To analyze the causes and management strategies of neck shaft angle loss in elderly patients with unstable intertrochanteric fractures after PFNA internal fixation.
Methods
A total of 126 patients （69 males and 57 females） who received PNFA internal fixation in our hospital from January 2021 to January 2023 were selected. Postoperative dry neck angle loss group （31 cases）， no loss group （95 cases）.SPSS 23.0 statistical software was used for data statistical analysis，and clinical data，surgical indicators and postoperative recovery of patients were collected. Ordered Logistic regression was used to analyze the relationship between the influencing factors and the loss of neck shaft angle.The effect of Harris score on postoperative loss of neck shaft angle was analyzed by stratified interaction.Differences in factor distribution characteristics were compared by latent class analysis （LCA）.
Results
（1） The operative time and hospital stay in the lost group were significantly longer than those in the non-lost group，and the amount of intraoperative blood loss was significantly higher than that in the study group（P＜0.001）.There were significant differences between the two groups in fracture reduction quality， internal fixation quality， and helical blade placement accuracy（P＜0.001）.（2）There were significant differences in Harris scores between the two groups at 7 days， 1 month， 3 months， 6 months and 12 months after surgery （P＜0.001）. （3） Singh index， osteoporosis，thickness of proximal femoral lateral wall，quality of fracture reduction，quality of internal fixation，and accuracy of helical blade placement were all important influencing factors of postoperative neck shaft angle loss（P＜0.001）.（4）The results of hierarchical interaction test showed that Singh index，osteoporosis，thickness of proximal femoral lateral wall， quality of fracture reduction， quality of internal fixation， and accuracy of helical blade placement were related to the loss of neck shaft angle after operation under different Harris scores before and after adjustment （all P＜0.05）. Pinteraction test showed that Harris score did not affect the relationship between the above indicators and postoperative neck shaft angle loss. （5） LCA showed that the effects of Singh index， osteoporosis， proximal femoral lateral wall thickness， fracture reduction quality， internal fixation quality，and helical blade placement accuracy on postoperative neck shaft angle loss were heterogeneous.
Conclusion
Singh index，osteoporosis，thickness of proximal femoral lateral wall，quality of fracture reduction， quality of internal fixation and accuracy of helical blade insertion are the key factors affecting the loss of neck shaft angle after PFNA internal fixation for unstable intertrochanteric fractures in the elderly.
To compare the effects of different postoperative weight-bearing times on early hip joint function recovery and fracture healing in elderly patients with intertrochanteric fractures treated with PFNA internal fixation.
Methods
From January 2020 to October 2022， 72 elderly patients （aged ≥60 years）with intertrochanteric fractures who completed a 6-month follow-up were included.All patients underwent closed reduction and internal fixation with proximal femoral nail antirotation（PFNA）.Based on postoperative weight-bearing time， patients were divided into early weight-bearing group （＜48 hours） and delayed weight-bearing group （＞48 hours）. The two groups were compared in terms of postoperative hospital stay，time to full weight-bearing，visual analog scale（VAS）score，activities of daily living（ADL）score，Harris hip joint function score， and radiographic fracture healing score.
Results
There was no significant difference in postoperative hospital stay between the two groups（P=0.295）.The time to full weight-bearing was significantly shorter in the early weight-bearing group than in the delayed weight-bearing group （P＜0.001）.VAS scores at 1， 3， and 6 months postoperatively were significantly lower in the early weight-bearing group compared to the delayed weight-bearing group （P=0.005， 0.006， 0.005）. Harris hip joint function scores at 1， 3， and 6 months postoperatively were significantly higher in the early weight-bearing group than in the delayed weight-bearing group （P=0.045， P=0.022， P=0.003）. Radiographic fracture healing scores at 1， 3， and 6 months postoperatively were significantly higher in the early weight-bearing group compared to the delayed weight-bearing group（P＜0.001，P＜0.001，P=0.001）.ADL scores at 3 and 6 months postoperatively were significantly higher in the early weight-bearing group compared to the delayed weight-bearing group （P=0.006，0.002）.There was no significant difference in ADL scores at 1 month postoperatively between the two groups（P=0.302）.
Conclusions
Early weight-bearing activity in elderly patients with intertrochanteric fractures results in earlier time to full weight-bearing，less postoperative pain，better activities of daily living，hip joint function，and improved fracture healing outcomes.Early weight-bearing should be clinically promoted and practiced.
To observe the effects of proximal femoral locking compression plate （LCP）and proximal femoral nail antirotation （PFNA） in the treatment of unstable femoral intertrochanteric fracture.
Methods
A total of 120 patients with unstable femoral intertrochanteric fracture admitted tothe hospital from April 2019 to January 2022 were selected， anddivided into LCP group and PFNA group by random number table method， with 60 cases in each group. Surgical conditions， postoperative recovery， hip function at 3 monthsand 6months after operation， and the incidence of complications during postoperative follow-up period were compared between the two groups.
Results
All 120 patients received complete follow-up，with a follow-up rate of 100%， and both groups continued to be followed up until 6 months after discharge.The operation time， intraoperative blood loss and postoperative drainage volume of LCP group were longer/more than those of PFNA group （t=15.576， 18.734， 11.455， all P=0.000）. At 3 months and 6 months after surgery，the excellent rate of Harris score in the LCP group was lower than that in the PFNA group（t=8.781，20.822， 12.362， all P=0.000）.The excellent and good rate of Harris score in LCP group was lower than that in PFNA group （χ2=9.377， 3.927， P=0.002， 0.048）， but there was no significant difference between the groups in the total incidence of complications during postoperative follow-up.
Conclusion
PFNA internal fixation has the advantages of less trauma， shorter operation time and faster postoperative recoveryin the treatment of unstable femoral intertrochanteric fracture. It is more conducive tojoint function recovery on the affected side.
By observing the musculoskeletal ultrasonographic findings of frozen shoulder in different clinical stages，to explore the correlation between musculoskeletal ultrasonographic findings and frozen shoulder clinical stages， and to explore the correlation between musculoskeletal ultrasonographic findings and frozen shoulder symptoms.
Methods
60 frozen shoulder patients who met the exclusion criteria were divided into three groups according to clinical stages. The glenohumeral distance （GHD）， posterior shoulder capsule thickness （PCT）， coracobrachial ligament thickness （CHL）， joint capsuleand supraspinatus muscleshear wave elastography （SWE）， blood flow in rotator interval （RI）of the affected shouder were measured by musculoskeletal ultrasound.The differences of shoulder ultrasonographic findings among the three groups were compared，and the correlation between ultrasonic findings and symptoms was observed.
Results
GHD， PCTand the positive ratio of RI blood flowwas significantly different in different stages， in which the GHD of stage 1 was the highest，and the PCT of stage 2 was the highest.There was a significant difference in the positive ratio of RI blood flow between stage 1 and stage 2，stage 1 and stage 3，but there was no significant difference between stage 2 and period 3.GHD and PCT on different stages were statistically significant.The larger the GHD value，the more inclined to clinical stage 1.The larger the PCT value，the more inclined to clinical stage 2.There was a positive correlation between flexion，abduction activity and GHD，and a negative correlation with PCT.There were significant differences in VAS activity and VAS sleep among different RI blood flow groups， and the scores of VAS activity and VAS sleep in RI bloodflow positive group were higher than those in negative group.
Conclusions
（1）Musculoskeletal ultrasound scan of RI blood flow，glenohumeral distance， posterior shoulder joint capsule thickness is helpful to judge the clinical stage of frozen shoulder.（2）The blood flow of RI，glenohumeral distance and the thickness of posterior articular capsule under musculoskeletal ultrasound are related to the clinical symptoms of frozen shoulder，which may be used as an intervention point to relieve the symptoms.
To analyze the surgical effect of volar single plate fixation with a simple volar approach in patients with unstable fractures of the dorsal displaced distal radius.
Methods
102 patients diagnosed with dorsal displaced distal radius fractures undergoing sole palmar approach and palmar single steel plate fixation from May 2020 to June 2022 were selected as research subjects.Patient general information，operation time，intraoperative blood loss，fracture healing time，length of hospital stay，palmar tilt angle，ulnar variance，radial height，wrist joint function，joint activity and complications were recorded，and the efficacy and influencing factors of the surgery were analyzed.
Results
The 102 patients underwent surgery（59.56±11.91）min，intraoperative bleeding（67.45±12.70）mL，fracture healing time（11.94±3.42）weeks，and hospitalization （7.55±1.35） days， and the differences of different joint mobility indexes before， 1 month and 3 months were statistically significant（P＜0.05）.The results of pairwise comparison showed that dorsal extension ROM，palm flexion ROM，anterior ROM，posterior ROM，ulnar angle and radial height were significantly increased，and the difference was statistically significant（P＜0.05）.At 1 month and 3 months after surgery，it was significant（P＜0.05）.The effect of the affected side and different AO fracture types on patient surgery，rehabilitation outcomes and prognosis was not significant， and there was no statistically significant difference in baseline，perioperative，and rehabilitation outcome indicators for patients with different affected sides（P＞0.05）.From the perspective of patient complications，two patients had incision infections，three had nerve or tendon injuries and traction，three patients had tendon adhesions，and three patients had wrist joint pain，with a total incidence rate of 11 cases.There was a significant correlation between preoperative palmar flexion ROM，postoperative 1-month palmar flexion ROM， postoperative 3-month palmar flexion ROM， postoperative 1-month supination ROM，postoperative 1-month ulnar variance，wrist joint function，and the occurrence of complications after surgery（P＜0.05）.
Conclusions
Sole palmar approach and palmar single steel plate fixation is an effective method for treating dorsal displaced distal radius fractures，and can be used for patients with different affected sides and differentAO fracture types，promoting the recovery of wrist joint function.
Exploring the short-term clinical efficacy of femoral locking plate combined with cortical bone plate in the treatment of bone defect induced femoral fractures and non union.
Methods
A retrospective analysis was conducted on 24 cases of postoperative femoral non union admitted to the bone trauma ward of our hospital from August 2016 to August 2021. 16 male patients and 8 female patients.
Results
The average age is 22-65 （41.54±13.46） years old. All patients were treated with femoral locking plates combined with allogeneic cortical bone plates. Harris and HSS scores are used to evaluate hip and knee joint function.Further evaluation includes surgical time and intraoperative blood loss.The average follow-up period for 24 patients was 12-16（13.58±1.32）months.All patients showed bone healing on imaging，and no limb deformities were observed；The average healing time is 4-13（6.38±2.06）months.In the last follow-up， the Harris score ranged from 69.2 to 96.6 （87.23±6.33）， with 10 cases being excellent， 11 cases being good， 2 cases being average， and 1 case being poor. The excellent and good rate was 87.5%； The HSS score ranges from 72 to 96（83.91±7.62），with 15 cases being excellent，7 cases being good，1 case being average，and 1 case being poor；The excellent rate is 91.7%.The average surgical time and intraoperative blood loss were 90-160（123.42±15.52）minutes and 340-600（438.75±78.87）mL，respectively.
Conclusions
The use of femoral locking steel plate combined with cortical bone plate for the treatment of bone defect induced femoral non union can achieve initial mechanical stability of the femur and long-term biological stability；Meanwhile， autologous iliac bone can effectively induce osteogenesis， and the combination of steel plates?and bone plates increases the stability of the femoral fracture end， achieving both mechanical and biological bone reconstruction，greatly increasing the probability of fracture healing.
The research on Unilateral biportal endoscopic （UBE） technology has received increasing attention.This study aims to investigate the global status and trends in this field.
Methods
The number of literature publications on UBE from January 1， 1965， to August 1， 2024， was retrieved from the Web of Science- Science Citation Index Expanded. Bibliometric methods were used to study and index the source data. For visual research，VOSviewer version 1.6.19 software was used for co-authorship， co-occurrence analysis， bibliographic coupling， and co-citation analysis， and the overall trend of UBE research in recent years was analyzed.
Results
A total of 700 articles were retrieved. The number of global research and publications on UBE has been increasing annually. South Korea has made the highest contribution to global research in the field of UBE， with the most citations and the highest h-index. Elsevier and Springer Nature have the highest number of publications. Rush University Rush Medical College， Rush University Medical Center， University Of California San Francisco School Of Medicine， and Rush University Medical Center Department Of Orthopedic Surgery are the four institutions that have made the greatest contributions.The research can be divided into three major categories：decompression，interbody fusion，and surgical procedures.Surgical procedures are predicted to be the next hot topic in this field.
Conclusions
According to the current global research trends，it is predicted that the number of UBE-related publications will continue to increase.Currently，South Korea is the largest contributor to research in this field.Most research efforts will focus on clinical research such as UBE surgical procedures，which may be the next hot spot in the UBE research field.
Vitamin D receptor （VDR） gene is one of the important candidate genes ， currently involved in the study of human bone mineral density，osteoporosis performance and development，which polymorphism affects the occurrence of diseases at the human cardiovascular， nervous， endocrine or other systems， and relates to the skeletal muscle strength and the occurrence of osteoporotic fracture， also affects the reaction of the supplement of vitamin D and calcium on body health. The expression of polymorphisms in the VDR gene is regulated by the intake of calcium and vitamin D and other genes，and its effects are influenced by race，sex，and age.
