2026年 · 第29卷第02期

To standardize the key techniques and protocols of prehospital emergency care for major trauma in China, and to improve the quality and efficiency of treatment, a multidisciplinary panel of experts in emergency medicine, trauma care, and prehospital rescue was organized to form an expert committee and a core working group. This initiative was co-sponsored by the Trauma Emergency and Multiple Trauma Group of the Trauma Society of the Chinese Medical Association, the Youth Group of the Disaster Medicine Society of the Chinese Medical Association, and the Combat and Trauma Care Specialty Alliance of Army Hospitals. The group systematically searched databases including PubMed, Embase, Cochrane Library, Web of Science, China Biology, Medicine, China National Knowledge Infrastructure, Wanfang Data, and VIP Information to collect relevant guidelines, systematic reviews, and clinical studies. Based on evidence-based findings and clinical practice scenarios, the consensus was drafted. Multiple rounds of consultation and voting were conducted, and a consensus meeting was held to resolve any disputed items. Ultimately, 16 recommendations were formulated addressing 14 core clinical questions in the prehospital management of severe trauma. The contents cover scene safety, rapid recognition and early warning of severe trauma, control of exsanguinating external hemorrhage (X), airway management (A), breathing management (B), circulation management (C), disability/neurologic assessment (D), exposure and temperature control (E), trauma in special populations (the elderly), immobilization and extrication, transport decision-making, prehospital-to-hospital handover, teamwork, and systematic training. This consensus strongly emphasizes the "xABCDE" assessment sequence and recommends key interventions such as the use of commercial tourniquets and wound packing for hemorrhage control, permissive hypotensive resuscitation, early administration of tranexamic acid, and the standardized application of pelvic binders. It also advocates the use of standardized communication models for prehospital-to-hospital handovers. This consensus provides prehospital emergency providers in China with a practical, evidence-based set of key techniques and protocols for severe trauma care, which will help promote the standardization of the prehospital trauma care system, support the development of a high-quality national prehospital trauma care system, and ultimately improve patient outcomes.

Purpose: This study aimed to evaluate the treatment of scaphoid nonunion with dual screw fixation in preventing postoperative humpback deformity. Methods: This retrospective study is from December 2010 to December 2021, and 18 patients with scaphoid nonunion were treated with dual screw fixation through the dorsal approach. This study included patients aged 16-60 years with scaphoid nonunion (>6 months) classified as Mack-Lichtman types I-III (mild arthritis), while excluding those with immature osteogenesis (<16 years), osteoporosis (>60 years), prior wrist surgery or fractures, avascular necrosis, advanced degenerative changes (types IV-V), small fragment fixation difficulty, or loss to follow-up. Scaphoid length and angles were assessed on X-rays. Wrist function was assessed based on the Mayo wrist score. Results: The average age of the participants was 27 (range 17-49) years. The mean time from injury to surgery was 13 (range 6-48) months. There were types I (n=5), II (n=11), and III (n=2) nonunions based on the Mack-Lichtman classification. Nonunion sites included proximal 1/3 (n=4), waist (n=8), and distal 1/3 (n=6). All nonunions healed at a mean of 15 (range 10-28) weeks. The preoperative scaphoid length was 20 (range 17-23) mm, and the data at bone union was 23 (range 21-26) mm. The preoperative scapholunate angle was 46° (range 18°-72°), and the data at bone union was 39° (range 30°-48°). The preoperative radiolunate angle was 24° (range 5°-51°), and the data at bone union was 18° (range 8°-29°). Follow-up lasted for a mean of 52 (range 24-119) months. Mayo wrist score improved from 47 (range 13-64) to 95 (range 78-100). There were 15 excellent, 2 good, and 1 satisfactory results. Conclusion: In the treatment of scaphoid nonunion, dual screw fixation through the dorsal approach can successfully prevent postoperative humpback deformity. Reduction is maintained to bone union without complications. The technique can be an alternative for the treatment of scaphoid nonunion.

Purpose: Distal radius fracture is a common trauma fracture and timely preoperative diagnosis is crucial for patient's recovery. With the rise of deep-learning applications in the medical field, utilizing deep-learning for diagnosing distal radius fractures has become a significant topic. However, previous research has suffered from low detection accuracy and poor identification of occult fractures. This study aims to design an improved deep-learning model to assist surgeons in diagnosing distal radius fractures more quickly and accurately. Methods: This study, inspired by the comprehensive analysis of anteroposterior and lateral X-ray images by surgeons in diagnosing distal radius fractures, designs a dual-channel feature fusion network for detecting distal radius fractures. Based on the Faster region-based convolutional neural network framework, an additional Residual Network 50, which is integrated with the Deformable and Separable Attention mechanism, was introduced to extract semantic information from lateral X-ray images of the distal radius. The features extracted from the 2 channels were then combined via feature fusion, thus enriching the network's feature information. The focal loss function was also employed to address the sample imbalance problem during the training process. The selection of cases in this study was based on distal radius X-ray images retrieved from the hospital's imaging database, which met the following criteria: clear anteroposterior and lateral X-ray images with a diagnosis of distal radius fractures confirmed by experienced radiologists. The exclusion criteria encompassed poor image quality, the presence of severe multiple or complex fractures, as well as non-adult or special populations (e.g., pregnant women). All cases meeting the inclusion criteria were labeled as distal radius fracture cases for model training and evaluation. To assess the model's performance, this study employed several metrics, including accuracy, precision, recall, area under the precision-recall curve, and intersection over union. Results: The proposed dual-channel feature fusion network achieved an average precision (AP)50 of 98.5%, an AP75 of 78.4%, an accuracy of 96.5%, and a recall of 94.7%. When compared to traditional models, such as Faster region-based convolutional neural network, which achieved an AP50 of 94.1%, an AP75 of 70.6%, a precision of 91.1%, and a recall of 92.3%, our method shows notable improvements in all key metrics. Similarly, when compared to other classic object detection networks like You Only Look Once version 4 (AP50=95.2%, AP75=72.2%, precision=91.2%, recall=92.4%) and You Only Look Once version 5s (AP50=95.1%, AP75=73.8%, precision=93.7%, recall=92.8%), the dual-channel feature fusion network outperforms them in precision, recall, and AP scores. These results highlight the superior accuracy and reliability of the proposed method, particularly in identifying both apparent and occult distal radius fractures, demonstrating its effectiveness in clinical applications where precise detection of subtle fractures is critical. Conclusion: This study found that combining anteroposterior and lateral X-ray images of the distal radius as input for deep-learning algorithms can more accurately and efficiently identify distal radius fractures, providing a reference for research on distal radius fractures.

Purpose: To retrospectively compare the clinical outcomes of intra-capsular vs. extra-capsular release of the lateral patellar retinaculum using 2 novel surgical techniques: the capsule-uncut immaculate lateral retinacular release (CUI method), and the L-shaped lateral retinacular release (L-shaped release). Methods: This is a retrospective comparative study. The clinical data of patients admitted to our department between October 2010 and October 2020 were retrospectively analyzed. Patients diagnosed with excessive lateral pressure syndrome and treated with arthroscopic retinacular release, with complete imaging data, and followed up for >1 year were included in the study. Previous history of knee surgery, cruciate ligament or collateral ligament ruptures, neoplastic diseases of the knee, patellar instability, history of knee fracture, varus/valgus of the knee joint, or Q angle >20° were exclusion criteria. All the included cases were divided into 2 groups based on the surgical method and subsequently stratified by age. The visual analogue pain scale was used to evaluate the degree of knee pain. Lysholm score and the International Knee Documentation Committee knee evaluation form score were used to evaluate knee function and activity. The preoperative and postoperative patellar tilt angles of the affected knee were measured. Comparison between groups was performed by the Wilcoxon test or the Mann-Whitney U test. Count data was represented by frequency, and comparison between groups was performed by χ2 test. Mann-Whitney U test and multiple linear regression model were used for univariate and multivariate analysis. Results: The clinical data of 200 patients were retrospectively analyzed. After screening by inclusion and exclusion criteria, 90 cases met the inclusion and exclusion criteria and were included in this study. The postoperative visual analogue scale scores of both groups were significantly lower than those before operation (p<0.001), and the postoperative Lysholm score and the score of the postoperative International Knee Documentation Committee knee evaluation form of the 2 groups were significantly higher than those before operation (p<0.001). The L-shaped release group was significantly higher than the CUI method group in Lysholm score (p=0.008). In the age ≥50 years group, the Lysholm score of the CUI method group was significantly lower than the L-shaped release group (p<0.001), and the changes in patellar tilt angle were significantly larger in the CUI method group than in the L-shaped release group (p=0.016). In the age <50 years group, there was no significant difference. Conclusions: Both the surgical methods have good clinical effects. L-shaped release is superior to the CUI method in improving knee function in the elderly patients (≥50 years old), while the CUI method is superior to L-shaped release in correcting patellar tilt in the elderly patients. In young patients, the CUI method has the same clinical effect as L-shaped release. The L-shaped release is relatively simple with a short learning curve, making it suitable for beginners treating younger patients with mild lateral contracture. However, the CUI method is more recommended for patients with severe lateral patellar tilt, obvious lateral contracture thickening, and elderly patients.

Purpose: Anatomical studies provide the foundation for surgical advancements, particularly in perforator-based procedures. Despite safety measures, hand injuries continue to occur, making reconstructive surgery essential for improving quality of life. Magnification techniques have transformed plastic surgery, aiding perforator-based surgeries and improving outcomes. This study aims to bridge the gap in anatomical knowledge and explore the potential benefits of dorsal metacarpal artery flap. Methods: This prospective study, conducted from July 2021 to June 2023, focused on the dorsal metacarpal artery perforators in fresh frozen cadavers. Fresh un-embalmed cadavers without signs of trauma or deformity to the upper limb were included. The anatomical study comprised the process of injecting red latex into the arteries located at the wrist, followed by dissection and measurements of number of perforators, calibre, distance of perforators from metacarpal head, and radial styloid. In the clinical phase, hand held Doppler was used to locate the perforators of the metacarpal arteries between metacarpal heads. Based on these perforators, flaps were raised for the patients with defects over the proximal fingers. Details about defect and flap and patients characteristics were tabulated and presented. Results: The study was carried out on 6 fresh frozen cadavers (12 hands). Anatomical findings revealed the anatomical location, calibre, and consistent number of metacarpal artery perforators and dorsal carpal artery perforators supplying the dorsum of the hand. There was one perforator from 1st, 2nd, and 3rd metacarpal arteries. More than 1 perforators was found originating from 4th and 5th metacarpal arteries. Perforator of 1st metacarpal artery was largest in size (1.23 ± 0.27) mm. The study included 25 patients with finger defects. Metacarpal artery perforator flaps were planned to cover these defects. Successful outcome were achieved in 92% of patients. Conclusion: Perforator-based flaps are effective for small to medium-sized hand defects, reducing the need for distant pedicled flaps. These flaps provide functional and aesthetic benefits while minimizing donor site complications. The unique anatomical insights from our study include the consistent number and location of dorsal metacarpal artery perforators, as well as their relation to key landmarks such as the juncturae tendineae and 2 bony prominences (first metacarpal head and radial styloid process).

Purpose: Trauma, a leading cause of disability and death globally, underscores the critical importance of timely medical intervention, particularly within the "golden hour" following injury. Yet, in low-middle-income countries, the absence or fledgling state of emergency medical systems (EMS) exacerbates mortality rates. This study aims to retrospectively analyze mortalities at a level 1 trauma center in India, comparing patients who received prehospital care with those who did not. Methods: Conducted at a level 1 trauma center in India from April 2019 to April 2020, this retrospective observational study included trauma patients who died during hospitalization. Exclusions comprised (1) patients deceased upon arrival, (2) patients receiving cardiopulmonary resuscitation, and (3) non-trauma deaths. Demographics, clinical profiles, causes of death, and transportation methods were scrutinized. Data encompassed patient transport details, clinical assessments, interventions, length of stay, and causes of death. Statistical analysis was performed using SPSS 14, with statistical significance set at p<0.05. Results: Among 55,277 trauma patients, 311 mortalities were recorded. Most were male (n=261, 83.9%), aged 21-40 years (n=133, 42.8%), with blunt trauma being the predominant cause (97.4%). The majority of patients had road traffic injuries (n=180, 57.9%) and falls (n=95, 30.5%). Threatened airway (n=144, 46.3%), tachycardia (n=159, 51.1%), and hypotension (n=74, 23.8%) were common on patients’ arrival. Traumatic brain injuries (70.4%) prevailed. Private vehicles transported 46.6% of patients, while only 7.0% arrived within the golden hour. Although patients who received prehospital care experienced delayed hospital arrival, they exhibited higher oxygen saturation and systolic blood pressure. Conclusion: Augmentation of prehospital care and EMS infrastructure in low-resource settings is crucial to mitigating trauma mortality. Although prehospital care delayed hospital arrival, it positively impacted physiological parameters and potentially improved patient outcomes. This study underscores the imperative of timely interventions and comprehensive EMS development to address the global trauma burden effectively.

Purpose: The objective of the study was to determine the causal interrelationships between sociodemography, clinic, and injury characteristics, and to access to rehabilitation services that generate disability in road traffic injury survivors in 2 regions of Southwest Colombia during the 2018-2021 period. Methods: An ambispective cohort study included 261 survivors from road traffic in 2 regions of Southwest Colombia (Cauca and Valle del Cauca) between April 19, 2021 and June 03, 2022. These survivors accepted treatment in 3 high-level comprehensive health institutions in Cali, Colombia, which are regional referral centers for trauma in the region. Patients (1) with hospitalization time ≥12 h, (2) aged ≥18 years, and (3) having the ability to understand the research questionnaires by themselves or their legal representatives, were included. Those with a history of deficiency before the road traffic injury were excluded. A structural equation model of causal pathways of disability was established to estimate exposure variables that are sociodemography, clinic, and access to rehabilitation services. The main outcome variable was disability, estimated by the World Health Organization Disability Assessment Schedule 2.0. Exposure variables related to clinical characteristics were measured through medical record review. The variables of access to rehabilitation services and disability were measured through a telephone-based survey. Structural equation analysis was performed, estimating the mediating effects of disability. The analyses were conducted in the software R Studio® y Mplus®. Results: The study found a significant gender difference in disability, with women presenting a significantly higher disability than men (β: 6.21; p = 0.041). Disability was also associated with clinical conditions, such as injury severity score (β: 0.67; p < 0.001) and length of hospitalization (β: 0.28; p < 0.001). Regarding access to health services, the risk of disability was higher among those who were readmitted to the health institution (β: 4.96; p < 0.001). Conclusions: Disability caused by road traffic injuries must be conceived as a complex phenomenon to be studied, involving the non-linear interaction between the individual's deficiencies and contextual factors.

Purpose: Proximal fractures of the tibia (i.e., shin bone) are often treated using proximal tibia fracture plates (PTFPs) that are not always biomechanically optimal. This is a review of biomechanical papers that studied the effect of modifying PTFP plate and screw variables. Methods: PubMed, Scopus, and Web of Science databases were searched for English-language papers published before February 2024 using the terms "biomechanics" plus "proximal or plateau" plus "tibia" plus "fracture or "plate." Eligibility criteria were applied: (1) biomechanical studies only; (2) optimization studies that systematically permutated plate or screw variables; (3) plate-and-screw fixation only; (4) intra-articular or extra-articular fractures. The papers were examined for implant variables such as plate geometry, plate material, screw number, etc., while papers were also examined for outcome metrics like interfragmentary motion, plate stress, overall stiffness, etc. Results: The 52 eligible PTFP papers considered the biomechanical effect of plate geometry, material, hole type, number, and position, while screw variables included geometry, number, and angle. Outcome metrics were interfragmentary motion (0-22.53 mm or 0°-60.1°), bone stress (1-1170 MPa), plate stress (3-586 MPa), and screw stress (3-1613 MPa), bone stress under the plate (2-11 MPa), number of loading cycles to failure (11,500-1,000,000), overall stiffness (22-24,869 N/mm or 0.4-63.8 Nm/degree), and failure strength (259-14,387 N). Reviewed papers showed that a PTFP's biomechanical stability could be maximized by using 1 or 2 plates that were contoured, larger, locking, metal, and/or placed on the largest surface of the bone fragment(s), while head, kickstand, and/or shaft screws should be longer, thicker, solid, metal, and/or angled. But more future work could be done on the biomechanical effect of plate design (e.g., alternative materials), bone quality (e.g., normal vs. osteoporotic), loading mode (i.e., axial, bending, torsion), etc. Conclusions: PTFPs should have their plate and screw variables optimized to provide the best biomechanical performance and clinical outcomes, but more work is required to determine the optimal conditions. Engineers and surgeons may find this review beneficial for designing, analyzing, or utilizing PTFPs.

Uncontrolled hemorrhage is a leading cause of mortality in trauma. It is considered the most significant preventable cause of death in trauma patients. Junctional hemorrhages are responsible for approximately 20% of this possibly preventable mortality. At this time, the options for controlling such hemorrhages are either by manual pressure points or the use of junctional tourniquets, which, although they have been proven to be effective, are cumbersome and not readily available to the medical team in the field. The objective of this study was to evaluate the effectiveness and feasibility of a new junctional tourniquet (Life Saving Tourniquet, T-W-Medical ltd.) that is simpler to use and can perform both as a regular tourniquet and a junctional one.

Avulsion injury of genitalia is rare, particularly in pediatric patients. The reconstruction of necrotic scrotal tissue presents a significant challenge. This case report describes a pediatric patient who experienced complete avulsion of the left inguinal, scrotal, and penile regions, accompanied by multiple pelvic fractures, and the scrotal tissue subsequently became necrotic. We performed scrotal reconstruction using a pedicled anterolateral thigh flap and fixed both testes. Postoperatively, the scrotum had a satisfactory appearance, with no significant reduction in testicular size compared to age-matched peers, indicating a successful repair.