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Background: For the treatment of long bone defects of the extremities caused by trauma, infection, tumors, and nonunion, it has been a challenge for clinical orthopedic surgeons. Bone transport technique have become the only way to treat bone defects. However, inevitable docking site complications related to bone transport technique have been reported by many studies. The purpose of this study was to evaluate risk factor of docking site complications of bone transport technique using Ilizarov method in the treatment of bone defect of lower extremity. Aim: The purpose of this study was to investigate the risk factors associated with docking site complication treated with Ilizarov bone transport technique in the treatment of tibial bone defect. Methods: The retrospective study including 103 patients who underwent bone transport for the treatment of large bone defect in tibia from October 2012 to October 2019. There were 90 male and 13 females with a mean age of 37 years (range 17-66years). The etiology of bone defect includes high-energy trauma in 25 cases, osteomyelitis in 61 and nonunion in 17. There were 19 cases in the proximal 1/3 of the diaphysis, middle 1/3 in 39 and distal 1/3 in 45 cases. There were 12 limbs in active infected state with sinus and drainage.17 patients suffered soft tissue defect after debridement. The mean bone defect was 6.6cm (range 3-13cm). Single bone transport in 80 cases, and double in 23 cases. The docking time, external fixation time, external fixation index, and docking site complications were documented and analyzed. Univariate analysis and logistic regression analysis were used to analyze the factors that may affect the docking site complication of tibial bone defect treated with Ilizarov bone transport technique. The clinical outcomes were evaluated using Association for the Study and Application of the method of Ilizarov criteria (ASAMI) at last clinical visit. Results: 103 patients were followed up for (24-48) months, with an average of 27.5 months, The soft tissue were successfully managed by musculocutaneous flap transfer in 17 cases. However, multiple complications occurred in docking site, with an average of 0.53 complications per patient, an average of 0.16 minor complications and 0.38 major complications per patient. Delayed union in 22 cases (21.4%), axial deviation in 19 cases (18.4%) and soft tissue incarceration in 10 cases (9.7%). According to the results of logistic regression analysis, the distance of bone defect (P=0.001,OR=1.976), and distal 1/3 (P=0.01,OR =1.976) were are risk factors for delayed union. Bone defect distance (P< 0.001, OR = 1.981), external fixation time (P = 0.012, OR= 1.017) were risk factors for axial deviation. Soft tissue defect (P=0.047,OR =6.766) and the number previous operation (P=0.001, OR =2.920) were risk factors for soft tissue incarceration. Base on ASAMI bone score, bony result was excellent in 91 patients, good in 7, fair in 3 and poor in 2. The ASAMI functional result was excellent in 67 patients, good in 26, fair in 8, poor in 2. Conclusion: Ilizarov bone transport technique is a practical and effective method for the treatment of tibial bone defects. However, the incidence of complications at the docking site is high, of which bone defect distance, external fixation time, the number of previous operations, soft tissue defects and the distal 1/3 are risk factors for complications at the docking site, and clinicians should pay attention to them.

Background Distal tibia osteomyelitis (DTO) treatment has become a challenging problem due to its difficult treatment and special location. Our goal is to provide a comprehensive and individualized treatment strategy, and to investigate the associated complications.Methods We retrospectively analyzed the data of 70 patients with DTO diagnosed and treated in our hospital from January 2015 to January 2022. The average age was 42.5 years (12–73 years), there were 34 cases accompanied by bone defects, and the average length of the bone defect was 3.2 cm (2 cm–17 cm). We divided the patients into three groups based on infection severity and specific location: 25 cases of a simple type (S type), 23 cases of complex ankle non-involved type (CAN type), and 22 cases of complex ankle involved type (CAI type). Comprehensive individualized treatment, including debridement, reconstruction, arthrodesis, and other surgical methods, was performed on patients of various types, rehabilitation exercises were guided, and patients were closely monitored. The efficacy was assessed using the following criteria: (1) treatment and related complications; (2) infection and defect healing; (3) improvement of ADL, VAS, and AOFAS scores; (4) evaluation of patients undergoing Ilizarov distraction osteogenesis; and (5) evaluation of patients undergoing ankle arthrodesis.Results The follow-up time was 30 months (10–84 months). With the exception of three patients who required amputation due to aggravated infection and concomitant basic diseases, all patients achieved infection control and healing, and the complications were properly treated. Three scores of patients with different types were significantly improved, and the differences were statistically significant. Patients undergoing Ilizarov distraction osteogenesis had satisfactory results, and the superior rates of ASAMI bone evaluation and function evaluation were 89%. All patients with ankle arthrodesis finally achieved bone healing, and the average fusion time was 4.5 months (3–7 months).Conclusion The comprehensive individualized treatment strategy is reliable for the treatment of DTO, as it can guide individualized treatment under different conditions, solve the problem of bone and soft tissue defects while controlling infection, reduce complications and properly handle them, and save as much function of the affected limb as possible.

Background The most commonly used approach for distal radius fractures is the traditional Henry approach. However, it requires an intraoperative incision of the pronator quadratus (PQ) muscle, which results in a series of complications if the repair of the PQ fails. Aim The objective of this study was to investigate the efficacy of sparing the pronator quadratus for volar plating of the distal radius fractures. Methods Seventy-six patients who suffered from distal radius fractures of types 23-B, 23-C1, and 23-C2 as per the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification were treated with volar locking plate fixation using either the PQ muscle incision and repair (group A, n = 39) or the PQ muscle preservation approach (group B, n = 37). Intraoperative index, postoperative efficacy and complications of patients were recorded and evaluated. Results All patients were followed up for more than one year after surgery. All fractures achieved union. There were significant differences in mean operative time, mean intraoperative blood loss, and mean fracture healing time between the two groups. Still, there were no significant differences in limb function scores between the two groups at the 12-month postoperative follow-up. Outcomes assessed at 1 week, 1 month, and 3 months after surgery demonstrated significant differences in the mean range of motion and pain-related visual analog scale (VAS) between the two groups. As the range of motion and grip strength increased, the VAS scores decreased, and there was no significant difference between the two groups at 12 months postoperatively. Although tendon irritation and delayed carpal tunnel syndrome were more common in group A than in group B (7.6% vs. 0% and 5.1% vs. 0%, respectively), the differences were not statistically significant. Conclusion The modified Henry approach with sparing pronator quadratus muscle has no significant advantage in the range of wrist motion and upper limb function in the late stage. Nevertheless, the intraoperative placement of the plate under the pronator quadratus muscle can shorten the operation time, reduce intraoperative bleeding, reduce early postoperative pain, promote early activity, and improve the patient's quality of life. It is recommended that the pronator be preserved at the time of surgery.

Background Serum ferritin is an important iron storage protein in the human body, which indicates iron storage and the body’s nutritional status, and is associated with a variety of chronic diseases. Few prospective studies have assessed the association between serum ferritin levels and non-alcoholic fatty liver disease (NAFLD). This prospective cohort study aimed to explore whether serum ferritin levels were associated with the incidence of NAFLD in a large-scale adult population. Methods A total of 15,748 participants without baseline NAFLD were enrolled in the cohort study (1-9 years follow-up periods, median: 4.5 years). Serum ferritin levels were determined by protein chip-chemiluminescence method, and NAFLD was diagnosed by abdominal ultrasonography. Multivariable Cox proportional hazards regression models were used to assess the association between baseline serum ferritin levels and the risk of NAFLD. Results During the follow-up period, 3,374 new NAFLD cases were observed, and the incidence rate of NAFLD was 83.4 per 1000 person-years. In the fully adjusted model, the hazards ratios (95% confidence interval) for incident NAFLD across serum ferritin levels quartiles were 1.06 (0.94-1.19), 1.25 (1.11-1.41), and 1.52 (1.28-1.79) (P for trend

Background: Timing the fixator removal is vital for a successful external fixation treatment. The purpose of this study was to determine the effectiveness of axial load-share ratio in vivo as a supplemental decision support tool for the safe removal of an Ilizarov external fixator.Methods: This prospective observational study consists of 83 patients undergoing tibial or femoral lengthening with Ilizarov circular external fixation in our institution, from January 2011 to October 2019. In group Ⅰ (38 patients), the external fixator was removed based on the surgeon’s clinical experience and radiographs from January 2011 to June 2015. In group Ⅱ (45 patients), from July 2015 to October 2019, the supplemental axial load-share (LS) ratio test was accomplished without the knowledge of the clinical results by another medical team. The test was performed by electronically measuring forces in the fixator rods and in a ground force plate. When the LS ratio < 10% was consistent with the conclusion (dense bone formation was achieved in the distraction zone) drawn from the corresponding routine radiographs by the treating surgeon, the external fixator was removed.Results: There was no statistical significance in demographic data between the two groups (P>0.05). In group Ⅰ, 4 of the 38 patients suffered refracture (the refracture rate was 10.5%) after fixator removal, and bone union was finally achieved with further intervention by intramedullary nail. In group Ⅱ, 36 patients terminated the external fixation after the first mechanical test, and another 9 patients terminated the external fixation at the subsequent test. None of the 45 patients in group Ⅱ suffered refracture (the refracture rate was 0%). There was statistical significance in the refracture rate between the two groups (PConclusions: Adequate assessment of bone regenerate is crucial before removing an external fixator to prevent deformation or refracture. The axial load-share ratio in vivo is a practically quantitative method to supplement radiography and clinical experience for the assessment of regenerate healing, and the axial load-share ratio dropped below 10% is a safe limit for the Ilizarov external fixator removal.

Background: Timing the fixator removal is vital for a successful external fixation treatment. The purpose of this study was to determine the effectiveness of axial load-share ratio in vivo as a supplemental decision support tool for the safe removal of an Ilizarov external fixator.Methods: This prospective observational study consists of 83 patients undergoing tibial or femoral lengthening with Ilizarov circular external fixation in our institution, from January 2011 to October 2019. In group Ⅰ (38 patients), the external fixator was removed based on the surgeon’s clinical experience and radiographs from January 2011 to June 2015. In group Ⅱ (45 patients), from July 2015 to October 2019, the supplemental axial load-share (LS) ratio test was accomplished without the knowledge of the clinical results by another medical team. The test was performed by electronically measuring forces in the fixator rods and in a ground force plate. When the LS ratio < 10% was consistent with the conclusion (dense bone formation was achieved in the distraction zone) drawn from the corresponding routine radiographs by the treating surgeon, the external fixator was removed.Results: There was no statistical significance in demographic data between the two groups (P>0.05). In group Ⅰ, 4 of the 38 patients suffered refracture (the refracture rate was 10.5%) after fixator removal, and bone union was finally achieved with further intervention by intramedullary nail. In group Ⅱ, 36 patients terminated the external fixation after the first mechanical test, and another 9 patients terminated the external fixation at the subsequent test. None of the 45 patients in group Ⅱ suffered refracture (the refracture rate was 0%). There was statistical significance in the refracture rate between the two groups (PConclusions: Adequate assessment of bone regenerate is crucial before removing an external fixator to prevent deformation or refracture. The axial load-share ratio in vivo is a practically quantitative method to supplement radiography and clinical experience for the assessment of regenerate healing, and the axial load-share ratio dropped below 10% is a safe limit for the Ilizarov external fixator removal.

Background: The existing approaches to treating elbow fractures include anterior, external, internal, and posterior approaches. Of these, the anterior approach is often not chosen by surgeons to avoid damaging important nerves and blood vessels. In fact, the anterior approach has unique advantages. The purpose of this study was to report the outcomes in 38 patients with coronal plane elbow fractures treated through the anterior approach.Methods: We retrospectively analyzed 38 cases of coronal plane elbow fractures treated through an anterior approach at our institution between March 2015 and July 2019. The length of the surgical incision, operation time, intraoperative blood loss, and postoperative complications were recorded. The range of flexion, extension, and rotation of the affected elbow and the healthy elbow were collected at follow-up. Functional outcomes were evaluated using the Mayo Elbow Function Score (MEPS).Results: All 38 patients were followed up. At the final follow-up, solid osseous union was confirmed for all coronal plane elbow fractures. The mean elbow flexion arc was 129.26 ± 6.9 degrees, and the extension arc was 8.87 ± 6.13 degrees. The mean pronation arc was 83.45 ± 2.9 degrees, and the supination arc was 80.05 ± 2.92 degrees. The mean MEPS was 90.0±7.53 points, with 18 excellent cases and 20 good cases. There was no significant difference in elbow extension, flexion, and pronation between 31 cases of single fracture and the healthy elbow (P > 0.05); the arc of supination was slightly worse than that of the healthy elbow (P < 0.05). The VAS pain scores of the patients before the operation, three months after the operation, and during follow-up were compared. The pain of the patients was significantly reduced after treatment (P < 0.05). Two patients experienced transient postoperative median nerve paralysis, from which they recovered within three months. One patient had mild heterotopic ossification and was not treated because it did not affect the function of the elbow joint. All patients returned to work and were satisfied with the treatment.Conclusion: The anterior approach has the benefits of simplicity, safety, minimal invasion, excellent exposure, and satisfactory prognosis for coronal plane elbow fracture.

Background: The existing approaches to treating elbow fractures include anterior, external, internal, and posterior approaches. Of these, the anterior approach is often not chosen by surgeons to avoid damaging important nerves and blood vessels. In fact, the anterior approach has unique advantages. The purpose of this study was to report the outcomes in 38 patients with coronal plane elbow fractures treated through the anterior approach.Methods: We retrospectively analyzed 38 cases of coronal plane elbow fractures treated through an anterior approach at our institution between March 2015 and July 2019. The length of the surgical incision, operation time, intraoperative blood loss, and postoperative complications were recorded. The range of flexion, extension, and rotation of the affected elbow and the healthy elbow were collected at follow-up. Functional outcomes were evaluated using the Mayo Elbow Function Score (MEPS).Results: All 38 patients were followed up. At the final follow-up, solid osseous union was confirmed for all coronal plane elbow fractures. The mean elbow flexion arc was 129.26 ± 6.9 degrees, and the extension arc was 8.87 ± 6.13 degrees. The mean pronation arc was 83.45 ± 2.9 degrees, and the supination arc was 80.05 ± 2.92 degrees. The mean MEPS was 90.0±7.53 points, with 18 excellent cases and 20 good cases. There was no significant difference in elbow extension, flexion, and pronation between 31 cases of single fracture and the healthy elbow (P > 0.05); the arc of supination was slightly worse than that of the healthy elbow (P < 0.05). The VAS pain scores of the patients before the operation, three months after the operation, and during follow-up were compared. The pain of the patients was significantly reduced after treatment (P < 0.05). Two patients experienced transient postoperative median nerve paralysis, from which they recovered within three months. One patient had mild heterotopic ossification and was not treated because it did not affect the function of the elbow joint. All patients returned to work and were satisfied with the treatment.Conclusion: The anterior approach has the benefits of simplicity, safety, minimal invasion, excellent exposure, and satisfactory prognosis for coronal plane elbow fracture.

Background: Timing the fixator removal is vital for a successful external fixation treatment. The purpose of this study was to determine the effectiveness of axial load-share ratio in vivo as a supplemental decision support tool for the safe removal of an Ilizarov external fixator.Methods: This prospective observational study consists of 83 patients undergoing tibial or femoral lengthening with Ilizarov circular external fixation in our institution, from January 2011 to October 2019. In group Ⅰ (38 patients), the external fixator was removed based on the surgeon’s clinical experience and radiographs from January 2011 to June 2015. In group Ⅱ (45 patients), from July 2015 to October 2019, the supplemental axial load-share (LS) ratio test was accomplished without the knowledge of the clinical results by another medical team. When the LS ratio < 10% was consistent with the conclusion (dense bone formation was achieved in the distraction zone) drawn from the corresponding routine radiographs by the treating surgeon, the external fixator was removed.Results: There was no statistical significance in demographic data between the two groups (P>0.05). In group Ⅰ, 4 of the 38 patients suffered refracture (the refracture rate was 10.5%) after fixator removal, and bone union was finally achieved with further intervention by intramedullary nail. In group Ⅱ, 36 patients terminated the external fixation after the first mechanical test, and another 9 patients terminated the external fixation at the subsequent test. None of the 45 patients in group Ⅱ suffered refracture (the refracture rate was 0%). There was statistical significance in the refracture rate between the two groups (PConclusions: Adequate assessment of bone regenerate is crucial before removing an external fixator to prevent deformation or refracture. The axial load-share ratio in vivo is a practically quantitative method to supplement radiography and clinical experience for the assessment of regenerate healing, and the axial load-share ratio dropped below 10% is a safe limit for the Ilizarov external fixator removal.

Objective Bilirubin, an antioxidant, is reported to relate with metabolic syndrome and cardiovascular diseases. The current study is to assess the relationship between total bilirubin (TB) and hypercholesterolemia in the Chinese population. Methods This cross-sectional study involved 48971 males and 31327 females who were in good health. Physical examinations and laboratory tests including TB and total cholesterol (TC) were performed. Subjects were divided into the following groups according to age: subjects younger than 30 years, subjects aged between 30 to 60 years and subjects older than 60 years. Binary logistic regression models examining factors independently related to TB was performed for males and females in different age groups. Results TB was negatively related to most parameters in males and females, such as body mass index (BMI), blood urea nitrogen (BUN), TC, triglycerides (TG), low-density lipoprotein (LDL) and glucose (G). The incidence of high TC was higher in females than in males and decreased with the increasing of TB in both genders. People older than 30 years demonstrated a similar trend. When there were no other covariates, TB appeared to be an important risk factor for high TC for men and women. However, this relationship disappeared when other covariates were added in the binary logistic regression models. Similar results also existed in men younger than 60 years and women younger than 30 years. Conclusions Our findings implied that serum TB concentration was not an independent risk predictor for hypercholesterolemia. TB was thought to be a covariate factor in the development of dyslipidemia.

Objectives The present study aimed to develop a random forest (RF) based prediction model for hyperuricemia (HUA) and estimate associated risk factors. Methods This cross-sectional study recruited 91,690 participants (52,607 males, 39,083 females). The prediction models were derived from training sets using RF learning machine. Performances of the prediction model were evaluated in validation datasets. Significant indicators were produced after comparing between true positive set and true negative set. Odds ratio was calculated by binary logistic regression models. Results The area under the receiver-operating curve was 0.732 in males and 0.837 in females in the RF prediction models. The sensitivity, specificity and negative predictive value of the models were 0.686, 0.656 and 0.882 in males, 0.786, 0.738 and 0.978 in females, respectively. According to the feature value of each index in RF, a total of 10 explanatory variables were selected for each gender. Triglyceride, creatinine, body mass index, waist circumference, alanine transaminase, age, weight and total cholesterol were high-risk factors for HUA in both genders. Conclusion RF demonstrated good stability and strong predictive power in predicting HUA in Chinese population. People with high risk factors should be encouraged to actively control the above factors to reduce the probability of developing HUA.

Background Early-life hormonal and nutritional factors can greatly influence the risk of non-alcoholic fatty liver disease (NAFLD). Adult height is a simple marker for these factors. This study aimed to investigate the association between adult height and NAFLD. Methods We performed a prospective cohort study of 35,994 participants aged 25 years or over with measured height at baseline. NAFLD was diagnosed by abdominal ultrasound and self-reported history of alcohol intake. Multivariable Cox proportional hazards regression models were conducted to assess the gender-specific association between height and the risk of NAFLD. Results During a follow-up period of 5.5 years, 6245 of 35,994 subjects developed NAFLD. The adjusted hazard ratios (95% confidence interval) of NAFLD for increasing quintiles of height were 1.00 (reference), 0.82 (0.73, 0.92), 0.84 (0.73, 0.97), 0.72 (0.61, 0.85) and 0.63 (0.50, 0.79) (P for trend P for trend Conclusions A higher adult height was associated with lower risk of NAFLD among males and females in Tianjin, China.

Background Early-life hormonal and nutritional factors can greatly influence the risk of non-alcoholic fatty liver disease (NAFLD). Adult height is a simple marker for these factors. We aimed to evaluate adult height as a predictor of NAFLD.Methods We performed a prospective cohort study of 35, 994 participants recruited from 2010 to 2016 in Tianjin, China. NAFLD was diagnosed by ultrasound. Adjusted Cox proportional hazards regression models were conducted in 2019 to assess the gender-specific association between the quintiles of height and the incidence of NAFLD.Results Participants were followed up for 5.5 years with a mean follow-up of 2.6 years. During the follow-up period, 6,245 of 35,994 participants developed NAFLD. The multiple-adjusted hazard ratios (95% confidence interval) of NAFLD for increasing quintiles of height were 1.00 (reference), 0.90 (0.81, 0.99), 0.97 (0.87, 1.07), 0.86 (0.78, 0.96), and 0.84 (0.75, 0.94) ( P for trend < 0.01) in males and 1.00 (reference), 0.97 (0.86, 1.09), 0.98 (0.86, 1.11), 0.93 (0.81, 1.06), and 0.84 (0.73, 0.96) ( P for trend = 0.02) in females, respectively.Conclusions The study is the first to demonstrate adult height is a new, simple and inexpensive marker for ultra-early prediction of NAFLD.