Clinical Orthopaedics

Neutrophil-to-Lymphocyte Ratio and Monocyte-to-Lymphocyte Ratio as Early Predictive Biomarkers of Surgical Site Infection Following Open Extremity Fractures: A Retrospective Cohort Study

Wed, 12 Aug 2026 00:00:00 +0800

Objective:To investigate the association between postoperative neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) and the development of surgical site infection (SSI) in patients with open extremity fractures, and to evaluate their utility for early risk stratification and optimization of antimicrobial stewardship. Methods: We conducted a retrospective cohort study involving 115 adult patients with open extremity fractures admitted to Yuhang District First People’s Hospital between January 2023 and December 2025. Patients were categorized into an infection group (n = 22, 19.1%) and a non-infection group (n = 93) based on the occurrence of SSI within 30 days postoperatively, per Centers for Disease Control and Prevention (CDC) and AO Foundation criteria. Baseline demographics, Gustilo-Anderson classification, injury-to-surgery interval, preoperative and serial postoperative (days 1, 3, and 7) complete blood count parameters (used to compute NLR and MLR), operative details, and clinical outcomes were extracted from electronic medical records. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of SSI. Receiver operating characteristic (ROC) curve analysis was used to assess discriminatory performance, including area under the curve (AUC), optimal cut-off values (determined by Youden index), sensitivity, and specificity. Results: The infection group exhibited a significantly higher proportion of Gustilo-Anderson type III injuries (50.0% vs. 20.4%, P < 0.01) and longer injury-to-surgery intervals (>6 hours: 45.5% vs. 24.7%, P = 0.042). Median NLR [8.12 (5.85–11.45)] and MLR [1.08 (0.82–1.45)] measured during postoperative days 1–3 were markedly elevated relative to the non-infection group [4.25 (3.10–5.76) and 0.67 (0.51–0.89), respectively; both P < 0.001]. Multivariate logistic regression confirmed that postoperative NLR (adjusted odds ratio [aOR] = 1.26, 95% CI: 1.12–1.41, P < 0.001) and MLR (aOR = 2.08, 95% CI: 1.42–3.05, P < 0.001) were independent predictors of SSI. ROC analysis demonstrated that NLR achieved an AUC of 0.805 (cut-off: 6.72; sensitivity: 76.5%; specificity: 77.4%), MLR an AUC of 0.778 (cut-off: 0.90), and their combination yielded superior discrimination (AUC = 0.859; sensitivity: 82.1%; specificity: 80.6%). Patients in the infection group experienced significantly prolonged hospitalization [16.5 (11–22) vs. 8.5 (6–11) days, P < 0.001] and higher reoperation rates (31.8% vs. 5.4%, P < 0.01). Conclusion: Early postoperative elevation of NLR and MLR constitutes a simple, cost-effective, and clinically actionable inflammatory signature predictive of SSI following open extremity fractures. Serial monitoring of these ratios may facilitate timely risk stratification, guide intensified antimicrobial and wound management strategies, and support personalized postoperative surveillance.

Application Research of Multidisciplinary Team New Media Rehabilitation Training for Elderly Patients Undergoing Hip Replacement Surgery

Yongwei Song, Mingxing Zhao, Xingguo Wang, Huili Deng — Wed, 12 Aug 2026 14:41:57 +0800

Objective: To explore the application effect of multidisciplinary team combined with new media technology in the rehabilitation training of elderly patients undergoing hip arthroplasty. Dseign: A total of 100 patients with hip arthroplasty were divided into experimental group (Multi-disciplinary team cooperation, combined with new media technology) and the control group. The effectiveness of the model was evaluated by comparing the experimental group and the control group. Results: the results showed that the hip function, the incidence of complications and the recovery of balance function of the elderly patients who received the multidisciplinary team rehabilitation training were better than those of the control group. There were significant differences in hip function and balance function (p<0.05). Conclusion: The multidisciplinary team new media rehabilitation training has a positive significance for improving the rehabilitation effect of elderly patients undergoing hip arthroplasty.

CRISPR/Cas9 Editing of miR-146a Suppresses Immobilization-induced Muscle Atrophy

Wed, 12 Aug 2026 00:00:00 +0800

Immobilization-induced muscle wasting is notoriously hard to counter pharmacologically. We tested whether CRISPR-mediated knockdown of miR-146a could offer protection and asked what might explain such an effect. Four sgRNAs were designed against the mouse miR-146a precursor; the best performer (lentiCRISPR miR-146a-3#), which gave ~80% cleavage in T7EI assays, was packaged into lentivirus. Forty C57BL/6 mice were randomly assigned to receive either this editing construct or a control vector, then underwent sham surgery or hindlimb immobilization. Western blotting confirmed Cas9 expression, and qPCR verified miR-146a reduction. In immobilized mice, miR-146a rose markedly, accompanied by elevated Atrogin-1 and MuRF-1 mRNAs, reduced myofiber cross-sectional area, and diminished p-mTOR and p-Akt signals. By contrast, animals given the miR-146a-editing virus showed lower atrogene expression, larger fibers, and restored mTOR/Akt phosphorylation. These results suggest that CRISPR-based miR-146a ablation mitigates disuse atrophy, and this benefit appears to be linked to reactivation of the mTOR/Akt anabolic pathway.

Clinical Research and Application of Robot-Assisted Percutaneous Fixation of Atlas Fractures

Huaxiang Wang, Gang Wu, Long Zhang, Xuanxian Zhao, Lang Cheng, Tao Huang — Wed, 12 Aug 2026 17:22:18 +0800

Objective: To systematically evaluate the clinical efficacy, biomechanical characteristics, and functional preservation advantages of robot-assisted percutaneous single-segment posterior fixation for atlas fractures. Methods: A retrospective analysis included 43 patients with atlas fractures admitted to Dazhou Orthopedic Hospital and collaborating hospitals between January 2022 and December 2024. Patients were randomized into a robot-assisted group (n = 21) and a traditional open surgery group (n = 22). Primary outcomes included screw placement accuracy (Gertzbein-Robbins grade A/B defined as successful), intraoperative blood loss, hospital stay duration, postoperative pain scores (VAS), and cervical range of motion (CROM scale). The robotic group underwent percutaneous single-segment fixation using the Tuodao Orthopedic Spinal Robot (NS100) for 3D navigation planning and dynamic tracking, while the traditional group received open posterior atlantoaxial fusion. Results: The robotic group demonstrated significantly higher screw placement accuracy 97.6% (41/42 screws) vs. 84.1% (37/44 screws) (P < 0.01). The robotic group also showed superior outcomes in intraoperative blood loss (35 ± 12 mL vs. 180 ± 45 mL, P < 0.001), hospital stay (4.2 ± 1.3 days vs. 8.5 ± 11.1 days, P<0.01), and improvement in 1-week postoperative VAS scores . At 6-month follow-up, the robotic group preserved >80% cervical rotation function, whereas the traditional group exhibited complete loss of upper cervical mobility (P < 0.001). Conclusion: Robot-assisted technology enables submillimeter-level navigation (error <0.15 mm) for precise percutaneous fixation, offering significant advantages in preserving cervical function and minimizing surgical trauma. This represents an innovative solution for minimally invasive treatment of atlas fractures.

The Efficacy of Pelvic Intramedullary Nailing Combined with Sacroiliac Screws in the Treatment of Unstable Pelvic Fractures in Elderly Patients

Thu, 13 Aug 2026 10:34:44 +0800

Objective: The 1-year mortality rate of elderly pelvic fractures reaches 23%, and minimally invasive and effective fixation has become a research hotspot. Traditional plate and screw fixation carries risks of complications. This study compared the clinical efficacy of novel pelvic intramedullary nails combined with sacroiliac screws (IMN group) versus traditional plate-screw fixation combined with sacroiliac screws (plate group) in treating unstable pelvic fractures in elderly patients.
Methods: A retrospective analysis was performed on 32 elderly patients (over 60 years old) diagnosed with unstable pelvic fractures admitted to our hospital from 2020 to 2024. The IMN group (n=13) received anterior ring fixation with intramedullary nails and posterior ring fixation with sacroiliac screws; the plate group (n=19) underwent anterior ring reconstruction plate fixation combined with posterior sacroiliac screw fixation. All patients were followed up for at least 1 year (average follow-up duration: 21 months). Observation indicators included 1-year survival rate, Majeed functional score, operation time, intraoperative blood loss, fluoroscopy frequency, fracture healing time (Matta criteria), and postoperative complications. Results: Three patients died within 1 year after surgery (1 in the IMN group, 2 in the plate group), all due to pulmonary infection. Compared with the plate group, the IMN group showed significantly shorter operation time (73.2±13.4 min vs 106.2±22.5 min, P<0.05), drastically reduced intraoperative blood loss (52.4±32.2 ml vs 381.6±322.7 ml, P<0.05), and higher Majeed functional scores (83.5±8.6 vs 78.6±9.2). No statistically significant intergroup differences were observed in fracture healing time (average 2.8–2.9 months), fracture reduction quality (18 cases with anatomical/satisfactory reduction in each group), or 1-year survival rate. No complications occurred in the IMN group, while 2 patients in the plate group developed subcutaneous effusion that resolved after debridement. The IMN group required more intraoperative fluoroscopy (63.6±28.9 vs 35.7±12.2). Conclusion: For elderly unstable pelvic fractures, pelvic intramedullary nailing combined with sacroiliac screws achieves equivalent fracture reduction quality, bone healing and 1-year survival rates compared with traditional plate-screw fixation. Meanwhile, this minimally invasive technique significantly shortens operation duration, cuts intraoperative blood loss and lowers complication rates, delivering satisfactory clinical outcomes.

Clinical Efficacy of Mobile Moxibustion Cupping Combined with Electroacupuncture for Wind Cold-Dampness Type Adhesive Capsulitis

Thu, 13 Aug 2026 11:09:03 +0800

Objective: To investigate the clinical efficacy of mobile moxibustion cupping combined with electroacupuncture in patients with wind-cold-dampness scapulohumeral periarthritis. Methods: A total of 70 patients with wind-cold-dampness scapulohumeral periarthritis treated in the orthopedic department of our hospital from September 2023 to January 2024 were enrolled and divided into two groups via random number table, with 35 cases in each group. The control group received electroacupuncture monotherapy, while the observation group was treated with additional mobile moxibustion cupping. Shoulder VAS pain score, Constant-Murley shoulder function score, WHOQOL-BREF quality of life score and TCM syndrome score were compared before and after treatment; the total effective rate and adverse reactions were recorded. Results: No statistically significant intergroup differences were found in all baseline indicators before intervention (P＞0.05). After treatment, the observation group obtained higher Constant-Murley and quality of life scores, as well as lower VAS and TCM syndrome scores than the control group (P＜0.05). All indicators in both groups were significantly improved compared with baseline (P＜0.05). The total effective rate reached 94.29% in the observation group, which was remarkably higher than 77.14% of the control group (P＜0.05). No adverse reactions such as skin scald, acupuncture syncope or allergy occurred during treatment. Conclusion: Combined therapy of mobile moxibustion cupping and electroacupuncture can relieve shoulder pain, ameliorate shoulder mobility and wind-cold-dampness TCM symptoms, and improve patients’ daily function and quality of life. With superior efficacy and high safety, this combined regimen is worthy of clinical promotion.

Theoretical Reconstruction and Clinical Value Analysis of the Traditional Chinese Medicine Concept of “Nurturing Instead of Treating” in Orthopedic Rehabilitation

Jinbo Hu — Thu, 13 Aug 2026 11:17:05 +0800

Objective: Focusing on the scenario of holistic rehabilitation management for bone injuries, this study aims to explore the practical application value of the Traditional Chinese Medicine (TCM) concept of “nourishment instead of treatment” and to investigate the implementation pathways for integrating traditional TCM therapies with modern rehabilitation techniques. Methods: By integrating historical TCM literature on bone injuries and combining it with practical clinical experience accumulated from daily diagnosis and treatment, this study outlines the intervention logic of this nourishment approach during different healing stages of fractures. It also conducts a multidisciplinary comparative analysis based on existing modern research findings in Enhanced Recovery After Surgery (ERAS) and bone tissue engineering. Results: A comprehensive review of ancient texts and clinical case observations reveals that “nourishment instead of treatment” does not simply entail passive rest and immobilization but rather represents an active rehabilitation model that synergistically combines the regulation of qi and blood, tonification of the liver and kidneys, and emotional counseling. This model can stimulate the body’s self-healing capacity, reduce the incidence of postoperative complications, and improve long-term limb mobility in patients, aligning closely with modern holistic medical approaches. Conclusion: As a practical extension of the “preventive treatment of disease” theory in the field of bone injuries, this concept provides a reference for constructing integrated TCM-Western medicine rehabilitation protocols for bone injuries. It holds significant practical value for both clinical promotion and subsequent evidence-based medical research.

Global, Regional and National Burdens of Gout in People Aged 20 - 54 Years from 1990 to 2021: An Analysis Based on the 2021 Global Burden of Disease Study

Hongqiu Li, Qingzhu Wu, A Liang, Zhonghai Zhao, Nan Jiang, Feng Yang — Thu, 13 Aug 2026 15:55:41 +0800

Objective: To describe the epidemiology of gout in people aged 20 - 54 years at global, regional, and national levels using data from the 2021 GBD study, and evaluate the impact of BMI and renal dysfunction on the burden of gout in this age group. Methods: Incidence, prevalence, and DALYs of gout were extracted from GBD 2021. Descriptive analysis was performed at global, regional, and national levels. Trends were analyzed using estimated annual percentage change (EAPC) and joinpoint regression analysis. Proportional attributable fractions of risk factors (high BMI and impaired kidney function) were calculated. Results: Globally, from 1990 to 2021, the rates of incidence, prevalence, and DALYs of gout in people aged 20 - 54 years increased. Regionally, the United States, China, and East Asia had significant increases. By SDI quintiles, the highest increases in prevalence and DALYs were in the High SDI quintile, and in incidence in the High-middle SDI quintile. Males had higher values than females. The fastest increasing periods for incidence (1996 - 2004), prevalence (1996 - 2004), and DALYs (1996 - 2003) were identified. Globally in 2021, high BMI and impaired kidney function accounted for certain proportions of DALYs, with regional and national variations. Conclusion: The burden of gout in people aged 20 - 54 years has increased significantly worldwide, with differences across various factors. Prevention strategies, improved management, and further research on gout in this age group are crucial, especially regarding its relationship with high BMI and impaired renal function.