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Objective: Rapid and effective reduction is difficult for minimally invasive plate osteosynthesis (MIPO) surgery. This study aims to introduce a bidirectional rapid reductor (BRR) designed to assist in the reduction during MIPO surgery for proximal humeral fractures (PHFs). Methods: This retrospective study was conducted between June 2021 and February 2022 in the Third Hospital of Hebei Medical University, involving patients diagnosed with PHFs. A detailed technical approach of BRR in MIPO surgery was described, and the patients' outcomes based on postoperative radiographic results including x‐ray postoperative follow‐up, and clinical outcome parameters including visual analogue scale (VAS) and constant‐Murley score at last follow‐up were reported. Results: A total of 12 patients were included in this study, comprising three males and nine females, with an average age of 67.58 years. The mean operative time was 70.92 min (range 63–80 min). The mean blood loss was 102.27 mL (range 50–300 mL). The mean VAS and constant‐Murley scores at final follow‐up were 0.33 and 88, respectively. All patients had their fractures healed without secondary displacement at last follow‐up. One patient experienced shoulder stiffness post‐operation. There were no adverse events or complications following the use of this technique, such as acromion fracture, nerve or blood vessel injury. Conclusion: The BRR can assist MIPO for good reduction of PHFs. However, the efficacy should be validated with a large‐sample randomized controlled trial and longer follow‐up. [ABSTRACT FROM AUTHOR]

Background: In elderly tibial plateau fractures (TPFs), the lateral condyles are involved frequently. This study aimed to compare the outcomes of open reduction and internal fixation (ORIF) and double reverse traction repositor (DRTR) assisted closed reduction and internal fixation (CRIF) in elderly patients with lateral TPFs. Methods: From January 2015 to July 2020, we retrospectively reviewed 68 patients treated surgically at our trauma center for lateral TPFs (Schatzker type I-III). 31 patients were eventually assigned to the DRTR assisted CRIF group, whereas 37 patients were assigned to the ORIF group. The primary outcomes included surgical details, radiological assessment, follow-up knee function, and complications. Results: The DRTR assisted CRIF group experienced a 43.6 mL decrease in intraoperative blood loss (161.3 mL vs 204.9 mL, P =.033), and the operation duration was 32.1 min shorter than the ORIF group (83.8min vs 115.9min, P <.001). No statistical difference was found between the two groups in terms of transfusion rate (3.2% vs 8.1%, p =.394), and postoperative hemoglobin level was lower in the ORIF group than in the DRTR assisted CRIF group (111.8±13.3 g/L vs 104.5±12.7 g/L, p =.025). There was no statistically significant difference in terms of widening of the tibia plateau (WTP), depth of articular depression (DAD), medial proximal tibial angle (MPTA) and posterior tibial slope angle (PTSA) preoperatively, immediately after surgery and at the last follow-up. No differences in malreduction (P=.566) or reduction loss (P =.623) were observed between the groups, and Lysholm and HSS scores were similar between the two groups (83.6 ± 15.8 vs 83.4 ± 5.1, P =.934; 89.3 ± 7.8 vs 86.9 ± 6.2, P =.172; respectively). However, ORIF was associated with a greater increase in postoperative complications than DRTR assisted CRIF (3.2% vs 27%, P =.008). Conclusion: Both types of internal fixation provide good radiological outcomes and knee function in the treatment of lateral TPFs in the elderly. However, DRTR assisted CRIF has the advantage of a shorter duration of surgery, less blood loss, and fewer postoperative complications, and appears to be a better treatment option for elderly patients with lateral TPFs. [ABSTRACT FROM AUTHOR]

Background: Limb length discrepancy is one of the most common complications after hip arthroplasty. We developed a device - intraoperative limb-length measurement and osteotomy device (ILMOD), and applied it to patients who were treated with hemiarthroplasty for femoral neck fracture to improve limb length discrepancy by providing an accurate osteotomy during hemi-arthroplasty.Methods: Between April 2012 and October 2013, 65 patients were treated with hip hemiarthroplasty for femoral neck fracture at our trauma center. 31 patients met the inclusion criteria and were randomly enrolled into two groups ILMOD group and control group. Hemiarthroplasty in this study was performed with cement fixation. Treatment-related measurements such as the operation time, attempts of osteotomy, and the volume of intra-operative blood loss were collected. In both groups, postoperative (1 month) radiologic analysis on anteroposterior weight-bearing pelvic view was performed to evaluate limb length discrepancy.Results: The results showed significant improvement in limb length discrepancy in ILMOD group, and analysis of postoperative radiographs found the mean length difference is 2.1 ± 1.9 mm in ILMOD group compared to 8.8 ± 5.1 mm in control group (P < 0.0001). No complications associated with the use of the device were reported, and none of the patients complained of the discomfort related to limb-length discrepancy after surgery. The average intra-operative time was significantly longer in ILMOD group (84.9 ± 9.2 min) compared to that in control group (70.9 ± 10.2 min) (P = 0.0004).Conclusions: The ILMOD is an effective device that can be used easily for intraoperative limb length measurement and osteotomy during hemiarthroplasty. This method is applicable with Kocher-Langenbeck approach, and the technique could also be used in total hip arthroplasty.Trial Registration: Chinese Clinical Trial Registry ChiCTR-OOC-15005904 . Registered 30 Junuary 2015. [ABSTRACT FROM AUTHOR]

Objective: To review the biomechanical research progress of internal fixation of tibial plateau fracture in recent years and provide a reference for the selection of internal fixation in clinic., Methods: The literature related to the biomechanical research of internal fixation of tibial plateau fracture at home and abroad was extensively reviewed, and the biomechanical characteristics of the internal fixation mode and position as well as the biomechanical characteristics of different internal fixators, such as screws, plates, and intramedullary nails were summarized and analyzed., Results: Tibial plateau fracture is one of the common types of knee fractures. The conventional surgical treatment for tibial plateau fracture is open or closed reduction and internal fixation, which requires anatomical reduction and strong fixation. Anatomical reduction can restore the normal shape of the knee joint; strong fixation provides good biomechanical stability, so that the patient can have early functional exercise, restore knee mobility as early as possible, and avoid knee stiffness. Different internal fixators have their own biomechanical strengths and characteristics. The screw fixation has the advantage of being minimally invasive, but the fixation strength is limited, and it is mostly applied to Schatzker typeⅠfracture. For Schatzker Ⅰ-Ⅳ fracture, unilateral plate fixation can be used; for Schatzker Ⅴand Ⅵ fracture, bilateral plates fixation can be used to provide stronger fixation strength and avoid the stress concentration. The intramedullary nails fixation has the advantages of less trauma and less influence on the blood flow of the fracture end, but the fixation strength of the medial and lateral plateau is limited; so it is more suitable for tibial plateau fracture that involves only the metaphysis. Choosing the most appropriate internal fixation according to the patient's condition is still a major difficulty in the surgical treatment of tibial plateau fractures., Conclusion: Each internal fixator has good fixation effect on tibial plateau fracture within the applicable range, and it is an important research direction to improve and innovate the existing internal fixator from various aspects, such as manufacturing process, material, and morphology.

Objective: To evaluate the effectiveness of the leverage reduction with proximal femoral nail antirotation (PFNA) ball head screw driver for difficult-reducing intertrochanteric fracture., Methods: The clinical data of 8 patients with difficult-reducing intertrochanteric fractures between July 2015 and February 2018 were retrospectively analysed. There were 3 males and 5 females, aged 66-89 years, with an average age of 76.3 years. According to Evans classification, there were 3 cases of type Ⅲ and 5 cases of type Ⅳ. The time from injury to operation was 2-8 days (mean, 3.9 days). All patients were reducted with ball head screw driver leverage through PFNA proximal incision during operation. The operation time, intraoperative blood loss, reduction time, and fluoroscopy times were recorded. Harris hip function score was used to evaluate the effectiveness at last follow-up., Results: The operation time was 52.5-83.7 minutes (mean, 68.1 minutes), the intraoperative blood loss was 49.8-96.4 mL (mean, 73.1 mL), the reduction time was 3.7-9.1 minutes (mean, 6.4 minutes), and the fluoroscopy times were 18.4-27.4 times (mean, 22.9 times). Patients were followed up 6-18 months (mean, 9.6 months). Postoperative X-ray films showed that the fracture obtained good reduction. No fracture displacement, fixation failure, and coxa vara occurred after operation. Fracture healing time was 3-6 months (mean, 4.6 months). At last follow-up, the Harris hip function score was 85-96 (mean, 91.6), with a result of excellent in 6 cases and good in 2 cases., Conclusion: The reduction of difficult-reducing intertrochanteric fracture by using ball head screw driver can obtain good reduction and reliable fixation. The method has such advantages as no more incision, and less blood loss and soft tissue injury.

Objective: To investigate the effects of Rho-kinase inhibitor--fasudil hydrochloride hydrate on vein graft intimal hyperplasia in vivo., Methods: Twenty-four healthy rabbits (2.3-2.5 kg) were randomly divided into two groups (n=12). Fasudil hydrochloride hydrate (experimental group) and normal sodium (control group) were given 3 days before operation with 30 mg/kg by intravenous injection everyday and continued until the end of the experiment. After a longitudinal incision, the femoral vein and the femoral artery were exposed about 3 cm. An approximately 2.5 cm segment of the famoral vein was harvested for the reversed-vein graft. The femoral artery was removed 1 cm segment and replaced by the harvested femoral vein. At 2 and 4 weeks after operation, the grafts were stained with HE to observe the thickness of the intima. Furthermore, the proliferating cell nuclear antigen (PCNA) and transmission electron microscope was used to study the proliferation of smooth muscle cell. In situ apoptosis was detected by TUNEL assay., Results: All rabbits survived till the end of the experiment. The color Doppler imaging examination showed that all grafts were patency. At 2 and 4 weeks after the operation, HE staining showed that the intimal hyperplasia were obvious in the two groups. There were lots of cells in the intima, and more fusiform smooth muscle cells in the media. At 2 and 4 weeks, the intimal thickness were (30.33 +/- 3.23) microm and (43.11 +/- 4.92) microm in experimental group and were (44.83 +/- 3.53) microm and (66.16 +/- 8.45) microm in control group. The rates of PCNA positive cell were 14.28% +/- 2.76% and 7.61% +/- 1.06% in experimental group and were 20.08% +/- 3.56% and 8.73% +/- 1.35% in control group. The rates of TUNEL positive cell were 3.55% +/- 0.36% and 1.22% +/- 0.18% in experimental group and were 1.11% +/- 0.31% and 0.55% +/- 0.11% in control group. There were significant differences (P < 0.05) between the two groups at 2 weeks or 4 weeks, between 2 weeks and 4 weeks within group., Conclusion: Intravenous injection of fasudil hydrochloride hydrate is an effective method for prevention of vein graft intimal hyperplasia of rabbit.

Objective: To investigate the value of using Footscan system to evaluate the therapeutic effect of two internal fixation methods on calcaneus fractures., Methods: From February 2006 to September 2006, 64 patients with fresh unilateral closed calcaneus fractures were randomly divided into two groups. The experimental group: 32 patients underwent minimally invasive open reduction and internal fixation with improved compressing plate and screw, including 28 males and 4 females aged 20-53 years old (average 36.7 years old); the course of disease was 3-14 days; there were 19 cases of type II, 11 of type III, and 2 of type IV according to Sanders fracture classification system. The control group: 32 patients underwent internal fixation of standard AO plate via L-shaped incision, including 29 males and 3 females aged 18-56 years old (average 37.1 years old); the course of disease was 4-15 days; there were 18 cases of type II, 11 of type III and 23 of type IV according to Sanders fracture classification system. No significant difference was noted between two groups in the general information (P > 0.05). At 1 and 2 years after operation, dynamic plantar pressure was measured using Footscan system, Maryland foot scores of two groups was compared, and statistical analysis was performed., Results: All patients were followed up for 2 years. No infection, cuticular border necrosis, and sural nerve distal end injury occurred in the experimental group, whereas in the control group, 3 patients suffered from cuticular border necrosis and recovered after dressing, and 1 patient had sural nerve distal end injury with decreased sensation in local skin. At 1 and 2 years after operation, in the control group, there were significant differences between the injured foot and the normal foot in terms of impulse, instep index, motion range of subtalar joint, lateral displacement of footplate pressure center, and calcaneal width when patients stood on both feet (P < 0.05), whereas in the experimental group, no significant differences were noted between the injured foot and the normal foot in terms of the above parameters (P > 0.05). Significant differences were noted between two groups in terms of the above parameters (P < 0.05). The Maryland score 1 year after operation was (86.74 +/- 8.56) points for the experimental group and (71.24 +/- 10.06) points for the control group; at 2 years after operation, it was increased to (87.35 +/- 8.49) points and (72.41 +/- 9.69) points, respectively, indicating there was a significant difference between two groups (P < 0.05)., Conclusion: Operative outcomes of internal fixation with improved compressing plate are superior to those of standard AO plate. Footscan system can provide a quantitative assessment on the operative effect of calcaneus fractures.

Objective: To assess the effect of topical application of 5-fluorouracil (5-FU) on intimal hyperplasia in rabbit vein graft., Methods: Sixty-four male New Zealand white rabbits, aged 5 months and weighing 2.8-3.0 kg, were randomly divided into group A, B, C, and D (n = 16 rabbits per group). Artery defect model was established by cutting about 1 cm artery from the middle part of the dissociated left common carotid artery. A section about 3 cm was cut from the right external jugular vein, and the harvested vein was inverted and end-to-end anastomosed to the artery defect with 9-0 non-traumatic suture. After anastomosis, the extima of the grafted veins in group A, B, and C was completely wrapped with cotton sheet (12 mm x 30 mm x 1 mm in size) immersed by 5-FU at a concentration of 50.0, 25.0, and 12.5 mg/mL, respectively, and each vein was treated 5 times (1 minute at a time). In group D, the extima of the graft veins was treated with normal saline instead of 5-FU. The grafted veins were obtained 1, 2, 4, and 6 weeks after operation, HE staining and Masson staining were preformed for histological changes of grafted vein wall, proliferating cell nuclear antigen (PCNA) immunohistochemistry staining and TUNEL labeling staining were conducted for proliferation and apoptosis of smooth muscle cell of the grafted vein, and transmission electron microscope observation was performed for cellular ultrastructure., Results: The HE staining, Masson staining, and PCNA immunohistochemistry staining showed that the thickness of intima in group A and B was obviously less than that in group C and D at 1, 2, 4, and 6 weeks after operation, and the proliferation cells in group A and B were less than that in group C and D at 1, 2, and 4 weeks after operation. The thickness of the intima, the degree of intima hyperplasia, the degree of vessel lumen stenosis of four groups at different time points were as follows: at 1 week after operation, group A [(12.69 +/- 1.68) microm, 0.73 +/- 0.05, 0.025 +/- 0.003], group B [(17.52 +/- 2.01) microm, 0.86 +/- 0.06, 0.027 +/- 0.004], group C [(21.92 +/- 1.85) microm, 1.06 +/- 0.09, 0.036 +/- 0.006] and group D [(26.45 +/- 3.86) microm, 1.18 +/- 0.08, 0.041 +/- 0.005]; at 2 weeks after operation, group A [(24.61 +/- 2.91) microm, 0.86 +/- 0.06, 0.047 +/- 0.003], group B [(37.28 +/- 2.78) microm, 1.17 +/- 0.09, 0.060 +/- 0.004], group C [(46.52 +/- 2.25) microm, 1.44 +/- 0.08, 0.073 +/- 0.003], and group D [(52.07 +/- 3.29) microm, 1.45 +/- 0.05, 0.081 +/- 0.006]; at 4 weeks after operation, group A [(61.09 +/- 6.84) microm, 1.38 +/- 0.08, 0.106 +/- 0.007], group B [(63.61 +/- 8.25) microm, 1.40 +/- 0.07, 0.107 +/- 0.010], group C [(80.04 +/- 7.65) microm, 1.64 +/- 0.07, 0.129 +/- 0.011], and group D [(84.45 +/- 9.39) microm, 1.68 +/- 0.10, 0.139 +/- 0.014]; at 6 weeks after operation, group A [(65.27 +/- 5.25) microm, 1.46 +/- 0.07, 0.113 +/- 0.005], group B [(65.82 +/- 7.12) microm, 1.45 +/- 0.05, 0.112 +/- 0.011], group C [(84.45 +/- 9.39) microm, 1.69 +/- 0.09, 0.135 +/- 0.007], and group D [(87.27 +/- 8.96) microm, 1.76 +/- 0.05, 0.140 +/- 0.012]. Group A and B were inferior to group C and D in terms of the above three parameters and cell proliferation index 1, 2 and 4 weeks after operation (P < 0.05). Group A and B were superior to group C and D in terms of cell apoptosis index of intima and media 1 and 2 weeks after operation (P < 0.05). Transmission electron microscope observation showed that the synthetic cell organelles such as rough endoplasmic reticulum, golgi apparatus, and ribosome in group A and B were obviously less than those in group C and D (P < 0.05)., Conclusion: Topical application of 5-FU can effectively inhibit intima hyperplasia of the vein grafts.