Damage control orthopaedics: State of the art

Damage control orthopaedics(DCO) originally consisted of the provisional immobilisation of long bone-mainly femur-fractures in order to achieve the advantages of early treatment and to minimise the risk of complications, such as major pain, fat embolism, clotting, pathological inflammatory response, severe haemorrhage triggering the lethal triad, and the traumatic effects of major surgery on a patient who is already traumatised(the "second hit" effect). In recent years, new locations have been added to the DCO concept, such as injuries to the pelvis, spine and upper limbs. Nonetheless, this concept has not yet been validated in well-designed prospective studies, and much controversy remains.Indeed, some researchers believe the indiscriminate application of DCO might be harmful and produce substantial and unnecessary expense. In this respect, too,normalised parameters associated with the acid-base system have been proposed,under a concept termed early appropriate care, in the view that this would enable patients to receive major surgical procedures in an approach offering the advantages of early total care together with the apparent safety of DCO. This paper discusses the diagnosis and treatment of severely traumatised patients managed in accordance with DCO and highlights the possible drawbacks of this treatment principle.

SCI收录的Journal of Pediatric Orthopaedics(《儿科矫形外科学》杂志)介绍

英文刊名：Journal of Pediatric Orthopaedics中文刊名：《儿科矫形外科学》

Evaluating learning and change in orthopaedics: What is the evidence-base?

Learning and change are key elements of clinical governance and are responsible for the progression of our specialty.Although orthopaedics has been slow to embrace quality improvement,recent years have seen global developments in surgical education,quality improvement,and patient outcome research.This review covers recent advances in the evaluation of learning and change and identifies the most important research questions that remain unanswered.Research into proxies of learning is improving but more work is required to identify the best proxy for a given procedure.Learning curves are becoming commonplace but are poorly integrated into postgraduate training curricula and there is little agreement over the most appropriate method to analyse learning curve data.With various organisations promoting centralisation of care,learning curve analysis is more important than ever before.The use of simulation in orthopaedics is developing but is yet to be formally mapped to resident training worldwide.Patient outcome research is rapidly changing,with an increased focus on quality of life measures.These are key to patients and their care.Costutility analysis is increasingly seen in orthopaedic manuscripts and this needs to continue to improve evidence-based care.Large-scale international,multi-centre randomised trials are gaining popularity and updated guidance on sample size estimation needs to become widespread.A global lack of surgeon equipoise will need to be addressed.Quality improvement projects frequently employ interrupted time-series analysis to evaluate change.This technique’s limitations must be acknowledged,and more work is required to improve the evaluation of change in a dynamic healthcare environment where multiple interventions frequently occur.Advances in the evaluation of learning and change are needed to drive improved international surgical education and increase the reliability,validity,and importance of the conclusions drawn from orthopaedic research.

Use of bone marrow derived stem cells in trauma and orthopaedics: A review of current concepts

There is a considerable amount of interest in the futurerole of bone marrow-derived stem cells(BMDSCs) and tissue engineering techniques to manage conditions within the musculoskeletal system. Repair of soft tissue and bone defects, in the early stages of injury, may lead to a reduction in progression of symptoms. Furthermore, troublesome soft tissue injuries that are notoriously fraught with problems either in healing or function, could be augmented with such techniques. The aim of this review paper is to look at the advances in such strategies to tackle these problems and assess how BMDSCs, with the aid of growth factors and scaffolds, are being used in vitro, animal and even human models to treat problems within the field of trauma and orthopaedics. There is plenty of evidence that the results are encouraging and thus gaining momentum toward their use in human studies.

Retraction note to four articles published in World Journal of Orthopaedics

Retraction Note to four articles published in World Journal of Orthopaedics:(1)Iwamoto J,Sato Y,Takeda T,Matsumoto H.Return to sports activity by athletes after treatment of spondylolysis.World J Orthop 2010;1(1):26-30 PMID:22474624 DOI:10.5312/wjo.v1.i1.26;(2)Iwamoto J,Sato Y,Takeda T,Matsumoto H.Effectiveness of exercise for osteoarthritis of the knee:A review of the literature.World J Orthop 2011;2(5):37-42 PMID:22474634 DOI:10.5312/wjo.v2.i5.37;(3)Iwamoto J,Sato Y,Takeda T,Matsumoto H.Analysis of stress fractures in athletes based on our clinical experience.World J Orthop 2011;2(1):7-12 PMID:22474626 DOI:10.5312/wjo.v2.i1.7;and(4)Iwamoto J,Takada T,Sato Y,Matsumoto H.Effect of risedronate on speed of sound in postmenopausal women with osteoporosis.World J Orthop 2013;4(4):316-322 PMID:24147269 DOI:10.5312/wjo.v4.i4.316.These articles[1-4]have been retracted at the request of the Editors-in-Chief as misconduct over authorship of the paper was detected and confirmed.

Traditional Chinese Medicine in orthopaedics—Problems and future direction

Introduction: Orthopaedic surgery includes varieties of injuries and other pathologies. Treatments are complicated while healing and recovery take time. Rehabilitation needs planning and commitment. In the Chinese Communities, traditional medicine has been popular since hundreds of years ago and has remained so in spite of the current advances in medicine. The purpose of this review is to identify the techniques being used in current situations, the indications and problems. Varieties of Traditional Treatments: 1) Topical applications of herbs are very much welcome after joint sprains, inflammatory conditions and even fractures. 2) On the wide area of physical training, the Chinese Tai-chi and Qigong are excellent gentle exercises for personal pursues. These exercises emphasize on body-mind interactions and carry strong philosophical insights. 3) Acupuncture has become standard rehabilitation practice in some hospitals and is getting even more popular in pain control and rehabilitation training after nerve injuries. Problems: Topical agents for pain and inflammation are not totally safe because allergic adverse conditions could happen from time to time. The major concern could be the unawareness of non-unions or delayed unions in fracture cases after herbal applications because the traditional healers are using too little modern assessment tools. Physical trainings and acupunctures are on the whole safe, only that indications are not clearly defined. Future Direction: 1) Concerning the topical agents used for pain and swelling, the essential research requirements include demonstration on the topical agents’ anti inflammatory, angiogenic and cell regenerative effects. The capability of skin penetration needs to be confirmed and a final clinical trial will further confirm the efficacy. 2) Clinical researches trying to obtain evidence on the use of Tai-chi and Qigong on the neuromuscular recovery are plentiful, while their effects on cardiovascular and respiratory health are likewise encouraging. 3) Acupuncture has already become a standard treatment option for pain control, nausea/vomiting and neuromuscular recoveries.

Prophylactic Wound Drainage in Orthopaedics: A Comparative Evaluation of Closed Suction Drainage versus No-Drainage in a Nigerian Teaching Hospital

Background: Surgical wound drainage is practiced routinely by many orthopaedic surgeons despite studies that challenge the practice. Among proponents, the advantages of drainage include prevention of haematoma and/or seroma formation which potentially reduces the chances for infection, prevention of wound swelling, prevention of compartment syndrome and improvement of the local wound environment. Opponents argue that prophylactic wound drainage confers no significant advantages, increases the risk of infection and the need for blood transfusion with the attendant risks of this therapy. Aim: To ascertain if prophylactic drainage of clean orthopaedic wounds confer any significant advantages by evaluating wound and systemic factors in two treatment groups. Patients and Methods: A prospective analysis of 62 patients was undergoing clean orthopaedic procedures. The patients were randomly assigned to a “No drain” (study) group and a “drain” (control) group. Each group had 31 patients. Surgeons were blinded to the randomization process and the evaluation of clinical outcomes. The parameters assessed included pain, superficial wound infection, the need for post-operative transfusion, wound leakage, dressing changes and the surgery-discharge interval. Data was analysed using SPSS statistics version 20 (IBM Corp., New York). Results: There were no significant differences in the demographic data. Femoral fractures were the commonest indication for surgery (43.55%), and plate and screw osteosynthesis was the commonest procedure (48.4% in the drain group and 67.7% in the no-drain group). There was a significantly higher need for post-operative transfusion in the drain group (22.6% against 0%) as well as a significantly prolonged capillary refill time (2.39 + 0.56 secs versus 2.03 + 0.41 secs). Although not statistically significant, there were four cases (12.8%) of superficial wound infection in the drain group and 1 case (3.2%) in the no-drain group. Conclusion: Prophylactic wound drainage confers no significant advantages over no drainage and may contribute to increased treatment costs through an increased post-operative transfusion requirements.

The 5 Hallmarks of Biomaterials Success: An Emphasis on Orthopaedics

Over the past 200 years, there has been significant advancements in the fields of bioengineering and orthopaedics. Investigators, clinicians and manufactures are learning that the success of implant systems is not limited to a single factor, but a combination of variables that must work in unison to provide stability and high survivorship. Innovations continue to advance these fields and include: biomimetic alterations, three-dimensional, patient-specific reconstructions and novel coatings to mitigate aseptic loosening or other pathologies. However, implant systems continue to fail in clinical practice since they do not adhere to key fundamental principles. Therefore, this article is intended to highlight 5 hallmarks of biomaterials that should be considered during design, surgery, and post-operative rehabilitation.

Application of Huangqi Guizhi Wuwu Decoction in Orthopaedics and Traumatology

The Huangqi Guizhi Wuwu Decoction(HQGZWWT)is composed of Huangqi(Astragali Radix),Shaoyao(Paeoniae Radix Alba),Guizhi(Cinnamomi Ramulus),Shengjiang(Zingiberis Rhizoma Recens),and Dazao(Jujubae Fructus)which has various pharmacological anti-inflammatory,analgesic,antioxidant,antitumor,lipid-lowering,and immunity-regulating activities.It has certain advantages in the treatment of orthopaedic diseases,such as cervical spondylosis,scapulohumeral periarthritis,lumbar disc herniation,knee osteoarthritis,rheumatoid arthritis,myofascial pain syndrome,etc.,with outstanding clinical efficacy,few adverse reactions,and high patient compliance.However,modern pharmacological researches on the whole prescription of HQGZWWT are insufficient and the therapeutic targets are not clear which needs further exploration.Besides,this prescription cannot treat ll orthopaedic diseases,so we should adhere to the thinking of four diagnostics in traditional Chinese medicine(TCM),select prescriptions based on syndrome differentiation,closely follow the pathogenesis,innovate and expand its scope of application,reflect the application advantages of this prescription in orthopaedics and traumatology and improve the total clinical efficiency.

Analysis of authors of Chinese Journal of Orthopaedics from 2005 to 2009

Objective To investigate the authors,the institution and endemic distribution of these authors of Chinese Journal of Orthopaedics,and understand the current situation and problems in the field of Orthopaedics.Methods The authors,the

The citation analysis of Chinese Journal of Orthopaedics from 2005 to 2009

Objective To evaluate the academic level and the popularity of Chinese Journal of Orthopaedics from the point view of citation.Methods According to the information of Chinese Medical Citation Index(CMCI),the amount and distribution of

Communication after cancellations in orthopaedics: The patient perspective

AIM: To examine patients' perceptions on communication surrounding the cancellation of orthopaedic operations and to identify areas for improvement in communication.METHODS: A prospective survey was undertaken at a university teaching hospital within the department of Trauma and Orthopaedics. Patients admitted to an acute orthopaedic unit, whose operations were cancelled, were surveyed to assess patient satisfaction and preferences for notification of cancellation of their operations. Patients with an abbreviated mental test score of < 9, patients unable to complete the survey independently, those under 16 years of age, and any patient notified of the cancellation by any of the authors were excluded from this study. Patients were surveyed themorning after their operation had been cancelled thus ensuring that every opportunity was given for the medical staff to discuss the cancellation with the patient. The survey included questions on whether or not patients were notified of the cancellation of their surgery, the qualifications of the person discussing the cancellation, and patient preferences on the process. Satisfaction was assessed via 5-point Likert scale questions.RESULTS: Sixty-five consecutive patients had their operations cancelled on 75 occasions. Fifty-four point seven percent of the patients who had cancellations were notified by a nurse and 32% by a doctor. No formal communication occurred for 13.3% cancellations and no explanation was provided for a further 16%. Patients reported that they were dissatisfied with the explanation provided for 36 of the 75(48%) cancellations. Of those patients who were dissatisfied, 25(69.4%) were notified by a nurse. Twenty-three of the 24(96%) patients notified by a doctor were satisfied with the explanation and that communication. Of those patients who were notified by a nurse 83% patients reported that they would have preferred it if a doctor had discussed the cancellation with them. There was a significant difference in satisfaction between those counselled by a nurse and those notified by a doctor(P < 0.0001).CONCLUSION: Communication surrounding cancellations does not meet patient expectations. Patients prefer to be notified by a doctor, illustrating the importance of communication in the doctor-patient relationship.

Advances of biodegradable magnesium-based implants for orthopaedics

Stainless steel,titanium alloys,cobalt-chromium alloys and other metal materials are the most widely used orthopaedic implants.However,there are still some problems in clinical application,including a mechanical mismatch between metal and bone,inflammation and secondary operation.As a new generation of medical metal materials,magnesium(Mg)and its alloys have attracted much attention due to their excellent biodegradability.Biodegradable Mg-based metals have good mechanical and osteogenic properties,and are expected to become implant materials to treat challenging orthopaedic diseases.However,the rapid corrosion rate is still one of the main challenges restricting its clinical application.Alloy and surface modification are effective methods to control the corrosion rate of Mg alloys.This paper reviews the mechanical and biological properties of biodegradable Mg alloys and the problems when they are applied clinically,emphasizing the latest progress of Mg-based metals in alloying and surface modification.The status of the application of Mg-based implants in orthopaedics are also described.

Nanozymes for biomedical applications in orthopaedics

As the next generation of artificial enzymes,nanozymes have attracted increasing attention in biomedical applications due to their multienzyme-like characteristics,multifunctionalities,low cost,and high stability.By taking advantage of their diverse activities,a growing number of nanozyme-mediated therapeutic strategies have been developed for various diseases.Herein,we provide a brief review of the representative studies of nanozymes,especially in orthopaedic diseases over the past decade,which include arthritis,osteoporosis,bone regeneration,bacteria-associated infections,and osteosarcoma.Moreover,the future potential applications and some major challenges are also discussed.This review would not only provide some instructive views of nanozymes but also promote the development of enzyme-mimetic strategies in orthopaedics.

Research progress and clinical translation of three-dimensional printed porous tantalum in orthopaedics

With continuous developments in additive manufacturing technology, tantalum (Ta) metal has been manufactured into orthopaedic implants with a variety of forms, properties and uses by three-dimensional printing. Based on extensive research in recent years, the design, processing and performance aspects of this new orthopaedic implant material have been greatly improved. Besides the bionic porous structure and mechanical characteristics that are similar to human bone tissue, porous tantalum is considered to be a viable bone repair material due to its outstanding corrosion resistance, biocompatibility, bone integration and bone conductivity. Numerous in vitro, in vivo, and clinical studies have been carried out in order to analyse the safety and efficacy of these implants in orthopaedic applications. This study reviews the most recent advances in manufacturing, characteristics and clinical application of porous tantalum materials.

Advancing orthopaedic trauma care through WhatsApp:An analysis of clinical and non-clinical applications,challenges,and future directions

The integration of WhatsApp,a widely-used instant messaging application(IMA),into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years.This paper explores the multifaceted role of WhatsApp in orthopaedics,focusing on its clinical and non-clinical applications,advantages,disadvantages,and future prospects.The study synthesizes findings from various research papers,emphasizing the growing reliance on mobile technology in healthcare.WhatsApp’s role in orthopaedics is notable for its ease of use,real-time communication,and accessibility.Clinically,it facilitates triage,teleconsultation,diagnosis,treatment,patient advice,and post-operative monitoring.Non-clinically,it supports telemedicine,teleradiology,virtual frac-ture clinics,research,and education in orthopaedic surgery.The application has proven beneficial in enhancing communication among healthcare teams,providing quick responses,and motivating junior physicians.Its use in educational settings has been shown to improve learner’s understanding and patient care.However,the use of WhatsApp in orthopaedics is not without challenges.Risks include the potential spread of misleading information,privacy concerns,and issues with image quality affecting diagnosis and treatment decisions.The paper acknowledges the importance of maintaining professional boundaries and the need for oversight measures to ensure content accuracy.Looking forward,the potential of WhatsApp and similar IMAs in orthopaedics lies in their ability to streamline data collection and retrieval,improve doctor-patient communication,and address challenges like bureaucratic red tape and limited resources.The paper suggests that future orthopaedic practice,particularly in emergency departments,will increasingly rely on such technologies for efficient patient management.This shift,however,must be approached with an understanding of the ethical,legal,and practical implications of integrating social media and mobile technology in healthcare.

Orthopaedics and traumatology in China： current status and future

With the advancement of China＇s social progress and economic growth, and consequent development of international academic exchanges in orthopaedic traumatology, along with many other related professions, the discipline in China has made considerable progress over the past few decades and continues to develop rapidly.

Pharmacist-led interventions to reduce inappropriate drug use in the orthopaedics department in China

As the demand for pharmaceutical services continues to grow, more and more attention has been paid to the pharmaceutical care effect. However, in China, the training pathways and practical work of clinical pharmacy are still in the exploratory stage. In the present review, we aimed to discuss the impact of pharmacist-led interventions in reducing inappropriate drug use in orthopaedics. Results showed clinical pharmacists can assist orthopaedists and nurses in the rational use of medication in all aspects of antibiotic therapy, pain control and anticoagulation therapy. The clinical interventions by pharmacists have greatly reduced medication errors and medical costs. However, there is still a long time to develop pharmacy service, improve the professional quality of pharmacists and enact the Chinese Pharmacist Law.

Damage control orthopaedics in 53 cases of severe polytrauma who have mainly sustained orthopaedic trauma

Objective： To discuss damage control orthopaedics in 53 cases of severe polytrauma who have mainly sustained orthopaedic trauma. Methods： The data of 53 cases of severe polytrauma who had mainly sustained orthopaedic trauma were retrospectively analyzed. And the methods and timing of damage control orthopaedics were discussed in this study. Results： We succeeded in rescuing the lives of all the 53 patients, and 38 patients returned to their former work. Conclusions： Injury Severity Score （ISS90） should be 17 in severe polytrauma patients, but in severe polytrauma patients who have mainly sustained orthopaedic trauma, the ISS90 of bone and joint injuries should be 16. We recommend that primary minimallyinvasive external fracture stabilization should be made for extremities and pelvis in these patients to avoid additional surgical trauma and that definitive secondary fracture care should be performed after medical stabilization for these patients in intensive care unit （ICU）.

Traditional Chinese Medicine and orthopaedics is there room for modern application？

INTRODUCTION Ever since there was human life, the frequency and impact of injuries are real challenges to survival and well-being. Attempts to heal injuries, whether severe or mild, have been major concerns and over time we have accumulated considerable experiences. All traditional medicines, whether European or Oriental, have extensive records of injury treatment and bone-setting. Such records are available in China, from as early as 1000 BC.