ObjectiveTo summarize the evolving concept in treatment of intertrochanteric fractures and the development of internal fixation devices. MethodsRelated literature concerning the implant devices to treat intertrochanteric fractures was reviewed and analyzed in terms of the biomechanical characteristics, clinical application, and complications. ResultsThe treatment of intertrochanteric fractures has undergone an evolving concept from conservative treatment to surgical treatment. Surgery strategies include extramedullary fixation and intramedullary fixation. Intramedullary fixation has gradually become the main treatment of intertrochanteric fractures due to its minimally invasive and biomechanical advantages. However, the current intramedullary fixation system still can not reconstruct the medial cortical support of the proximal femur, which leads to some failures in the treatment of unstable fractures. ConclusionThe development of internal fixation of intertrochanteric fractures is based on the deep understanding and biomechanical theory of intertrochanteric fractures in clinical practice. In the future, the updated design of internal fixation devices will depend on the treatment principle of reconstruction of medial support and secondary stabilization of intertrochanteric fractures, and finally the purpose of improving success rate and reducing postoperative complications of intertrochanteric fracture will achieved.
Ilizarov’s technology is an internationally recognized clinical treatment method for limb orthopedics, but there are many complications related to external fixation. With the development and progress of the times, the remote-control intramedullary lengthening nails had risen to prominence on the international stage as the second generation of orthomelic technology based on Ilizarov’s technology. Since the first remote-control intramedullary lengthening nail appeared in the 1980s, after more than 40 years of development, there are currently more than 3 types of extension mechanisms in remote-control intramedullary lengthening nails and a mature and stable clinical treatment model has been formed during the past long-term clinical treatment and experiments, such as the End-Point-First (EPF) program proposed by Professor Peter H. Thaller in Germany. Compared with Ilizarov’s technology, the remote-control intramedullary lengthening nail has obvious advantages in convenience, comfort, risk of infection, soft tissue injury, postoperative pain, and controllability of limb lengthening. This article mainly introduces the development and clinical treatment concept of remote-control intramedullary lengthening nail and the latest clinical treatment status of limb lengthening therapy abroad, hoping to provide new cognition and ideas for the further development of limb orthopedics in China.
Objective To summarize the optimal evidence for improving the management of chronic wounds exudate, so as to provide evidence-based references for medical professionals, therapists, patients, and their caregivers. Methods PubMed, Wanfang, CNKI, Medlive, UpToDate, etc., were searched by computer for literature about chronic trauma exudate management. The retrieval time limit was from 1998 to 2023. Two researchers trained in evidence-based practice evaluated the quality of the included literature and finally extracted evidence from the literature that met the quality evaluation criteria. Results A total of 11 articles were included, including 2 expert consensuses, 7 systematic reviews, 1 randomized controlled trial, and 1 guideline, covering 7 aspects of the assessment of the nature of chronic wounds exudate, selection of exudate assessment tools, management of antimicrobial concerns, selection and application of wound dressings, negative pressure wound drainage therapy, wound drainage bags, and affected limb elevation or compression therapy for patients with venous leg ulcers. A total of 13 best evidences were extracted. Conclusions When applying evidence, medical professionals should fully evaluate and combine the individual circumstances of the patient, make full use of existing resources, new treatment concepts and technologies, and carry out comprehensive integrated management. This can optimize the management of chronic wounds exudate and improve the quality of life of patients.