Lingchao Kong

Introduction: Minimally invasive surgical treatment is increasingly favored for intra-articular displaced calcaneal fractures with a high risk of soft tissue complications. The calcaneus is the largest tarsal bone in the foot and plays a critical role in weight-bearing and gait mechanics; displaced fractures often result in significant functional impairment. Sanders Type II fractures, characterized by a single major fracture line that divides the posterior articular surface into two major bone fragments, are one of the most common subtypes and present a therapeutic challenge in balancing mechanical stability with soft tissue preservation. Methods: A finite element model of Sanders Type II calcaneal fractures was established to compare five fixation methods under physiological tendon loading: (1) a periosteal locking plate, (2) four hollow screws, (3) four K-wires placed along the screw trajectory, (4) two intra-articular K-wires combined with two standard K-wires, and (5) six K-wires placed at dispersed locations. Outcome measures included maximum fragment displacement, implant-induced bone stress, and implant stress. Results: Rigid internal fixation (hollow screws) provided the best initial stability and the least displacement of the bone fragments. A key finding was that under the most severe static loading condition (dorsiflexion with maximum Achilles tendon force), the maximum fragment displacement for all K-wire configurations (≤0.103 mm) was below both the clinically reported acceptable threshold (≤0.5 mm) and the safe healing range (<1 mm), indicating sufficient initial healing stability. Furthermore, K-wires generated significantly lower stress on the bone than the plate, while cannulated screw fixation carried the lowest risk of implant failure. Based on extended observations from clinical literature, K-wire fixation offers potential advantages including a minimally invasive approach, flexible handling, low implant burden, and the possibility of outpatient removal to avoid secondary surgery. Conclusion: Although rigid implants are biomechanically superior, K-wire fixation provides clinically acceptable initial stability and, combined with its minimally invasive characteristics, represents an attractive alternative. The choice of fixation method requires a comprehensive consideration of individual patient factors (such as bone quality and functional demands) and the overall treatment strategy.

Knee Osteoarthritis (KOA) represents a prevalent chronic degenerative disorder. Currently, the diagnosis and monitoring of KOA are typically founded on clinical symptoms and imaging examinations when joint damage has already manifested. Consequently, reliable biochemical markers are highly demanded for the early diagnosis of osteoarthritis. This study aimed to investigate whether serum retinol-binding protein 4 (RBP4) levels in patients with primary KOA can serve as a potential biomarker for early joint damage and to analyze their predictive value for the onset and progression of KOA. A case-control study was carried out at the First People’s Hospital of Hefei during the period from December 2024 to February 2025. A total of 160 participants were encompassed in the study (comprising 40 patients diagnosed with early-stage and 40 with late-stage KOA, and 80 age-matched healthy controls). Serum levels of RBP4, C-reactive protein (CRP), Cartilage oligomeric matrix protein (COMP), and matrix metalloproteinase-3 (MMP-3) were quantified using sandwich enzyme-linked immunosorbent assay (ELISA). Erythrocyte sedimentation rate (ESR) was determined via the Infrared ESR Analyzer. Finally, an early diagnostic model for KOA was developed and evaluated for its predictive performance. RBP4 levels were significantly elevated in patients with KOA, with late-stage disease exhibiting markedly higher concentrations compared to early-stage counterparts. Serum RBP4 exhibited a positive correlation with symptom duration, age, Body Mass Index (BMI), visual analogue pain scores (VAS), Kellgren and Lawrence (KL) grade, MRI grade, CRP, COMP, and MMP-3, but negatively correlated with hospital for special surgery knee score (HSS). The area under the Receiver Operating Characteristic (ROC) curve (AUC) for the diagnosis of RBP4 is 0.878, and the AUC for differentiating controls and early-stage KOA is 0.832. Serum RBP4 is a lipid metabolism–related biomarker that correlates with KOA severity and exhibits strong early-stage diagnostic performance. The online version contains supplementary material available at 10.1186/s13075-026-03805-x.

Osteoarthritis (OA) is a common degenerative joint disease that often leads to pain and diminished quality of life in patients. For end-stage osteoarthritis, surgical intervention remains the only effective treatment. However, for the majority of patients, surgery is not the initial consideration. The management of osteoarthritis primarily focuses on alleviating associated clinical symptoms, and rational non-surgical conservative treatment is the recommended approach for patients in the early to middle stages. Intra-articular injection therapy represents one of the most effective non-surgical treatment options, second only to oral analgesics and anti-inflammatory medications, with a lower incidence of systemic complications. Compared to surgery, it is more cost-effective and less invasive. Among these, intra-articular corticosteroid injection is a widely adopted non-surgical treatment by rheumatologists for osteoarthritis. Numerous studies have demonstrated that intra-articular corticosteroid injections can provide short-term pain relief in osteoarthritis. Triamcinolone Acetonide (TA) is one of the commonly used corticosteroids, valued for its notable anti-inflammatory and analgesic effects. It is extensively applied in intra-articular injections for osteoarthritis to alleviate pain and potentially delay disease progression. The purpose of this paper is to review the mechanism of action of Triamcinolone Acetonide, its current applications and efficacy in osteoarthritis, safety profile, and future directions, thereby providing a theoretical foundation and practical guidance for clinical management strategies in osteoarthritis.

Background: Massive irreparable rotator cuff tears (MIRCTs) present challenges in terms of traditional treatments and can result in pain and functional impairment. Due to the limitations of traditional treatments for MIRCTs, alternative options such as superior fulcrum reconstruction (SFR) using the autologous peroneus longus tendon (PLT) have been explored. This study aims to evaluate the clinical and radiographic outcomes of SFR with autologous PLT grafts for the treatment of MIRCTs after a minimum follow-up period of 1 year. Methods: This was a prospective cohort study. Thirty-six patients with MIRCTs who underwent arthroscopic SFR with PLT grafts were enrolled and prospectively followed for a minimum of 1 year. Clinical and radiographic evaluations were performed preoperatively and at 3, 6, and 12 months postoperatively. Follow-up evaluations included assessments using the American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), visual analog scale (VAS), Quick-Disabilities of the Arm, Shoulder, and Hand (DASH) score, and measurements of shoulder joint range of motion. Radiography and MRI were used to evaluate the acromiohumeral distance (AHD), Hamada grade, and graft integrity. Repeated measures ANOVA was used to analyze the within-group and between-group differences under different conditions, followed by Bonferroni post-hoc tests to compare outcomes in the postoperative alignment subgroups. Results: At the 1-year assessment (n = 36), 34 patients (94.4%) healed well and 2 (5.6%) had MRI-confirmed graft failure. Significant improvements were observed in ASES, QuickDASH, SSV, VAS, forward flexion, external rotation, internal rotation, and AHD scores (all P < 0.05). The use of autologous PLT grafts in SFR resulted in favorable functional outcomes, with a high graft healing rate at the 1-year follow-up. Conclusions: Significant improvements were observed in the ASES, QuickDASH, SSV, VAS scores, and shoulder joint range of motion, highlighting the effectiveness of this approach for patients with MIRCTs.

Total knee arthroplasty (TKA) is an effective treatment for end-stage knee osteoarthritis (KOA). Previous studies have found that KOA patients commonly experience sleep disorders during the perioperative period of TKA, which can significantly affect postoperative recovery, pain management, and quality of life. Sleep disturbances during the perioperative period of TKA are a complex issue influenced by multiple factors. Although clinical interventions have shown promising efficacy, the underlying mechanisms remain unclear and require further research. This article reviews the specific causes of sleep disturbances in TKA patients during the perioperative period, aiming to provide a reference for personalized sleep regulation interventions to improve postoperative outcomes. The article begins by searching public databases using selected keywords to identify recent studies on the management of sleep dysfunction during the perioperative period of TKA. Through a summary of the relevant literature, the review focuses on the incidence, influencing factors, interventions, and potential mechanisms of sleep dysfunction during the perioperative period of TKA. It aims to optimize perioperative management and support the future development of high-quality clinical intervention randomized controlled trials, ultimately contributing to the optimization of postoperative sleep management strategies and enhancing rapid recovery and long-term satisfaction in TKA patients.

Objective: The core challenge in treating Schatzker type IV tibial plateau fractures lies in balancing mechanical stability with minimally invasive techniques. Traditional double-plate fixation carries a high risk of soft tissue complications, while single-plate fixation provides insufficient mechanical strength. This study aims to systematically evaluate and compare the biomechanical performance of five internal fixation strategies for Schatzker type IV-A and IV-B fractures using finite element analysis (FEA), exploring whether optimized fixation configurations can achieve synergy between minimally invasive treatment and stability. Method: Three-dimensional models of Schatzker type IV-A and IV-B fractures were constructed based on CT data from a 43-year-old male patient. Soft tissue models including ligaments and menisci were established. Five fixation methods were simulated: isolated medial plate (IMLP), medial plate with two posteromedial tension screws (IMLP + 2PMS), medial plate with two lateral tension screws (IMLP + 2LTS), posteromedial and medial double plating (PMP + MLP), and medial and lateral double plating (MLDP). Axial loads from 300 N to 2400 N were applied to simulate conditions ranging from standing to vigorous activity. Implant stress, tibial shaft stress, and fracture fragment micromotion were quantified. Result: Under a 1200 N load, hybrid fixation modes (IMLP + 2PMS and IMLP + 2LTS) demonstrated superior biomechanical performance. They exhibited the lowest peak implant stress (Type IV-A: IMLP + 2PMS 124.21 MPa; Type IV-B: IMLP + 2PMS 115.64 MPa), significantly better than the IMLP group (∼248 MPa), and comparable or superior to double-plate fixation groups (MLDP, PMP + MLP). While fracture fragment displacement showed no significant differences across all fixation methods, IMLP + 2PMS effectively reduced stress in type IV-B fragments. Regarding stress distribution in the tibial shaft, hybrid fixation provided a more uniform and physiological pattern compared to double-plate fixation. The results indicate differential responses to fixation strategies between type IV-A and IV-B fractures, with type IV-B deriving more pronounced benefits from posteromedial tension screws. Conclusion: The hybrid fixation configuration of a “medial plate combined with tension screws” represents a biomechanically optimal solution for treating Schatzker type IV-A and IV-B fractures. It provides stability comparable to double-plate fixation while significantly reducing implant stress concentration and the “stress-shielding” effect through a minimally invasive approach, achieving a synergy between minimal invasiveness and stability.

Spinal Cord Injury (SCI) is a severe disorder of the central nervous system, typically caused by trauma or disease, which significantly impacts the quality of life of affected individuals. Secondary inflammation following spinal cord injury is a critical factor influencing prognosis, making the exploration of the inflammatory microenvironment crucial for the treatment of SCI. Xanthoxylin, a small organic molecule extracted from plants, has demonstrated notable anti-inflammatory effects. To investigate the role of Xanthoxylin in spinal cord injury, we initially employed Hoechst staining and flow cytometry, revealing that Xanthoxylin reduces neuronal apoptosis. Subsequently, through Western blot, immunofluorescence, and qPCR, we discovered that Xanthoxylin promotes the polarization of microglia from the M1 inflammatory phenotype to the M2 anti-inflammatory phenotype. Furthermore, transcriptome sequencing identified differential expression in the NF-κB pathway, which was corroborated by Western blot analysis. Finally, animal experiments were conducted to further validate the therapeutic effects of Xanthoxylin on spinal cord injury in mice. These results suggest that Xanthoxylin has a significant therapeutic effect on SCI in mice. Overall, our study is the first to demonstrate the therapeutic effect of Xanthoxylin on SCI and provides a scientific exploration of its underlying mechanisms, offering new directions for pharmacological treatment of spinal cord injury.

This study aims to evaluate the biomechanical performance of five different internal fixation strategies for Schatzker type IV-C tibial plateau fractures using three-dimensional finite element analysis. By analyzing stress distribution and displacement patterns under physiological load, we seek to identify optimal fixation modalities for clinical application. We established a three-dimensional finite element model of Schatzker IV-C tibial plateau fractures and evaluated five internal fixation modalities via finite element analysis. These modalities included a medial plate (Model 1), a medial plate with two posterior tension screws (Model 2), a medial plate with two lateral tension screws (Model 3), a posterior medial double plate (Model 4), and a medial lateral double plate (Model 5). To simulate the biomechanics of unilateral knee axial compression during normal adult gait, an axial force of 1,200 newtons (N) was applied, with 60% of the force distributed to the medial plate. We comprehensively analyzed equivalent von Mises stresses, displacements, and equivalent stress-displacement plots for each fixation. Model 5 demonstrated the best overall performance in terms of internal fixation stress (91.46 MPa) and fracture block stress (10.826 MPa), suggesting optimal stress distribution and fracture block protection. Model 3 performed best in terms of internal fixation displacement (4.391 mm), suggesting an advantage in fracture block stability. While the models performed well in several areas, the double plate fixation scheme was superior in terms of stress distribution and fracture stability. It is ideal for managing complex fractures. A single medial plate (Model 1) provides adequate fixation and stability for fractures without the lateral intercondylar ridge. Lag screws with the medial plate (Models 2 and 3) effectively reduce stress and minimize trauma. Double plate on the posterior medial side (Model 4) significantly enhances fixation and prevents displacement for complex fractures. Medial-lateral double plate fixation (Model 5) provides the most favorable biomechanical stability for fractures with extensive lateral plateau comminution. However, balance the benefits against increased complexity, particularly in patients with compromised soft tissue or high functional demands. Selecting internal fixation based on the fracture line can optimize outcomes and speed recovery.

Background: Knee osteoarthritis (KOA) is a degenerative joint disease characterized by cartilage degradation, synovial inflammation, and joint pain. The infrapatellar fat pad (IFP) has been suggested to play a role in modulating the inflammatory processes in KOA. Excision of the IFP is considered a potential therapeutic approach to reduce inflammation and slow disease progression. Methods: A mouse model of KOA was used to evaluate the impact of IFP excision on inflammation. Mice were divided into five groups: sham (control), unexcised IFP, quarter excision, partial excision, and complete excision of the IFP. Knee joints were collected at early, middle, and late stages of KOA. Gait analysis, micro-computed tomography (micro-CT), HE staining, Safranin O-Fast Green staining, and immunohistochemistry (IHC) were performed to assess joint stability, bone changes, and inflammatory markers (MMP-3, IL-6, TNF-α, COL-2). qRT-PCR was conducted for cartilage tissue analysis. Results: Partial IFP excision significantly improved joint stability, particularly in the middle and late stages of KOA. Micro-CT analysis showed increased bone volume fraction (BV/TV) and trabecular thickness (Tb.Th) in excised groups, with the most significant effects in the partial and complete excision groups. IHC and qRT-PCR indicated reduced MMP-3, IL-6, and TNF-α levels in excised groups, particularly in the partial and complete excision groups, suggesting reduced inflammation. COL-2 expression was higher in excised groups, particularly in late-stage KOA, indicating cartilage protection. The partial excision group exhibited the most balanced reduction in inflammation and improved cartilage integrity across all disease stages. Conclusion: IFP excision, especially partial excision, significantly modulates the inflammatory response in KOA. Partial excision showed the most effective and balanced impact on joint stability, bone integrity, and cartilage protection, offering potential as a therapeutic approach for KOA.