Guidelines for management of pediatric acute hyperextension spinal cord injury

Pediatric acute hyperextension spinal cord injury(SCI)named as PAHSCI by us,is a special type of thoracolumbar SCI without radiographic abnormality and highly related to back-bend in dance training,which has been increasingly reported.At present,it has become the leading cause of SCI in children,and brings a heavy social and economic burden.Both domestic and foreign academic institutions and dance education organizations lack a correct understanding of PAHSCI and relevant standards,specifications or guidelines.In order to provide standardized guidance,the expert team formulated this guideline based on the principles of science and practicability,starting from the diagnosis,differential diagnosis,etiology,admission evaluation,treatment,complications and prevention.This guideline puts forward 23 recommendations for 14 related issues.

Comparison of Proximal Femoral Geometry and Risk Factors between Femoral Neck Fractures and Femoral Intertrochanteric Fractures in an Elderly Chinese Population

Background： Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess the differences in proximal femoral geometry parameters between patients with femoral neck fractures and patients with intertrochanteric fractures to provide guidance for individualized customized prosthesis and accurate reconstruction of proximal femurs in elderly Chinese patients. Methods： We retrospectively studied the electronic medical records of 198 elderly patients over 65 years of age who were admitted to the orthopedic department with hip fractures between January 2017 and December 2017 in The Third Hospital, Hebei Medical University. Age, fracture site, gender, and proximal femoral geometry parameters （.neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]） were recorded. Student＇s t-test was used to compare the continuous variables, Chi-square test was used to analyze categorical variables, and multiple logistic stepwise regression analysis was used to evaluate the influencing factors of hip fracture type. Results： Statistically significant differences in NSA （137.63 ± 4.56° vs. 132.07 ± 4.17°, t = 1.598, P 〈 0.001）, CEA （37.62 ± 6.77° vs. 43.11 ±7.09°, t = 5.597, P 〈 0.001 ）, FND （35.21 ± 3.25 mm vs. 34.09 ±3.82 mm, t = 2.233, P = 0.027）, and FNAL （99.30 ± 7.91 mm vs. 103.58± 8.39 ram, t = 3.715, P 〈 0.001 ） were found between the femoral neck fracture group and femoral intertrochanteric fracture group. FHD, FND, FSD, HAL, and FNAL were different between sexes （all P 〈 0.001 ）. The greater NSA was the risk factor for femoral neck fractures （,odds ratio [OR]： 0.70, P 〈 0.001 ）, greater CEA and longer FNAL were risk factors for femoral intertrochanteric fractures （OR： 1.15, 1.17, all P 〈 0.001）, and greater FND was a protective factor for femoral intertrochanteric fractures （OR： 0.74, P 〈 0.001）. Conclusions： We demonstrate differences in geometric morphological parameters of the proximal femur in different hip fracture types, as well as an effect of sex. These differences should he considered in the selection of prostheses for fracture internal fixation and hip replacements. These data could help guide the design of individualized customized prostheses and improve the accurate reconstruction of the proximal femur for elderly Chinese hip fracture patients.

Minimally Invasive Reduction and Fixation in Orthopedic Trauma

In China,approximately,4.41 million individuals sustain fractures every year.With the rapid development of economy,industrialization,and urbanization as well as the aging of the Chinese population,it is predictable that the number of traumatic fractures will inevitably increase dramatically in the near future.According to the nation-wide data on the clinical epidemiology of orthopedic trauma during 2010-2011,

Innovations in Orthopedics and Traumatology in China

According to the latest data released by the National Bureau of Statistics, the total population of the mainland of China is 1.33 billion in 2010, including 177 million people aged 60 years or older, accounting for 13.25% of the total population, which increased to 15.53% in 2014. With the degree of growing aging population in our country, patients with musculoskeletal diseases increased greatly, which are the most common cause of severe chronic pain and physical disability among older people. Meanwhile, with the fast development of economy and industrialization in China, the number of patients of traffic injury and construction injury increases rapidly. Taken together, the expenses in orthopedics and traumatology will inevitably increase, challenging the existed medical and health system, presenting significant financial and emotional burden on the society. To address this challenge and improve the patient＇s care, the innovation of advanced concepts, surgical skills, and novel instruments for accurate diagnostic and treatment methods in orthopedics and traumatology has become more and more vital and imperative in our country.

Concept and Classification of a Derived Injury Resulting from a Primary Injury in Orthopedic Trauma

Aderived disaster is a commonconceptin natural emergencies, such as earthquakes. In recent years, the incidence of fractures caused by high-energy trauma has increased annually with socioeconomic development in China.[1-3] Accordingly, derived injuries resulting from primary injuries have also been increasing considerably. However, most surgeons in the field of orthopedics and traumatology do not yet have adequate knowledge of such kind of derived injuries. We summarized our experience in managing a patient who experienced reinjury caused by a primary injury over the last decade and proposed the concept of a derived injury. In addition, we aimed to introduce a classification of derived injuries, explore their significance in orthopedic trauma, and discuss methods to minimize their severity.

Stable mechanical fixation in a bionic osteochondral scaffold considering bone growth

In the field of tissue engineering,there is significant subsidence of the porous design scaffold several months after implantation.To avoid stress shielding and stimulate bone and cartilage ingrowth,high scaffold porosity is needed to diminish the mechanical properties of the scaffold.The closer the mechanical properties of the scaffold are to those of surrounding tissues,the better biological properties it will get.Besides,adequate mechanical stability is needed as the scaffold needs to be well fixed in the target area and it will endure load after surgery.Evaluating the mechanical fixation of the scaffold at the initial stage and the long-term performance of a scaffold for in vivo study is hard,as no facility can be put into the target area for the friction test.This study investigated the mechanical stability of the biomimetic scaffold at the initial stage of implantation by finite element analysis(FEA).According to in vivo study,scaffold could not maintain its original position and would sink 1-2 mm in the target area.The simulation results suggested that mechanical loading is not the main reason for scaffold subsidence.

Law of dynamic deformation of bone

Human bones change dynamically.For a human,bones usually start to form at the 7thweek of the embryonic period and continue to develop until the human has reached skeletal maturity.During this stage of development,themass,density,morphology,hardness and strength of human bones are constantly changing.There are studies that describe the dynamic changes in bone morphology in each part of the human body from the embryonic period to puberty.For example,the femoral neck torsion angle(FNTA)is approximately 30 to 40 degrees at birth,and the angle gradually recedes to 10 to 15 degrees by early adolescence.Infants have a large femoral neck-shaft angle(NSA),and this angle decreases gradually to an angle common in adults.Recent studies have focused on the physiological and molecular mechanisms by which bones sense,transduce,and respond to mechanical loads and have investigated the effects of aging processes on the relationship between cortical bone properties(such as cross-sectional geometry and bone mineral density)and mechanical function.[1,2]

Brave to Advance the Theoretical and Technologica Innovation on the Basis of Orthopedic Practice

Innovation springs from practice, and its soul lies in practical thinking. All human wisdom is a product of practice and needs to be tested during the practice. With the rapid development of medicine, a clinician has to keep pace with the new era, grasp the pulse of the times and innovate. Only in this way, could he or she lead the trend of the new era. Clinical medicine is a practical science and implemented mainly by clinicians, requiring them to explore the truth and pursue technological innovation all the time. At the same time~ as an academic leader, a clinician is encouraged to practice actively, to take risks to innovate, to pursue truth and test truth in the practice, discarding old ideas and correcting wrong theories and technologies. To summarize, a clinician has to push tbrward practice-based innovation of theory and technology to keep up with the pace of the times.

Femoral Condyles Tangential Views： An Effective Method to Detect the Screw Penetration of Femoral Condyles After Retrograde Nailing

Background： Postoperative knee soft tissue irritation is a common complication after retrograde nail fixation of femoral fractures. Distal locking screw prominence is one of the causes for soft tissue irritation. This study aimed to determine whether the use of the femoral condyles tangential views improve the diagnostic accuracy compared with anteroposterior （A-P） view in detecting distal locking screw penetrations during retrograde femoral nailing. Methods： The angle between the sagittal plane and lateral aspect of the condyle and the angle between the sagittal plane and medial aspect of condyle were measured on computed tomography （CT） images. After the angles were measured and recorded, cadaveric femurs were used in a simulated surgical procedure. The retrograde femoral nail was inserted into the femur and placed distal locking screws, which were let1 2, 4, and 6 mm proud of the medial and lateral condyles for each femur. A-P view, lateral condyle tangential view and medial condyle tangential view were obtained. All fluoroscopic images were recorded and sent to three observers blinded to the experimental procedure to determine whether screws penetrated the condyle cortex or not. Results： According to the results of CT scan, the lateral condyle view was 20.88 ＋ 0.98± and the medial condyle view was 40.46 ± 3.14°. In the A-P view, we detected 0% at 2 mm penetration, 16.7% （lateral condyle screw） and 25.0% （medial condyle screw） at 4 mm, and 41.7% （lateral condyle screw） and 58.3% （medial condyle screw） at 6 mm. In the lateral tangential view, we detected 91.7% at 2 mm penetration of the lateral condyle and 100% at 4 mm and 6 ram. In the medial tangential view, we detected 66.7% at 2 mm penetration of the medial condyle and 100% at 4 mm and 6 ram. The femoral condyle tangential views provided significant improvement in detecting screw penetrations at all lengths （2, 4, and 6 mm） compared with the A-P view （P 〈 0.05）. Conclusions： The femoral condyles tangential views increased the accuracy of detecting screw penetrations on the medial and lateral condyles. Routine clinical use of the femoral condyles tangential views has the potential to increase accuracy in detecting distal locking screw penetration during retrograde femoral nailing.

15%Efficiency All-Polymer Solar Cells Based on a Polymer Acceptor Containing B←N Unit

The development of new polymer acceptors strongly paves the power conversion efficiency(PCE)improvement of all polymer solar cells(all-PSCs).Herein,we develop a new polymer acceptor PBN26,which is the alternating copolymer of 2,2′-((2Z,2′Z)-((12,13-bis(2-octyldodecyl)-3,9-diundecyl-12,13-dihydro-[1,2,5]thiadiazolo[3,4-e]thieno[2″,3″:4′,5′]thieno[2′,3′:4,5]pyrrolo[3,2-g]thieno[2′,3′:4,5]thieno[3,2-b]indole-2,10-diyl)bis(methanylylidene))bis(3-oxo-2,3-dihydro-1 H-indene-2,1-diylidene))dimalononitrile and B←N bridged thienylthiazole(BNTT).The optimized all-PSCs device based on PBN26 exhibits a PCE of 15.09%,which is the highest value of the all-PSCs based on B←N-based polymer acceptors at present.Moreover,we also fabricate an all-PSC module with active area of 10 cm2 by blade coating,which exhibits a PCE of 8.78%.These results prove that polymer acceptors containing B←N units are promising for all-PSC device applications.