Objective: The incidence of hip fracture in the elderly is increasing. Robot navigation technology has the advantages of minimally invasive and accurate. To explore the difference between the clinical effects of proximal femoral anti-rotation intramedullary nail (PFNA) assisted by robot navigation in the treatment of femoral intertrochanteric fracture and traditional PFNA in the treatment of femoral intertrochanteric fracture in the elderly; analyze the advantages and feasibility of PFNA assisted by robot navigation in the treatment of femoral intertrochanteric fracture in the elderly. Patients and Methods: From February 2021 to October 2022, the elderly (> 65 years old) with femoral intertrochanteric fracture underwent surgery in our center. Divided the patients included in the study into 2 groups based on the surgical method. The surgical method of robot group was PFNA fixation assisted by robot navigation, while the surgical method of traditional group was classic PFNA fixation, Baseline data (general condition, Evans classification, time from injury to operation, preoperative hemoglobin) and observation indicators (intraoperative bleeding, operation time, the length of incision for mail nail insertion, postoperative hemoglobin drop, blood transfusion rate and the Harris score of hip joint 1 year after operation) of the two groups were collected to compare whether there were differences between the two groups. Results: There was no statistical difference in baseline data between the two groups (P> 0.05). The intraoperative bleeding in the robot group was 68.17± 10.66 mL, the intraoperative bleeding in the traditional group was 174± 8.11mL (P< 0.001). The operation time in the robot group was 68.81 ± 6.89 min, in the traditional group, the operation time was 76.94 ± 8.18 min (P< 0.001). The length of incision for mail nail insertion in the robot group was 3.53 ± 0.63 cm, the length of the incision for mail nail insertion in the traditional group was 4.23 ± 0.71 cm (P< 0.001). 5 patients (13.9%) in the robot group received blood transfusion treatment, and 13 patients (36.1%) in the traditional group received blood transfusion treatment (P=0.029). The hemoglobin in the robot group decreased by 14.81 ± 3.27 g/l after operation compared with that before operation, while that in the traditional group decreased by 16.69 ± 3.32 g/l (P=0.018). The Harris score of the hip joint of the affected limb in the robot group was excellent in 25 cases, good in 8 cases and poor in 3 cases one year after the operation; In the traditional group, Harris scores were excellent in 18 cases, good in 11 cases and poor in 7 cases (P=0.021). Conclusion: PFNA fixation of femoral intertrochanteric fracture with robot navigation assistance has the advantages of minimally invasive and accurate, shorter operation time, less bleeding and lower blood transfusion rate than traditional surgical methods, and has certain advantages in reducing postoperative complications of elderly patients.

Objective: Spiral fracture of tibia combined with posterior malleolar fracture (PMF) is a special and regular injury. There is no uniform fixation method for PMF in this kind of injury. Intramedullary nail is the first choice for the treatment of tibial spiral fracture. We proposed a minimally invasive percutaneous screw combined with intramedullary nail technology to fix the PMF in the tibial spiral fracture. This study aims to explore the effectiveness and advantages of this technology. Materials and methods: From January 2017 to February 2020, 116 cases of spiral fracture of tibia combined with PMF who were operated in our hospital were divided into Fixation Group (FG) and No Fixation Group (NG) according to whether PMF was fixed. After minimally invasive percutaneous screw fixation of ankle fracture in FG patients, the tibial intramedullary nail was inserted to fix the fracture. Collected the operation and postoperative recovery of the two groups of patients, including the operation time, intraoperative blood loss, AOFAS score, VAS score and dorsiflexion restriction of ankle joint at the last follow-up, and compared whether there is any difference between the two groups of patients. Results: The fracture of both groups healed.2 patients in NG had secondary displacement of PMF during operation, and the fracture finally healed after fixation. There were statistical differences between the two groups in terms of operation time, AOFAS score and weight bearing time. The operation time of FG was 67.9±11.2 min, and that of NG was 60.8±9.4 min; The weight bearing time of FG was 57.35±34.72 days, and that of NG was 69.17±21.43 days; The AOFAS score of FG was 92.50±3.46, and that of NG was 91.00±4.16. There were no significant difference in blood loss, VAS and dorsiflexion restriction of ankle joint between the two groups. The blood loss of FG was 66.8±12.3 ml, the blood loss of NG was 65.6±11.7 ml, the VAS score of FG was 1.37±0.47, the VAS score of NG was 1.43±0.51, the dorsiflexion restriction of FG was 5.8±4.1; the NG was 6.1±5.7. Conclusion: For the injury of tibial spiral fracture combined with PMF, our fixation technology can achieve minimally invasive fixation of PMF with percutaneous screws on the basis of intramedullary nail fixation of tibial fracture, promoting early functional exercise of ankle joint and early weight bearing of patients. This fixation technology is also characterized by simple and fast operation.

The purpose of this study was to evaluate the advantages of robot navigation system-assisted intramedullary nail treatment for humeral shaft fractures and compare it’s efficacy with that of traditional surgical intramedullary nail treatment. This was a retrospective analysis of patients with humeral shaft fractures who received intramedullary nail treatment at our centre from March 2020 to September 2022. The analysis was divided into a robot group and a traditional surgical group on the basis of whether the surgery involved a robot navigation system. We compared the baseline data (age, sex, cause of injury, fracture AO classification, and time of injury-induced surgery), intraoperative conditions (surgery time, length of main nail insertion incision, postoperative fluoroscopy frequency, intraoperative bleeding), fracture healing time, and shoulder joint function at 1 year postsurgery (ASES score and Constant–Murley score) between the two groups of patients. There was no statistically significant difference in the baseline data or average fracture healing time between the two groups of patients. However, the robotic group had significantly shorter surgical times, longer main nail incisions, fewer intraoperative fluoroscopies, and less intraoperative blood loss than did the traditional surgery group (P < 0.001). Robot navigation system-assisted intramedullary nail fixation for humeral shaft fractures is a reasonable and effective surgical plan. It can help surgeons determine the insertion point and proximal opening direction faster and more easily, shorten the surgical time, reduce bleeding, avoid more intraoperative fluoroscopy, and enable patients to achieve better shoulder functional outcomes.

Purpose: The stromal cell protein metalloproteinase 9 (MMP9), associated with extracellular matrix degradation and remodeling, promotes tumor invasion and metastasis and regulates cell adhesion molecule and cytokine activity. This study evaluated MMP9 in pan-cancer and screened for compounds and drug candidates that can inhibit it. Methods: MMP9 expression in pan-cancer tissues was evaluated in a pan-cancer dataset from the University of California Santa Cruz database, along with the correlation between MMP9 and the tumor microenvironment (TME), RNA modification genes, and tumor mutation burden. MMP9 crystal structures were downloaded, and a ligand-based pharmacophore model was constructed. A machine learning model was constructed for further screening. The identified compounds were pooled into Discovery Studio 4.5 for absorption, distribution, metabolism, and excretion (ADME) and toxicity prediction. Molecular docking was used to demonstrate the binding affinity and mechanism between the compounds and MMP9, and the stability of the ligand-receptor complex was assessed. Results: The expression levels of MMP9 differed between tumor tissues. Prognostic analysis showed that high MMP9 expression indicates poor survival and tumor progression in glioma (GMBLGG), pan-kidney (KIPAN; KICH+KIRC+KIRP), uveal melanoma (UVM), low-grade glioma (LGG), adrenocortical carcinoma (ACC), and liver hepatocellular carcinoma (LIHC). MMP9 expression in GMBLGG, KIPAN, UVM, LGG, ACC, and LIHC was positively correlated with the TME. The ligand-based pharmacophore model and the machine learning model identified 49 small molecules. ADME and toxicity prediction identified CEMBL82047 and CEMBL381163 as potential MMP9 inhibitors, showing robust binding affinity with MMP9. The resulting complexes are stable in the natural environment. Conclusion: CHEMBL82047 and CHEMBL381163 are ideal compounds for inhibiting MMP9. The findings of this study will contribute to the design and improvement of MMP9-targeting drugs.

Posterior tibial plateau bicondylar fracture combined with anterior cruciate ligament injury, also known as the “Posterior Condylar Triad”, is a regular combination injury. The traditional surgical strategy involves first fixing the posterior condyle in the prone position and then treating the anterior cruciate ligament avulsion injury after the patient turns over. This surgical strategy is cumbersome, requires multiple surgical preparations, prolongs the surgical time, and increases the patient’s risk. Our centre proposed one lateral prone position with three incisions to treat the “Posterior Condylar Triad”. This was a retrospective analysis of the clinical data of 11 “Posterior Condylar Triad” patients who underwent surgical treatment at our centre from February 2017 to August 2020. Using a unified surgical strategy, the patient rotates the limb in a lateral prone position. The posterior condyle fracture of the tibial plateau is treated through a posterior medial incision and posterior lateral Frosch approach. Finally, anterior cruciate ligament avulsion fracture is treated through a small incision on the medial side of the patella. All patients were encouraged to perform functional exercises of the knee joint early after surgery. The postoperative complications (deep vein thrombosis, poor wound healing, deep infection, internal fixation failure and fracture reduction loss) and knee joint function (knee joint range of motion, Lysholm score and SF36 scale) of the patients were recorded 1 year after surgery. All patients’ fractures healed smoothly, with an average fracture healing time of 17.0 weeks, ranging from 12 to 22 weeks. There were 2 patients with deep vein thrombosis (DVT) after the operation. One patient experienced wound fat liquefaction, and no patients reported serious complications, such as loss of fracture reduction, failure of internal fixation, or deep infection. One year after surgery, the average range of motion (ROM) of the affected limb’s knee joint was 3.6–120.5°, the average Lysholm score was 86.7, ranging from 61 to 100, and the average SF36 score was 76.96, with a range of 52.45–94.75. The “Posterior Condylar Triad” is a serious injury, and our proposed surgical strategy can simplify the surgical process, avoid large-scale changes in patient position during surgery, shorten surgical time, and reduce the risk of surgical anaesthesia, enabling patients to achieve good clinical prognosis.

We reported 2 cases of patellar tendon rupture at the lower pole of the patella. For patellar tendon rupture, simple suture fixation has been proved to be inadequate in strength. Our center uses custom-made anchor-like plate and suture to treat proximal patellar fracture. The fixation strength is reliable, no additional bone tunnel is required, and the fixation of the lower patellar fracture can be achieved at the same time. After the operation, the patient starts functional exercise of the knee joint at an early stage, The function of the knee joint of the patient recovered well after 1 year, without other complications.