF is the same, the IMAC correction ability decreases, and PDMH increases. Scattering the LDPF and IMAC, they are both highly positively and linearly related. Scattering the LDPF and PDMH, the two were also positively and linearly related in all four different ILOP groups. The change in the slope of the lines was heterogeneous, the effects of ILOP on IMAC and PDMH were nonlinear. The optimal ILOP inclination angle was 15 degrees to 30 degrees, as observed by the fitted lines. Between 15 degrees and 30 degrees, the IMAC ability decreased less, while the PDMH was moderate and could produce clinical efficacy. The optimal inclination angle for longitudinal osteotomy was determined to be 15–30 degrees. The developed formula serves as a practical tool for preoperative planning.

OBJECTIVES:The treatment of refractory skin and soft tissue defects (RSSTDs) has long posed a global challenge for surgeons. Traditional closure methods, such as skin grafting and flap repair, are often associated with significant trauma and a steep learning curve. Skin stretching, which enables the generation of "extra skin," has emerged as a promising alternative. This study aims to evaluate the efficacy of a disposable skin-stretch closure (DSSC) device combined with vacuum sealing drainage (VSD) in the treatment of RSSTDs. METHODS:A prospective single-arm clinical study was conducted to analyze the clinical data of 43 patients with RSSTDs who were treated with the DSSC device for wound repair at our hospital between July 2022 and December 2024. Among these patients, 30 were male and 13 were female, with ages ranging from 14 to 71 years (mean: 41.86 ± 16.02 years). The wound areas ranged from 4 to 90 cm2 (mean: 18.56 ± 18.04 cm2). Wound conditions (including closure and healing) and the presence of complications were recorded. Wound closure was defined as the approximation of wound edges by manually compressing the bilateral skin to achieve tension-free or minimal-tension coaptation, allowing direct suturing. Closure time and closure rate (wound area/closure time) were recorded. Wound healing was defined as 100% re-epithelialization of the wound surface, confirmed during two consecutive follow-up assessments spaced 2 weeks apart, with no exudate, drainage, or dressing requirements. Healing time and healing grade (classified as Grade A, B, or C according to wound healing classification standards) were recorded. RESULTS:All 43 patients were followed up, and all wounds achieved primary healing. No complications, including wound edge damage, necrosis, infection, dehiscence, or edema, were reported. Patients did not report pain or discomfort, and no significant scar formation was observed during the follow-up. The wound closure time ranged from 5 to 17 days (mean: 9.07 ± 2.93 days), which was comparable to the 7.8 ± 3.8 days reported in the literature. The wound closure rate ranged from 0.35 to 7.44 cm2/day (mean: 1.99 ± 1.63 cm2/day). The wound healing time ranged from 17 to 29 days (mean: 22.74 ± 2.80 days). The Visual Analog Scalescores ranged from 1 to 3 (mean: 2.02 ± 0.64), significantly lower than the 7.0 ± 1.0 reported in the literature. One patient experienced complete wound healing within 17 days without the need for suturing. CONCLUSION:The DSSC device was effective in treating RSSTDs, with short wound closure times, minimal complications, and a simple procedure.

Percutaneous reduction is a minimally invasive procedure for treating intra-articular calcaneal fractures that helps preserve the integrity of the soft tissues around the subtalar joint and reduces surgical complications. Auxiliary traction and temporary fixation are critical components in the process of percutaneous reduction. To overcome the limitations of current techniques for the percutaneous reduction of intra-articular calcaneal fractures, we introduced a technique in which wrist external fixators are used for assistance. This study aims to assess the effectiveness and safety of this approach through a retrospective case series. From March 2015 to September 2018, patients with intra-articular calcaneal fractures who met the inclusion criteria underwent wrist external fixator-assisted percutaneous reduction at our hospital. Postoperatively, X-rays and CT scans were used to evaluate the degree of fracture reduction. The American Orthopedic Foot Ankle Society (AOFAS) Ankle–Hindfoot score, along with the range of motion of the ankle and subtalar joints, was measured at the final follow-up. Among the 31 patients who completed the follow-up, 10 had Sanders type II fractures, and 21 had Sanders type III fractures. Postoperative imaging revealed significant improvements in calcaneal alignment, including the Böhler and Gissane angles. Excellent or good restoration of the subtalar joint surface was achieved in 83.8

BACKGROUND:Atherosclerosis (AS), the leading cause of cardiovascular disease, involves complex molecular mechanisms that remain incompletely understood, particularly in the context of diet-induced vascular lesions. METHODS:We established an AS model in Bama miniature pigs using a high-cholesterol, high-fat diet (HCFD) and performed quantitative proteomic analysis on coronary artery tissues. Key proteins were identified using protein-protein interaction (PPI) network analysis and subsequently validated by histopathological evaluation in porcine and murine coronary arteries. The underlying molecular mechanisms were elucidated using Western blot analysis. RESULTS:The HCFD successfully induced an atherosclerotic phenotype characterized by significantly elevated serum lipid levels. Proteomic analysis identified 108 differentially expressed proteins (DEPs) between the AS and control groups. From four identified hub proteins, we focused on clusterin (CLU), which was markedly upregulated in atherosclerotic coronary tissues, particularly within endothelial cells (ECs) and smooth muscle cells (SMCs). Mechanistically, CLU upregulation activated the LRP1/AKT signaling pathway, thereby promoting atherogenesis. CONCLUSION:Our study reveals that elevated CLU expression accelerates the process of AS by activating the LRP1/AKT pathway. These data elucidate a novel pro-atherogenic role for CLU and establish the CLU/LRP1/AKT axis as a promising therapeutic target for managing AS, particularly in pathologies driven by high-fat diets.

Fracture diagnosis is critical in clinical settings, and imaging modalities like X-ray and CT scans are crucial for bone fracture diagnosis. Although X-ray scans are more convenient and affordable, they are prone to misdiagnosis and missed diagnosis due to the limited number of poses that can be observed and the uneven distribution of grayscales. Deep learning methods show great potential in improving the efficiency and accuracy of x-ray fracture diagnosis.This paper proposes MTL-DlinkNet, a multi-task learning model based on D-linkNet, that can perform both classification tasks for automatic identification of calcaneus fractures, and segmentation tasks for generation of regions of interest (RoI). The model achieves high accuracy (0.989 AUC) while annotating the data at the same time, making diagnosis more efficient and reducing the burden on doctors. The paper also presents an intelligent diagnostic tool for calcaneus fracture that assists doctors in clinical settings. The main contributions of this work include building a dataset of foot X-rays for fracture diagnosis, proposing a better-performing fracture diagnosis deep learning model, and developing an efficient diagnostic tool. Experimental results show that the MTL-DlinkNet model achieves better performance than the baseline models.Overall, this paper demonstrates the potential of deep learning methods in improving fracture diagnosis accuracy and efficiency, especially when multi-task learning is used, with practical applications in clinical settings.

Osteoporotic fractures represent a significant public health challenge in the context of an aging global population, with the rising prevalence of osteoporosis intensifying the demand for effective fracture treatment. Restoring the structure and function of bone tissue damaged by osteoporosis-induced defects remains a critical issue in clinical practice. In recent years, bioactive metallic materials such as magnesium, zinc, and strontium have gained considerable attention due to their exceptional mechanical properties, biocompatibility, and biodegradability, positioning them as promising materials for osteoporotic fracture repair. This review systematically explored the biological mechanisms, application advancements, and associated challenges of magnesium, zinc, and strontium in fracture healing. Key topics included their roles in promoting osteoblast proliferation and differentiation, inhibiting osteoclast activity, and modulating the bone microenvironment. Additionally, this review examined the optimization strategies for their clinical application, such as their integration into bone scaffolds, the functionalization of conventional materials, and the synergistic effects between different metals. Finally, this review analyzed the current progress and unresolved issues in this field, offering a forward-looking perspective on the clinical potential of bioactive metallic materials in precision treatment of osteoporotic fractures.

Objective:To evaluate the effectiveness of the channel-assisted minimally invasive repair (CAMIR) technique combined with flexor hallucis longus (FHL) tendon transfer in the treatment of Achilles tendon sleeve avulsion. Methods:A retrospective analysis was conducted on 17 patients with Achilles tendon sleeve avulsion who underwent CAMIR technique combined with FHL transfer between January 2019 and January 2023. The cohort comprised 13 males and 4 females, aged 32 to 65 years (mean, 49.7 years). Etiologies included sports-related injuries in 15 cases and blunt trauma in 2 cases. The interval from injury to surgery ranged from 4 to 368 days (median, 15 days). All patients exhibited calcification at the Achilles tendon insertion site, with 7 cases complicated by Haglund deformity. Postoperative complications were meticulously monitored, and tendon healing was assessed via MRI. Clinical outcome were evaluated using the visual analogue scale (VAS) score for pain, Tegner activity level rating scale, ankle activity score (AAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Victorian Institute of Sport Assessment-Achilles (VISA-A) score, and subjective clinical scoring systems preoperatively and at last follow-up. Results:The operation time was 50-62 minutes (mean, 56 minutes), and the intraoperative blood loss was 5-50 mL (mean, 19.7 mL). All patients were followed up 12-67 months (mean, 38 months). No postoperative complication, such as Achilles tendon re-rupture, incision infection, deep vein thrombosis, heel raise insufficiency, or sural nerve injury, was observed. At last follow-up, MRI examination confirmed satisfactory tendon healing in all cases. Significant improvements were noted in VAS scores, Tegner activity level rating scale, AAS scores, AOFAS ankle-hindfoot scores, and VISA-A scores compared to preoperative ones ( P<0.05). At last follow-up, the subjective clinical score ranged from 6 to 10 (median, 9). Conclusion:The CAMIR technique combined with FHL tendon transfer is a good treatment for repair of Achilles tendon sleeve avulsion, with good recovery of ankle function and few complications.

BackgroundDiabetes insipidus (DI) usually coexists with hyponatremia in patients with acute spinal cord injury (SCI). However, the incidence of DI after acute SCI has rarely been reported. In this study, we aimed to determine the incidence rates and risk factors for these conditions and explore early detection and intervention strategies.MethodsPatients with acute SCI who were sequentially admitted to our center between January 2010 and November 2021 were included. Clinical information was extracted from the medical records. Univariate analyses were performed for each potential risk factor. Variables with a P < 0.1 in univariate analysis were included in the multivariate logistic regression analysis, and those with a P < 0.05 were defined as independent risk factors.ResultsThe cohort included 317 patients. One hundred ten (34.7%) of the 317 patients with acute SCI developed hyponatremia, and 60 (18.9%) developed DI. The median time to onset of hyponatremia was 5 days (interquartile range [IQR]: 4-6), and the median time to onset of DI was 7 days (IQR: 6-8). Multivariate logistic regression analysis identified a cervical level of injury and a more severe injury (ASIA A) as strong independent risk factors for hyponatremia (both P < 0.001). Among fracture types, only Type C (compared to Type I) was individually associated with hyponatremia (P = 0.038), although the overall fracture-type variable was not significant (P = 0.156). In contrast, for DI, in addition to cervical level and ASIA A injury (both P < 0.001), the fracture-type variable was a significant predictor overall (P < 0.001), with both Type B (P = 0.027) and Type C (P < 0.001) fractures (vs. Type I) being independent risk factors.ConclusionWe found a high incidence of hyponatremia (34.7%) and DI (18.9%) in patients with acute SCI. Hyponatremia was mainly associated with higher-level and more severe SCI, with an added risk observed in fracture type C, whereas DI was associated with higher-level SCI, more severe injuries, and fracture types B and C. Our study highlights the interconnected nature of hyponatremia and DI as manifestations of acute SCI. Future research should adopt a unified pathophysiological framework that integrates these findings to better understand the underlying mechanisms.

Close reduction and internal fixation have gained popularity for the treatment of pelvic fractures. However, the closed reduction of bilateral displaced posterior pelvic ring disruption is a great challenge even for the most experienced surgeon. In this study, we describe in detail a novel unlocking closed reduction technique (UCRT) frame that allows strong traction for bilateral posterior pelvic ring displacement and presents preliminary clinical outcomes. We retrospectively reviewed 32 patients with bilateral displaced posterior pelvic ring disruptions (AO/OTA 61-C2 and C3) who were initially treated with this technique between July 2017 and July 2022. According to the AO/OTA classification, there were 9 cases (28.12

Background : To explore potential biomarkers for early diagnosis of atherosclerosis(AS) and provide basic data for further research on AS, the characteristics of serum metabolomics during the progression of AS in mini-pigs were observed dynamically.Methods : An AS model in Bama miniature pigs was established by a high-cholesterol and high-fat diet. Fasting serum samples were collected monthly for metabolomics and serum lipid detection. At the end of the treatment period, pathological analysis of the abdominal aorta and coronary artery was performed to evaluate the lesions of AS,thereby distinguishing the susceptibility of mini-pigs to AS. The metabolomics was detected using a high-resolution untargeted metabolomic approach. Statistical analysis was used to identify metabolites associated with AS susceptibility.Results : Based on pathological analysis, mini-pigs were divided into two groups: a susceptible group( n = 3) and a non-susceptible group( n = 6). A total of 1318 metabolites were identified, with significant shifting of metabolic profiles over time in both groups. Dynamic monitoring analysis highlighted 57 metabolites that exhibited an obvious trend of differential changes between two groups with the advance of time. The KEGG(Kyoto Encyclopedia of Genes and Genomes) pathway enrichment analysis indicated significant disorders in cholesterol metabolism, primary bile acid metabolism,histidine metabolism, as well as taurine and hypotaurine metabolism.Conclusions : During the progression of AS in mini-pigs induced by high-cholesterol/high-fat diet, the alterations in serum metabolic profile exhibited a time-dependent pattern, accompanied by notable disturbances in lipid metabolism, cholesterol metabolism, and amino acid metabolism. These metabolites may become potential biomarkers for early diagnosis of AS.

Purpose: To investigate the clinical effect of percutaneous kyphoplasty (PKP) guided by computed tomography (CT) combined with the three-dimensional coordinate guidance system on the treatment of osteoporotic vertebral compression fracture (OVCF). Methods: 32 cases of OVCF in the elderly admitted to our hospital from October 2019 to March 2021 underwent CT-guided PKP combined with the three-dimensional coordinate guidance system, and 36 vertebrae were treated. The patients’ VAS pain scores (visual analog scale) and ODI (Oswestry disability index) were observed after surgery, and the paired t-test was used to compare these indexes. Results: The 36 vertebrae that were treated with CT-guided PKP combined with the three-dimensional coordinate guidance system underwent unilateral pedicle puncture according to the path planned by CT images. With the ideal position of the puncture needle and a high success rate of puncture, the puncture time was 1.2–2.6 minutes, with an average of about 1.5 minutes; the injected bone cement ranged from 3 to 5.5 mL, with an average of 4.2 mL, and there were no spinal nerve injuries or leakage of the cement in the canal. VAS score decreased from 7.65 ± 0.60 before the operation to 2.59 ± 0.28 one day after the operation (P < 0.01); ODI decreased from 62.3 ± 2.18 before the operation to 27.91 ± 1.32 after the operation (P < 0.01). Conclusion: The application of CT-guided PKP combined with the three-dimensional coordinate guidance system has the advantages of accurate puncture, short operation time, less intraoperative bleeding, and low complications. This treatment is safe, reliable, and satisfactory for patients, and is worthy of clinical promotion.

Background Implant choice for the fixation of femoral neck fracture is one of the most important management controversies. This study aims to evaluate and compare the short-term outcomes associated with the use of the Femoral Neck System (FNS), Multiple Cancellous Screws (MCS), and Dynamic Hip Screws (DHS) in treating femoral neck fractures in a young patient population. Methods From June 2018 to June 2021, a total of 120 surgeries for a primary femoral neck fracture were retrospectively analyzed. This review encompassed demographic details of the patients and the mechanisms behind the injuries. Key surgical parameters such as operation duration, intraoperative blood loss, fluoroscopy duration, and hospital stay were meticulously documented. The employed surgical technique was described. All patients were followed up at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Avascular necrosis of the femoral head (AVN), nonunion, malreduction, implant failure or other complications were noted. The functional status at the last follow-up was assessed using the Harris functional scoring criteria. Results There were 90 males and 30 females, with a mean age of 40.4 years. As to patient characteristics, there were no significant differences between the three groups. DHS group showed longer operation time(52.15 ± 4.80 min), more blood loss(59.05 ± 5.87 ml) and longer time of hospitalization(7.6 ± 0.90 d) than FNS group (39.65 ± 2.84 min, 45.33 ± 9.63 ml and 4.87 ± 0.48 d) and MCS group (39.45 ± 3.10 min, 48.15 ± 7.88 ml and 5.04 ± 0.49 d) ( p < 0.05). In addition, the time of fluoroscopy in FNS group (15.45 ± 3.67) was less than that in MCS group (26.3 ± 4.76) and DHS group (27.1 ± 5.67) ( p < 0.05). The cost of FNS group(44.51 ± 2.99 thousand RMB) was significantly higher than the MCS and DHS groups. The FNS, MCS and DHS groups showed a similar mean length of femoral neck shortening (LFNS) and Harris score. The FNS, MCS and DHS groups showed a similar mean rate of AVN and internal fixation failure. Conclusions Following successful fracture reduction, FNS, MCS, and DHS are effective for in the young femoral neck fractures. No difference was found in complications between the three groups. However, the reduced fluoroscopy time associated with FNS contributes to shorter operation durations. The adoption of minimally invasive techniques correlates with decreased blood loss and shorter hospital stays. Nevertheless, these advantages may be offset by the potential economic burden they impose.

BACKGROUND:Osteoarthritis (OA) is a progressive joint condition marked by the slow degradation of articular cartilage. Vinpocetine (Vin), a synthetic derivative of vincamine derived from the vinca plant, exhibits anti-inflammatory and antioxidant properties. Nevertheless, the specific role and mechanism of Vin in the treatment of OA remain largely unexplored. OBJECTIVES:The study is designed to uncover the impacts of Vin on tert‑butyl hydroperoxide (TBHP)-induced ferroptosis and to explore its potential role and underlying mechanisms in the treatment of OA. Concurrently, we established an OA mouse model through medial meniscal instability surgery to assess the therapeutic effects of Vin in vivo. METHODS:Through network pharmacology analysis, we have identified the key targets and potential pathways of Vin. To simulate an oxidative stress-induced OA environment in vitro, we induced chondrocyte injury using TBHP. We tested how Vin affects chondrocytes under TBHP induction by DHE and DCFH-DA probes, BODIPY-C11 and FerroOrange staining, mitochondrial function assessment, Western blotting, co-immunoprecipitation, and immunofluorescence techniques. Simultaneously, we established an OA mouse model through medial meniscal instability surgery to assess the in vivo therapeutic effects of Vin. In this model, we used X-ray and micro-CT imaging, SO staining, TB staining, H&E staining, and immunohistochemistry to analyze the role of Vin in detail. RESULTS:This study demonstrated that Vin effectively suppressed TBHP-induced ferroptosis and extracellular matrix (ECM) degradation and significantly lessened mitochondrial damage associated with ferroptosis. In the OA mouse model, Vin improved cartilage degeneration, subchondral remodeling, synovitis, and ECM degradation. Vin worked by activating the Nrf2/GPX4 pathway and inhibiting the Keap1-Nrf2 interaction. This study focused on the function of ferroptosis in OA and its influence on chondrocyte damage and disease progression, offering novel perspectives on potential treatments. CONCLUSION:Vin activated the Nrf2/GPX4 pathway, thereby slowing OA progression, inhibiting ferroptosis, and preventing ECM degradation.

BACKGROUND:Precise measurement of the intraosseous corridor within the superior pubic ramus is essential for the accurate percutaneous placement of a retrograde superior ramus screw (SRS). However, conventional manual measurement methods are often subjective, leading to variations in results among observers. Our goal was to develop an automated and dependable method for determining the retrograde SRS corridor. METHODS:We developed an automated technique that utilized a computed tomography (CT) image-based search algorithm to identify the retrograde SRS corridor with the maximum diameter. We evaluated the reliability of this automated approach in comparison to a manual method using 17 pelves. Subsequently, we used both methods to measure the diameter, length, and orientation of the retrograde SRS corridor in 204 pelves in a Chinese population and assessed the intra- and interobserver agreement of each method by calculating the root-mean-square error (RMSE) and constructing Bland-Altman plots. We determined the screw applicability (percentages of hemipelves that could be treated with specific sizes of screws) for each method. Additionally, we investigated potential factors influencing the corridor, such as sex, age, height, and weight, through regression analysis. RESULTS:The intra- and interobserver intraclass correlation coefficients (ICCs) for the automated method (0.998 and 0.995) were higher than those for the manual approach (0.925 and 0.918) in the assessment of the corridor diameter. Furthermore, the diameter identified by the automated method was notably larger than the diameter measured with the manual method, with a mean difference and RMSE of 0.9 mm and 1.1 mm, respectively. The automated method revealed a significantly smaller corridor diameter in females than in males (an average of 7.5 and 10.4 mm, respectively). Moreover, use of the automated method allowed 80.6% of the females to be managed with a 4.5-mm screw while a 6.5-mm screw could be utilized in 19.4%, surpassing the capabilities of the manual method. Female sex had the most substantial impact on corridor diameter (β = -0.583). CONCLUSIONS:The automated method exhibited better reliability than the manual method in measuring the retrograde SRS corridor, and showed a larger corridor diameter for screw placement. Females had a significantly smaller corridor diameter than males. Given the intricate nature of the automated approach, which entails utilizing different software and interactive procedures, our current method is not readily applicable for traumatologists. We are working on developing integrated software with the goal of providing a more user-friendly solution for traumatologists in the near future. LEVEL OF EVIDENCE:Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Objective:To evaluate the positional relationship between protective channel and sural nerve while treating acute Achilles tendon rupture with channel assisted minimally invasive repair (CAMIR) technique based on anatomical observations of cadaver specimens. Methods:Twelve adult cadaveric lower limb specimens (6 left, 6 right) were utilized. A CAMIR device was implanted at a distance of 4 cm from the proximal end of the specimen to the Achilles tendon insertion. The skin was incised along the tendon's medial side, the sural nerve was dissected, and the positional relationship with the protective channel was observed. The distance from the sural nerve-Achilles tendon intersection to the calcaneal insertion, the vertical distance between protective channel and the calcaneal insertion, and the horizontal distance between the sural nerve and protective channel were measured by using vernier caliper. Results:Anatomical examination demonstrated a variable positional relationship between the sural nerve and protective channel, with the sural nerve positioned above (8 specimens) or below (4 specimens) the protective channel. The distance from the sural nerve-Achilles tendon intersection to the calcaneal insertion was (105.67±14.94) mm, the vertical distance between protective channel and the calcaneal insertion was (93.20±9.57) mm, and the horizontal distance between the sural nerve and protective channel was (0.31±0.14) mm. Conclusion:The use of CAMIR technique for the treatment of acute Achilles tendon rupture can effectively avoid iatrogenic injury to the sural nerve.

Objective:To explore the difference in effectiveness between a dynamic rehabilitation protocol and a traditional static rehabilitation protocol after the treatment of acute Achilles tendon rupture with channel assisted minimally invasive repair (CAMIR) technique through a prospective comparative trial, aiming to provide a reference for clinically selecting a feasible treatment regimen. Methods:Patients with acute Achilles tendon rupture admitted between June 2021 and June 2022 were included in the study, with 60 patients meeting the selection criteria. They were randomly divided into a dynamic rehabilitation group ( n=30) and a static rehabilitation group ( n=30) using a computer-generated random number method. There was no significant difference in baseline data such as gender, age, body mass index, smoking history, injured side, cause of injury, and disease duration between the two groups ( P>0.05). After Achilles tendon anastomosis by using CAMIR technique, the dynamic rehabilitation group implemented early partial weight-bearing training with the assistance of an Achilles heel boot and controlled ankle joint exercises for 6 weeks, while the static rehabilitation group maintained a non-weight-bearing status during this period. Complications in both groups were recorded. At 3 and 6 months after operation, the Achilles tendon total rupture score (ATRS) was used to evaluate the degree of functional limitation of the Achilles tendon in the affected limb, and the 12-Item Short Form Health Survey (SF-12 scale) was used to assess the patients' quality of life, including physical component summary (PCS) and mental component summary (MCS) scores. Results:No sural nerve injury occurred during operation in both groups. All patients were followed up 12-18 months (mean, 14 months). The dynamic rehabilitation group had significantly higher ATRS scores at 3 and 6 months after operation compared to the static rehabilitation group ( P<0.05). At 3 months after operation, the dynamic rehabilitation group had significantly lower PCS, MCS, and SF-12 total scores compared to the static rehabilitation group ( P<0.05). At 6 months, all quality of life scores in the two groups were similar ( P>0.05). Two cases (6.6%) in the dynamic rehabilitation group and 5 cases (16.7%) in the static rehabilitation group developed complications, with no significant difference in incidence of complications ( P>0.05). Conclusion:For acute Achilles tendon rupture, the dynamic rehabilitation protocol after Achilles tendon anastomosis by using CAMIR technique can improve early functional recovery and maintains comparable safety and effectiveness compared to static rehabilitation.