1. Intramedullary nailing technique The intramedullary nailing technique is one of the greatest advances made in the treatment of fractures in the last century, and has become the preferred means and method of treating long diaphyseal fractures with indications. To fix a fracture with an intramedullary nail, only a small incision is made in the skin away from the fracture site. The fracture is closed and repositioned by inserting the intramedullary nail into the medullary cavity through a small incision at the correct site with an opener, which not only cuts the skin of the fracture site, but also does not strip the periosteum of the fracture fragment or disturb the biological environment of the fracture site, which is conducive to fracture healing and also reduces the incidence of infection, in line with the principle of minimal invasion. The application of interlocking screws expands the surgical indications for intramedullary nailing, which can be used only for the treatment of transverse or short oblique fractures, but also for the treatment of other types of fractures. The expansion of the medulla can solve the problem of matching the curvature of the medullary cavity with the intramedullary nail, and also allows the use of thicker intramedullary nails to increase the strength of the support, and the debris produced by the expansion of the medulla can also play the role of internal bone grafting to promote the healing of the fracture, which is its advantage; the expansion of the medulla will cause the destruction of the blood supply of the intramedullary cortex, which may have a negative impact on the healing of the fracture, and the risk of infection in the treatment of open fractures, which is its drawback. The non-expanded intramedullary nail is mostly solid and strong, but its texture is hard and its curvature does not easily match the medullary cavity, and it cannot be used with thicker nails. Of course, non-expanded medullary can reduce the damage to the endosteal blood supply, improve the healing rate and reduce the infection rate, and can be used for the treatment of I to II degree open fractures, which can achieve faster healing than treatment with external fixation frame. 2. External fixation brace treatment Fixing the fracture with external fixation brace, the fixation screw is drilled percutaneously into the bone stem at a site far away from the fracture, also without disturbing the fracture site, in line with the principle of minimally invasive. The ease of surgical operation, as well as the postoperative adjustability, are its main advantages. Especially in the management of open fractures, the fixation screw can be placed away from the trabecular site, providing great convenience for the repair of the trabeculae and later treatment, and the external homotomy brace is therefore the preferred fixation method for the treatment of open fractures. However, because the fixation rod is far away from the bone stem, there is a certain moment and the elasticity of the fixation screw, the stability of fixation is problematic, especially when used to fix femoral stem fractures, fixation failure and fracture re-displacement often occur, and even lead to delayed or non-union of the bone. Therefore, it is mostly used in the early treatment of open fractures for temporary fixation, and then changed to internal fixation when conditions are suitable; of course, it can also be used for the final treatment of non-weight-bearing long bones, such as distal humerus and skull fractures. However, cable jointing technique has also been used to compensate for the lack of stability of external fixation brackets for the treatment of unconnected long bone fractures with good results. Despite the inevitable need for incision and reduction for intra-articular fractures and many epiphyseal fractures, more and more surgeons are still following the principle of minimally invasive reduction and fixation by using limited incision and reduction internal fixation combined with external fixation brackets, in order to minimize the damage to the blood and tuck supply of the fracture fragment by surgical trauma and to achieve the best possible anatomical reduction to meet the needs of functional recovery of the limb. However, the stability of the external fixation brace needs to be improved, as the fixation screws are exposed outside the body and are prone to loosening and nail tract infection due to improper care, which depends on the improvement of instruments and application techniques, such as using fixation screws with hydroxyapatite coating to help prevent loosening. There are various types of external fixation stents in clinical use nowadays, in addition to the classic stent Single-arm external fixation stent, but also both stents, etc. They each have their own characteristics, but the principle is the same, the pursuit of stability without losing simplicity. There are also clinical reports of the application of braces with articulation to treat intra-articular fractures and joint stiffness, achieving a combination of motion and immobility, providing fixation while allowing moderate movement, and exerting unique therapeutic effects in many cases. Development of minimally invasive fracture techniques In recent years, with the increasing maturity of computer technology and precision mechanical automatic control technology, and the continuous improvement of imaging quality of medical imaging equipment, the computer-aided surgical navigation system developed by combining computerized medical image three-dimensional visualization processing technology, medical robotics, spatial three-dimensional positioning navigation system and clinical surgery has brought the fracture fixation techniquesl into a new development stage. The application of computer-assisted navigation technology to assist in intramedullary nail fixation and pelvic fracture repositioning and fixation is like a tiger with wings, which not only improves the accuracy of surgery but also reduces the radiation exposure of patients and surgeons, which is the best of both worlds. Currently, computer-assisted orthopedic surgery can be accomplished to position and image the placement of the endograft, and the use of CAOS can make distal locking nailing more accurate and faster, reducing X-ray exposure to the patient and the surgeon. 2.1 Application of endoscopy The clinical application of endoscopy has pioneered minimally invasive surgery, and arthroscopic surgery is its main representative in orthopedics, and its application in the field of traumatic orthopedics is becoming more and more promising. In terms of knee arthroscopy, it can not only deal with meniscus injury and synovial disease, but also do meniscus transplantation, anterior and posterior cruciate ligament reconstruction and cartilage defect transplantation and repair; now it has developed to complete the reset and fixation of tibial plateau, intertrochanteric fracture and other intra-articular fractures under the supervision of arthroscopy, changing the traditional intra-articular fracture incision and internal fixation surgical method, establishing the emblem-shaped incision, small trauma, less bleeding, less perioperative pain, less hospitalization time, and more effective surgery. The arthroscopic-assisted surgery, with small trauma, less bleeding, less perioperative pain, shorter hospital stay and faster postoperative recovery, reflects the essence of “minimally invasive surgery”. However, arthroscopic fracture internal fixation surgery still has problems such as relatively cumbersome, extra cost and limited indications, which need to be studied and solved, so that arthroscopic surgery can become a routine technique in traumatology orthopedics and improve the effect and level of minimally invasive trauma treatment. 2.2 Internal implants for fixing fractures In order to adapt to the minimally invasive techniques used for treating fractures, the internal implants used for fixing fractures are constantly improved, refined and updated. From the concept of biological fixation, point contact plates were developed to reduce the compression of the cortical bone in contact with the plate and to reduce the extent of possible osteoporosis and necrosis . In order to span the fracture site and facilitate bone grafting, waveform splints are used clinically, etc. The development of locking compression plates and their successful clinical application have greatly improved the stability of internal fixation of fractures and strongly promoted the healing of fractures, while providing a reliable fixation method for osteoporotic fractures with the same fixation. It is a change from the principle that ordinary bone plate is fixed by friction between the plate and bone through the addition of E mal, and the threads are designed to match each other between the head of the screw and the screw hole of the plate, and after the screw is tightened, the screw and the plate are integrated to provide good angular stability for the fracture, which acts like a fixed brace placed in the body. The locking plate is required near the bone surface and can be placed without contacting the bone, so it does not need to be shaped strictly, and the periosteum does not have to be peeled off during placement, and it does not exert pressure on the periosteum when placed in the tongue, thus avoiding damage to the periosteal vessels and achieving the purpose of protecting the blood flow of the bone. In addition to locking plates for fixing diaphyseal fractures, there are also special types for fixing metaphyseal fractures, such as the LPHP for treating proximal humeral fractures. The LCP is designed with a clever combination of plain screw holes and ribbed screw holes. Depending on the specific circumstances of each case, the ribbed holes can be used in their entirety to make the plate an internal brace, or the plain screw holes can be used selectively to insert Tension screws can also be selectively inserted through the normal screw holes to implement pressure between the bone fragments to improve the effect of repositioning while ensuring stability. The introduction of the minimally invasive stabilization system provides a new minimally invasive means and method for the treatment of periprosthetic fractures, including distal femoral, intercondylar, tibial plateau and proximal tibial fractures, and is particularly suitable for joint fractures with comminuted metaphyseal fractures. The LISS is essentially a locking joint plate with the shape of the articular end conforming to the anatomical contour of the bone, and the position and angle of the white diamond locking nail placed in this end are precisely calculated and combined with the plate. The LISS is equipped with a precise installation mold, which not only allows the plate to be inserted under the muscle layer through the articular end wound and over the epiphyseal fracture, but also allows each locking screw to be inserted percutaneously through the positioning hole of the mold, minimizing the trauma to soft tissues and reducing wound complications and infections. and infection rates. Of course, LISS has certain indications, it is suitable for multiple fractures of the tibia, while for single transverse fractures of the middle and lower tibia, it is not necessary to use LISS, because it is more expensive than dumplings, and there is no need to increase the burden of the patient for no reason. Of course, the use of LISS requires experience and skill because the fracture end of the diaphysis is not exposed during surgery, and for some relatively complex fractures, it may be more difficult to achieve satisfactory repositioning, which is completely dependent on the practice and skill of the surgeon. However, the new generation of minimally invasive internal fixation techniques, represented by LISS, heralds the future of orthopaedic trauma and may not be in doubt. Comparing LISS and PFNA treatment, LISS is used as a minimally invasive surgical modality to treat femoral rotor fractures it is an eccentric nail plate structure, which is slightly inferior to the intramedullary fixation system in terms of shear resistance, but for some specific types of complex anterior intertrochanteric fractures, fractures involving the lateral cortex of the greater trochanter, subtrochanteric fractures, LISS has a greater advantage, while for rotor fractures near the base of the femoral neck to The new minimally invasive fixation system and locking compression plate with LISS fixation screws can provide a new option for modern orthopaedic surgical treatment, which is minimally invasive percutaneous splinting … The use of locking intramedullary nails is becoming increasingly popular. The use of locking intramedullary nails is becoming increasingly popular in the surgical treatment of long diaphyseal fractures… Changes and developments in the principles of fracture treatment Delayed healing and osseous discontinuity occur in approximately 5% to 1% of cases after fracture and are clinically challenging to treat either nonoperatively or surgically. Non-surgical treatment has the advantages of less damage and lower risk of infection, and in many cases is the preferred treatment for bone discontinuity, and it is mostly effective. One of these methods is extracorporeal shockwave, which uses the principle that shockwave energy rarely decays when propagating in tissues with similar acoustic impedance and does not damage tissues, while releasing energy at the interface of tissues with very different acoustic impedance, generating tension and pressure, causing microfracture at the fracture site, enhancing local blood flow rate and blood supply, and thus promoting fracture healing. The literature reports a healing rate of 64% with primary shockwave treatment and 72% after secondary shockwave, with an overall efficiency of 80%. Similarly, electrical stimulation can also be used clinically to treat bone discontinuity, with a total efficiency of 72%. Using the strong osteogenic properties of bone marrow, injection of autologous bone marrow at the fracture site can also be used to treat osteochondrosis. 72 cases of osteochondrosis were reported to be treated with this method, and 72.2% of the patients eventually obtained satisfactory healing. Of course, if conservative treatment does not work, surgery may be a necessary option. The causes of osteonecrosis are multifaceted and the surgical approach is highly specific. More often than not, it is necessary to address both the stability of fracture fixation and bone graft enhancement to induce osteogenesis during surgery. The clinical use of an interlocking intramedullary nail with marrow expansion to treat noninfected osteonecrosis in long bones can serve both purposes. The reamed marrow allows the use of a thicker intramedullary nail than the original one, increasing the strong replication of the intramedullary nail and providing a firmer fixation; the reamed marrow produces debris and as a result, active substances such as growth factors within the bone marrow are released at the fracture site, promoting the ossification of the fibrocartilage; in addition, the use of an intramedullary nail with a compression device also allows intraoperative compression of the fracture end, bringing the bone ends into close contact and promoting fracture healing. In the literature, 50 cases of non-infected radius osteochondral nonunion were treated with expanded intramedullary nails, 34 with closed nailing and 16 with incisional repositioning, and all cases healed firmly within 6 months. Recently, internal fixation devices pre-coated with growth factors have been developed, and experimental studies have shown that healing of fractures can be significantly accelerated with pre-coated internal fixation screws and intramedullary nails. The success rate of fracture treatment will be significantly improved with the widespread use of pre-coated internal fixation devices. For infected bone nonunion of long bones, because the intramedullary nail fixation may aggravate the infection in the medullary cavity, external fixation frame is mostly used for treatment at present. Through thorough local debridement, excision of infected granulation, fibrous tissue and dead bone, fixation of the fracture with a ring external fixator, supplemented by the application of antibiotics and hyperbaric oxygen, the treatment of infected bone nonunion can achieve satisfactory results. For infected osteochondritis with combined bone defects, the fracture can also be fixed with an external brace after debridement and the bone defect filled with calcium sulfate pellets with tobramycin. This artificial bone material releases antibiotics when it degrades, which can effectively control infection, and its osteogenic effect can eventually repair the bone defect, both of which can be achieved. Autologous bone is still the gold standard for bone grafting because of its osteoconductive and osteoinductive effects, and because it has no immune rejection or disease transmission defects. It is only the limited number of autologous bone sources and the additional trauma associated with bone extraction that have limited its clinical application and led to the use of allogeneic bone as a substitute. This has changed in recent years with the development and application of various artificial bones, as many studies have shown that artificial bone has been effective in inducing osteogenesis and promoting bone healing.