Construction and validation of a nomogram for blood transfusion after open reduction and internal fixation (ORIF) of proximal humeral fractures in the elderly: a cross-sectional study.

PURPOSE: Few studies have focused on the risk factors leading to postoperative blood transfusion after open reduction and internal fixation (ORIF) of proximal humeral fractures (PHFs) in the elderly. Therefore, we designed this study to explore potential risk factors of blood transfusion after ORIF for PHFs. We have also established a nomogram model to integrate and quantify our research results and give feedback. METHODS: In this study, we retrospectively analyzed the clinical data of elderly PHF patients undergoing ORIF from January 2020 to December 2021. We have established a multivariate regression model and nomograph. The prediction performance and consistency of the model were evaluated by the consistency coefficient and calibration curve, respectively. RESULTS: 162 patients met our inclusion criteria and were included in the final study. The following factors are related to the increased risk of transfusion after ORIF: time to surgery, fibrinogen levels, intraoperative blood loss, and surgical duration. CONCLUSIONS: Our patient-specific transfusion risk calculator uses a robust multivariable model to predict transfusion risk.The resulting nomogram can be used as a screening tool to identify patients with high transfusion risk and provide necessary interventions for these patients (such as preoperative red blood cell mobilization, intraoperative autologous blood transfusion, etc.).

Preparation of CTCNFs/Co9S8 hybrid nanofibers with enhanced microwave absorption performance.

A three-step synthesis strategy has been applied to the preparation of Co9S8-loaded tubular carbon nanofibers (CTCNFs/Co9S8 hybrid nanofibers) with excellent microwave absorbing ability. Firstly, tubular polymer nanofibers (TPNFs) are synthesized using the confined self-condensation method that we developed. Afterwards, TPNFs are converted into surface carboxylated tubular carbon nanofibers (CTCNFs) by carbonization and subsequent acidification processes. Finally, a hydrothermal method is used for the controllable growth of Co9S8 nanoparticles on CTCNFs, and a series of CTCNFs/Co9S8 hybrid nanofibers with different Co9S8 loading are obtained. The prepared CTCNFs/Co9S8 hybrid nanofibers possess abundant effective interface and defect dipoles, which will lead to stronger polarization. Using the strategy of enhancing dielectric loss, the microwave dissipation ability of CTCNFs/Co9S8 hybrid nanofibers has been significantly improved, showing an excellent low-frequency absorbing performance with a minimum reflection loss of -46.81 dB@5.3 GHz. In addition, the composition, structure and properties of nanofibers have been systematically characterized. The Co9S8 loading on CTCNFs and the filler content of CTCNFs/Co9S8 hybrid nanofibers in matrix are studied and optimized. The microwave attenuation mechanism is also explained.

Development of a Nomogram for Predicting Blood Transfusion Risk After Hemiarthroplasty for Femoral Neck Fractures in Elderly Patients.

BACKGROUND The aim of this study was to determine the risk factors and develop a nomogram for blood transfusions after hemiarthroplasty (HA) in patients with femoral neck fractures (FNFs). MATERIAL AND METHODS We performed a retrospective study including consecutive elderly FNF patients treated by HA between January 2015 and December 2017. Perioperative information was obtained retrospectively, uni- and multivariate regression analyses were conducted to determine risk factors for blood transfusion, and a nomogram model was constructed to predict the risk of blood transfusion. The predictive performance and consistency of the model were evaluated by the consistency coefficient (C-index) and the calibration curve, respectively. RESULTS Of 178 patients, 151 were finally enrolled in the study and 21 received blood transfusion. Binary logistic regression analysis showed the low preoperative hemoglobin (Hb), longer time to surgery, general anesthesia, longer surgery duration, and higher intraoperative blood loss (IBL) were risk factors for blood transfusion. The accuracy of the contour map for predicting transfusion risk was 0.940. CONCLUSIONS We found a correlation between blood transfusion requirement and low preoperative Hb, longer time to surgery, general anesthesia, longer surgery duration, and higher IBL, and we then developed a nomogram. Our nomogram model can be used to evaluate the transfusion risk for FNF patients after HA, and provides better guidance for clinicians to intervene perioperatively, so as to reduce the incidence of blood transfusion.

Comparison between minimally invasive deltoid-split and extended deltoid-split approach for proximal humeral fractures: a case-control study.

BACKGROUND: With the rapid aging of the population, the incidence of proximal humeral fracture (PHF) has increased. However, the optimal method for open reduction and internal fixation (ORIF) remains controversial. METHODS: We performed a retrospective analysis of patients with PHF who underwent locking plate internal fixation at our institution from January 2016 to December 2018. Patients were divided into two groups based on the surgical approach used: an expanded deltoid-split approach group (ORIF group) and minimally invasive deltoid-split approach group (minimally invasive percutaneous plate osteosynthesis, [MIPPO] group). The groups were compared in terms of demographic and perioperative characteristics, and clinical outcomes. RESULTS: A total of 115 cases of PHF were included in our study, of which 64 cases were treated using the minimally invasive deltoid-split approach and 51 using the extended deltoid-split approach. Fluoroscopy was performed significantly less frequently in the ORIF group and the surgical duration was shorter. However, the postoperative visual analogue scale (VAS) pain score and duration of postoperative hospital stay were significantly higher compared to the MIPPO group. Moreover, secondary loss was significantly less extensive in the ORIF group compared to the MIPPO group, while there was no significant group difference in fracture healing time, Constant shoulder score, or complications at the last follow-up visit. CONCLUSIONS: The clinical outcomes associated with both the minimally invasive and extended deltoid-split approaches were satisfactory. The data presented here suggest that the extended deltoid-split approach was superior to the minimally invasive deltoid-split approach in terms of operational time, fluoroscopy, and secondary loss of reduction, while the minimally invasive approach was superior in terms of postoperative pain and hospital stay. Accordingly, neither procedure can be considered definitively superior; the optimal surgical procedure for PHF can only be determined after full consideration of the situation and requirements of the individual patient.

Surface Microstructure Regulation of Porous Polymer Microspheres by Volume Contraction of Phase Separation Process in Traditional Suspension Polymerization System.

In the present work, the suspension polymerization method is used for the preparation of porous polymer microspheres with different surface morphology, and the preparation mechanism is systematically expounded. The morphology results show that the smooth, convex, and wrinkled microspheres could be controlled by adjusting the ratio of monomer to porogens. The micelles forming the framework support the "Eggshell," and its size and shape directly affect the morphology of "Eggshell." The addition of monomers (GMA), whose polymer has low glass transition temperature (Tg ), is important for the formation of wrinkled morphology. The amount of toluene and polydimethylsiloxane also affects the surface morphology of microspheres. In addition, the effect of polydimethylsiloxane is also more significant. The preparation process of the wrinkled P(GMA-St-EGDA) microspheres with abundant epoxy groups can be amplified. The morphology of the material prepared in the 100 L reactor is well maintained, and the yield in the size range of 80-160 µm is more than 80%. The surface wrinkled porous polymer microspheres have potential applications in the fields of enzyme carrier, separation and purification, and light scattering.

Serial changes in the head-shaft angle of proximal humeral fractures treated by placing locking plates: a retrospective study.

BACKGROUND: Although the proximal humeral fractures (PHFs) treated with locking plate have been well applied, there are few studies concerning on the serial HSA changes after locking plate placement. The purpose of this retrospective study was to explored the clinical significance of serial HSA changes after surgery. METHODS: We retrospectively analyzed the clinical data of 122 patients between January 2012 to December 2016 in our hospital. The serial change of the HSA and Neer's score of 122 patients were recorded and analyzed. Then, we evaluated the HSA changes affected functional recovery in conjunction with medial support (MS). Moreover, multivariable linear regression analysis was performed to identify any potential confounding factors that may influence functional recovery. RESULTS: Of 146 patients, 122 (50 males and 72 females) patients were finally enrolled in our study. Our preliminary data suggested that the most decrease of HSA occurred in the period of 1 to 3 months (p < 0.001) postoperatively, and functional recovery was significantly related with the change of HSA (R2 = 0.647, p < 0.001). The presence of MS plays an important role in maintaining postoperative HSA and restoring function. Moreover, Neer type 4 fracture, the difference between the postoperative HSA (on the injured side) and that of the uninjured side (the ΔHSA), and the HSA change to the end of follow-up were all significantly associated with functional recovery. CONCLUSIONS: Serial HSA changes were evident in PHF patients in whom locking plates had been inserted; it is essential to maintain reduction for 1-3 months postoperatively. MS is important in this context and surgeons must maximally restore MS. Furthermore, the functional outcome tended to improve when the HSA of the injured side was restored to a value close to that of the uninjured side.

Preparation of core-shell C@TiO2 composite microspheres with wrinkled morphology and its microwave absorption.

In this work, we successfully synthesize the core-shell structure carbon@titanium dioxide (C@TiO2) composite microspheres with wrinkled surface through a three-step method and build up the relationship between the TiO2 layer thickness and the microwave absorption property. The absorbing mechanism of the novel microsphere is revealed. Interface polymerization is applied for preparation of wrinkled poly glycidyl methacrylate/divinylbenzene polymer microspheres (PGMA/PDVB); Then, TiO2 layer is controllably coated on the surface of PGMA/PDVB microspheres by hydrolysis of tetrabutyl titanate (TBT); C@TiO2 composite microspheres are obtained by vacuum carbonization with PGMA/PDVB@TiO2 microspheres as the precursor. TiO2 layer thickness on the surface of C@TiO2 composite microspheres can be effectively adjusted by controlling the amount of TBT. When the amount of TBT is 0.75 mL, C@TiO2 composite microspheres exhibit the outstanding electromagnetic loss performance. The maximum reflection loss value (RLmax) reaches -49.21 dB at the thickness of 2 mm, corresponding effective absorption bandwidth is 5.27 GHz. The maximum effective absorption bandwidth is 5.5 GHz at 2.2 mm. The results show that the introduction of TiO2 can regulate electromagnetic parameters and enhance interface polarization ability. Meanwhile, the surface wrinkle structure offers more opportunities for multiple reflections of electromagnetic and introduces a large number of defective skeleton structure. The synergy of multiple advantages makes the absorbing performance of C@TiO2 composite microspheres significantly improved. This work plays a guiding role for the composition and the structure optimization of existing microwave absorbers.

Development of a Nomogram to Predict Postoperative Transfusion in the Elderly After Intramedullary Nail Fixation of Femoral Intertrochanteric Fractures.

PURPOSE: The aim of our study was to explore the risk factors related to blood transfusion after intramedullary nail fixation of elderly femoral intertrochanteric fracture (FTF) and establish a nomogram prediction model. PATIENTS AND METHODS: We conducted a retrospective study including elderly FTF patients treated by intramedullary nail between January 2017 and December 2019. Perioperative information was obtained retrospectively, uni- and multivariate regression analyses were performed to determine risk factors for blood transfusion. A nomogram model was established to predict the risk of blood transfusion, and consistency coefficient (C-index) and correction curve were used to evaluate the prediction performance and consistency of the model. RESULTS: Of 148 patients, 119 were finally enrolled in the study and and 46 patients (38.7%) received a blood transfusion after the operation. Logistic regression analysis the female, lower preoperative Hb, ASA score >2, general anesthesia, and higher intraoperative blood loss were independently associated with the blood transfusion. The accuracy of the contour map for predicting transfusion risk was 0.910. CONCLUSION: These risk factors are shown on the nomogram and verified. Through the assessment of the risk of blood transfusion and the intervention of modifiable risk factors, we may be able to reduce the blood transfusion rate to a certain extent, so as to further guarantee the safety of the elderly patients during the perioperative period.

A nomogram for predicting reduction loss risk after locking plate fixation for proximal humeral fractures.

PURPOSE: The purpose of our study was to determine the risk factors for reduction loss in patients with proximal humeral fractures after locking plate fixation and establish a nomogram prediction model. METHODS: We retrospectively analyzed the clinical data of proximal humeral fractures patients who had been surgically treated for locking plate in our institution from January 2016 to December 2018. Perioperative information was obtained through the electronic medial record system, univariate and multivariate analyzes were performed to determine the risk factors of reduction loss, and a nomogram model was constructed to predict the risk of reduction loss. The predictive performance and consistency of the model were evaluated by the consistency coefficient (C-index) and the calibration curve, respectively. RESULTS: 115 patients were finally enrolled in our study. Multivariate analysis results showed that age, fracture classification, medial comminution, and calcar screw status were independent risk factors for reduction loss. The accuracy of the contour map for predicting transfusion risk was 0.944. CONCLUSION: We found a correlation between reduction loss and age, fracture classification, medial comminution, and calcar screw status after locking plate fixation for proximal humeral fractures patients. Our nomogram is helpful for clinicians to identify high-risk patients, early intervention and reduce the incidence of reduction loss.

Development of surface imprinted heterogeneous nitrogen-doped magnetic carbon nanotubes as promising materials for protein separation and purification.

To promote the development of molecular imprinting technique in the separation and analysis of protein, novel bovine serum albumin (BSA) surface imprinted nitrogen-doped magnetic carbon nanotubes (N-MCNTs@MIPs) are developed by this paper. The imprinted materials are prepared by depositing polydopamine (PDA) on the surface of nitrogen-doped magnetic carbon nanotubes (N-MCNTs). N-MCNTs prepared by high temperature pyrolysis and chemical vapor deposition exhibit high specific surface area, positive hydrophilicity, abundant nitrogen functional groups and excellent magnetic properties. These characteristics are conducive to the increase of effective binding sites, the smooth development of the protein imprinting process in the aqueous phase, the improvement of the binding capacity and the simplification of the separation process. The amount of BSA adsorbing on the N-MCNTs@MIPs can reach 150.86 mg/g within 90 min. The imprinting factor (IF) is 1.43. The results of competitive adsorption and separation of fetal bovine serum showed that N-MCNTs@MIPs can specifically recognize BSA. The excellent reusability and separation ability for real sample prove that N-MCNTs@MIPs have the potential to be applied to the separation and purification of proteins in complex biological samples.

Hidden blood loss and the influential factors after intramedullary nail fixation of extra-articular tibial fractures - a retrospective cohort study.

PURPOSE: There were few reports in the literature about the hidden blood loss (HBL) after intramedullary nail (IMN) fixation for extra-articular tibial fractures. Our purpose was to evaluate the amount of hidden blood loss after intramedullary nail fixation for extra-articular tibial fractures, meanwhile, identified the influential factors causing HBL. METHODS: From January 2015 to December 2017, 122 consecutive extra-articular tibial fracture patients fixed with IMN and 96 met all inclusion criteria for the chosen analysis. Preoperative hematocrit (Hct) levels on admission and postoperative Hct levels on the third day after surgery to calculate the amount of HBL. RESULTS: The mean HBL was 473.29 ± 102.75 ml after IMN fixation of extra-articular tibial fractures, the multiple regression analysis showed gender, surgical duration, and the diameter of the medullary cavity at the narrowest part of the tibia had an independent influence on HBL. CONCLUSIONS: A significant amount of postoperative HBL has occurred after IMN fixation of extra-articular tibial fractures. Surgeons should be aware that more HBL can be developed in patients who have male sex, small medullary cavity, and long-time surgical duration. HBL deserves attention to ensure patients' safety in the perioperative period of IMN fixation for extra-articular tibial fractures.

Novel synthetic method for magnetic sulphonated tubular trap for efficient mercury removal from wastewater.

Highly efficient Hg(II) adsorption from wastewater remains a crucial task for human health and environment protection. In present work, a simple method was used to develop a carbon-based mercury magnetic "trap" (magnetic sulphonated tubular trap, MSTT) as proved by increasing surface area and wide diameter porous magnetic trap with a high density of strong Hg(II) chelating groups. Various parameters including the initial concentration of Hg(II), pH, contact time and adsorbent dosage are analyzed. The adsorption results of MSTT and sulphonated tubular trap (STT) are closely fitted with the Langmuir adsorption isotherm with maximum adsorption capacities were 970.87 (mg/g) and 952.38 (mg/g). It reveals 99.9 ± 0.5% Hg(II) adsorption occurs at pH 6.8, which is close to neutral pH. These traps can efficiently reduce Hg(II) from 10 (mg/L) to 0.3 (µg/L) in a short time of 10 min. This level is lower than the permissible limit for the drinking water. The calculated thermodynamic parameters ΔH°, ΔG°, and ΔS° indicate that the adsorption of Hg(II) onto MSTT and STT are endothermic, spontaneous and random adsorption process. The regeneration of adsorbents and high Hg(II) adsorption efficiencies in the presence of other metal ions will endow the prepared MSTT and STT with a promise for efficient Hg(II) adsorption for environmental remediation.

Fabrication of magnetic tubular fiber with multi-layer heterostructure and its microwave absorbing properties.

A new type of microwave absorbing material (TCF@Fe3O4@NCLs) with multi-layer heterostructure is designed and fabricated via a one-step pyrolysis process of the precursor (PF@Fe3O4@PDA). PF@Fe3O4@PDA is prepared by the technology of confined self-polycondensation, solvothermal method coupled with polymerization of dopamine (DA). The as-obtained material has the structure of tubular carbon nanofibers (TCF) embedded with Fe3O4 nanoparticles, dispersed Fe3O4 nanoparticles, and nitrogen-doped carbon layers (NCLs) from inside to outside. Notably, tubular carbon nanofibers provide the major dielectric loss. Fe3O4 nanoparticles significantly improve the microwave absorption ability at low frequencies and provide appropriate magnetic loss. NCLs improve the conductivity and facilitate the generation of multiple polarization effects, resulting in enhanced dielectric loss. The absorption mechanism is further elucidated. Based on the synergistic effect of double dielectric/magnetic loss composite materials, the interface introduced by multi-layer heterostructure, and conductive networks, TCF@Fe3O4@NCLs exhibits excellent reflection loss (RL) of -43.6 dB and effective absorption bandwidth (EBA) of 4.6 GHz (8.2-12.8 GHz) with a loading of 10%. The results demonstrate potentially promising prospects of TCF@Fe3O4@NCLs as new material candidate for microwave absorption.

New method for hydrogel synthesis from diphenylcarbazide chitosan for selective copper removal.

In this work, a simple method was developed for hydrogel preparation from 1,5-Diphenylcarbazide (DPC) and chitosan (CS) through Diazotization reaction of CS as a selective adsorbent (DPCCS) for Cu(II) ions. CS was treated with sodium nitrate and subsequent crosslinking reaction with DPC for the preparation of DPCCS. Different techniques were used for characterization of DPCCS. Various parameters such as, temperature, pH, and concentration of Cu(II) were used for adsorption studies. Kinetics of Cu(II) ion on DPCCS follows the Pseudo second order and equilibrium of adsorption occurs in short time. The equilibrium data was best fitted with the Langmuir isotherm and the maximum adsorption capacity of DPCCS was 185.505 mg g-1. Thermodynamic parameters ΔG°, ΔH° and ΔS° suggested that the adsorption of Cu(II) ion on the surfaces of DPCCS was spontaneous, endothermic and randomness of Cu(II) ion in the solution was enhanced respectively. Regeneration of DPCCS and Cu(II) ion recovery were studied up to five cycles without the lost of the adsorption capacity.

Indirect 3D printing technology for the fabrication of customised ß-TCP/chitosan scaffold with the shape of rabbit radial head-an in vitro study.

BACKGROUND: With the development of indirect three-dimensional (3D) printing technology, it is possible to customise individual scaffolds to be used in bone transplantation and regeneration. In addition, materials previously limited to the 3D printing (3DP) process due to their own characteristics can also be used well in indirect 3DP. In this study, customised ß-TCP/chitosan scaffolds with the shape of rabbit radial head were produced by indirect 3D printing technology. METHODS: Swelling ability, porosity, mechanical characterisation, and degradation rate analysis were performed, and in vitro studies were also implemented to evaluate the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells (MSCs) on the scaffolds. CCK8 cell proliferation assay kit and alkaline phosphatase (ALP) staining solution were used to study cell proliferation and early ALP content at the scaffold surface. Moreover, the osteogenic differentiation of MSCs on scaffolds was also evaluated through the scanning electron microscopy analysis. RESULTS: ß-TCP/chitosan scaffold has good performance and degradation rate, and in vitro cell experiments also confirm that the scaffold has adequate cytocompatibility and bioactivity. CONCLUSION: This study provides a promising new strategy for the design of customised scaffolds for the repair of complex damaged tissues.

Comparison of plate and intramedullary nail fixation of extra-articular tibial fractures: A retrospective study exploring hidden blood loss.

PURPOSE: To explore the hidden blood loss (HBL) in treatment of extra-articular tibial fractures with plate and intramedullary nail fixation. METHODS: We conducted a retrospective study including 209 consecutive patients treated by plate (Group LCP) or intramedullary nail fixation (Group IMN) for extra-articular tibial fractures between January 2015 to December 2017. Demographics, intraoperative data, perioperative laboratory values, transfusion rate, and early complications were collected and analyzed. RESULTS: Of 209 patients, 96 patients fixed with IMN and 113 fixed with LCP. The average HBL was 272.71 ± 57.88 ml in Group LCP and 507.66 ± 109.81 ml in Group IMN, and there was statistical difference in the HBL between two groups (p < 0.001). The Hb and Hct loss, surgical duration, and postoperative number of anemic patients in Group IMN were significantly higher than in Group LCP (p < 0.001), and IMN fixation has a significantly higher rate of transfusion (p = 0.027), whereas patients in group IMN has significantly less VBL (p < 0.001), shorter postoperative hospital stay (p < 0.001), and less superficial infection (p = 0.014). CONCLUSIONS: There was a significant amount of hidden blood loss after reamed intramedullary nail fixation for extra-articular tibial fractures, which was much higher than expected. In view of the morbidity of acute anaemia and transfusion, we suggest that for patients who suffer from extra-articular tibial fractures with multiple injuries, or those with low haemoglobin preoperatively, plates might be more suitable than nail fixation.

Oxidized Regenerated Cellulose Can Reduce Hidden Blood Loss after Total Hip Arthroplasty: A Retrospective Study.

Background: There is a large amount of hidden blood loss (HBL) after total hip arthroplasty (THA), but the effective and safe methods to reduce HBL are still controversial. Methods: Sixty-nine consecutive patients who underwent THA in our hospital from January 2015 to December 2015 were analyzed retrospectively. The patients were divided into two groups, Group A (THA without oxidized regenerated cellulose) and Group B (THA with oxidized regenerated cellulose). Demographics, perioperative laboratory values, intraoperative data, blood loss, transfusion rate, transfusion reactions, and surgical complications were collected and analyzed. Results: A total of 37 (54%) patients used oxidized regenerated cellulose (ORC) in operation. The total blood loss (TBL), postoperative blood loss (PBL), hemoglobin (Hb) loss, and hidden blood loss (HBL) in group B were significantly lower than in group A. Conclusions: The use of ORC to fill the bone surface and soft tissue gap before incision closure can effectively reduce HBL and may be a potential treatment for blood prevention after THA.

Preparation of surface protein imprinted thermosensitive polymer monolithic column and its specific adsorption for BSA.

In this work, a novel thermosensitive surface protein imprinted polymer monolithic column (TsIPMC) was synthesized by combining high internal phase emulsion with 1,1-diphenylethene (DPE) controlled polymerization. Innovatively, DPE and acrylic acid (AA) monomers were introduced in high internal oil and water phases respectively. The research showed that DPE could not only initiate the polymerization of monomers, but also improve the pore performance of monolithic columns. The elution efficiency of template or target protein could be significantly improved by the thermoresponse characteristics of TsIPMC. The effects of DPE and AA on adsorption capacity and imprinting factor (IF) were studied. The optimization results presented that the optimal addition amounts were 55 mg and 50 mg. Under such conditions, the IF of as-prepared TsIPMC was 1.61 and the saturated adsorption capacity was 66 mg/mL. The influences of the flow rate and target protein concentration on the adsorption equilibrium time and effluent volume were revealed. TsIPMC showed higher selectivity for different competing proteins. The reuse stability result showed that the adsorption of TsIPMC to BSA decreased by 3.69% after 12 times of reuse, and the IF remained basically unchanged. TsIPMC would demonstrate the potential applications in the field of protein purification and separation.

Modified pedicle screw placement at the fracture level for treatment of thoracolumbar burst fractures: a study protocol of a randomised controlled trial.

INTRODUCTION: The optimal treatment for burst fractures of the thoracolumbar spine is controversial. The addition of screws in the fractured segment has been shown to improve construct stiffness, but can aggravate the trauma to the fractured vertebra. Therefore, optimised placement of two pedicle screws at the fracture level is required for the treatment of thoracolumbar burst fractures. This randomised controlled study is the first to examine the efficacy of diverse orders of pedicle screw placement and will provide recommendations for the treatment of patients with thoracolumbar burst fractures. METHODS AND ANALYSIS: A randomised controlled trial with blinding of patients and the statistician, but not the clinicians and researchers, will be conducted. A total of 70 patients with single AO type A3 or A4 thoracolumbar fractures who are candidates for application of short-segment pedicle screws at the fractured vertebral level will be allocated randomly to the distraction-screw and screw-distraction groups at a ratio of 1:1. The primary clinical outcome measures will be the percentage loss of vertebral body height, screw depth in the injured vertebrae and kyphosis (Cobb angle). Secondary clinical outcome measures will be complications, Visual Analogue Scale scores for back and leg pain, neurological function, operation time, intraoperative blood loss, Japanese Orthopaedic Association score and Oswestry Disability Index. These parameters will be evaluated preoperatively, intraoperatively, on postoperative day 3, and at 1, 3, 6, 12 and 24 months postoperatively. ETHICS AND DISSEMINATION: The Institutional Review Board of the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University have reviewed and approved this study (batch: LCKY2018-05). The results will be presented in peer-reviewed journals and at an international spine-related meeting after completion of the study. TRIAL REGISTRATION NUMBER: NCT03384368; Pre-results.

Arthroscopic-assisted balloon tibioplasty versus open reduction internal fixation (ORIF) for treatment of Schatzker II-IV tibial plateau fractures: study protocol of a randomised controlled trial.

INTRODUCTION: Arthroscopic-assisted balloon tibioplasty is an emerging technology that has shown advantages in recovering depression of the articular surface. However, studies evaluating clinical outcomes between arthroscopic-assisted balloon tibioplasty and traditional open reduction internal fixation (ORIF) are sparse. This is the first randomised study to compare arthroscopic-assisted balloon tibioplasty with ORIF, and will provide guidance for treating patients with Schatzker types II, III and IV with depression of the medial tibial plateau only. METHODS AND ANALYSIS: A blinded randomised controlled trial will be conducted and a total of 80 participants will be randomly divided into either the arthroscopic-assisted balloon tibioplasty group or the ORIF group, at a ratio of 1:1. The primary clinical outcome measures are the knee functional scores, Rasmussen radiological evaluation scores and the quality of reduction based on postoperative CT scan. Secondary clinical outcome measures are intraoperative blood loss, surgical duration, visual analogue scale score after surgery, hospital duration after surgery, complications and 36-Item Short-Form Health Survey score. ETHICS AND DISSEMINATION: This study has been reviewed and approved by the Institutional Review Board of the Second Affiliated Hospital of Wenzhou Medical University (batch: 2017-12). The results will be presented in peer-reviewed journals after completion of the study. TRIAL REGISTRATION NUMBER: NCT03327337, Pre-results.