Changes of axial length in primary and secondary school students in Yunnan and associated factors / 中国学校卫生

Objective@#To explore the pattern of change of axial length/curvatrue radius ratio (AL/CR) and associated factors in primary and secondary school students in Yunnan, so as to provide scientific basis and prospective guidance for early myopia intervention and control.@*Methods@#A total of 685 students from grades 2 to 3 and grade 7 in 2 cities/counties in Yunnan Province were selected by multi stage stratified random cluster sampling method in 2020. All the participants were followed up twice with questionnaire of myopia related factors, uncorrected distance visual acuity, and refractive parameter measurement from October,2021 and March,2023,respectivelty. The distribution and change of AL/CR in different classes and groups were analyzed, and the influencing factos of AL/CR cumulative progression were explored using generalized linear model.@*Results@#AL/CR ratio in primary school students was (2.95±0.09) at baseline, increased to (2.99±0.11) at the first follow up and (3.04±0.12) at the second follow up. AL/CR ratio in middle school students(3.08±0.13) at baseline, increased to (3.12±0.15) at the first follow up and (3.15±0.14) at the second follow up. The generalized linear model showed that after controlling for environmental factors, ethnicity ( β =-0.017) , cumulative progression of the SE ( β =-0.027) influenced the changes of AL/CR ratio among the primary school students, whereas the changes of AL/CR ratio were associated with baseline AL ( β =-0.005), baseline corneal curvatrue radius ( β =0.032) and cumulative progression of SE( β =-0.035) among middle school students ( P <0.05).@*Conclusions@#The AL/CR ratio of primary and secondary school students in Yunnan can be used to judge different refractive status types, but its variation is not only related to SE progression, but also affected by different ethnic groups and baseline ocular biological parameters. so the value of AL/CR application in assessing the progression of myopia needs to be further confirmed.

Accuracy of the ratio of axial length to corneal radius in the assessment of myopia in children and adolescents / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the accuracy of the ratio of axial length(AL)to the average corneal radius(CR)(AL/CR value, i.e., axial ratio)in assessing myopia in children and adolescents.METHOD:Cross-sectional study. A total of 340 cases(680 eyes)of children and adolescents aged 4-16 years old were collected from the ophthalmology clinic of Shangyu People's Hospital of Shaoxing between January 2022 and October 2022. All patients were subjected to optometry after cycloplegia to obtain spherical equivalent(SE), check and record the patient's AL, average CR, and calculate the AL/CR value.RESULTS:All subjects in this study underwent optometry after cycloplegia, and a total of 609 eyes(89.6%)were found to have myopia(SE≤-0.50 D), 58 eyes(8.5%)with hyperopia(SE≥+0.50 D)and 13 eyes(1.9%)with emmetropia(-0.50 D&#x0026;#x003E;SE&#x0026;#x003E;+0.50 D). There was a statistically significant difference in SE, AL and AL/CR values among different refractive states(P&#x0026;#x003C;0.01), but there was no difference in CR(P&#x0026;#x003E;0.05). All subjects have refractive parameters: SE +8.75--8.75(average -2.25±2.38)D; AL 19.91-27.54(average 24.41±1.22)mm; CR 7.17-8.71(average 7.83±0.27); AL/CR values range from 2.50-3.50(average 3.12±0.14), correlation analysis showed a relative strong negative correlation between SE and AL/CR and AL(r=-0.891, P&#x0026;#x003C;0.01; r=-0.758, P&#x0026;#x003C;0.01), but no significant correlation between SE and CR(r=0.067, P&#x0026;#x003E;0.05), there was a positive correlation between AL and CR(r=0.483, P&#x0026;#x003C;0.01). The linear relationships between SE and AL/CR, AL were SE=45.026-15.162×AL/CR, R2=0.794, SE=33.741-1.474×AL, R2=0.574, respectively. The gold standard was based on the optometric results of cycloplegia, the sensitivity, specificity, misdiagnosis rate and missed diagnosis rate of AL/CR value for myopia were 0.962, 0.839, 0.169, 0.038, respectively, and the accuracy was 94.85%, the Kappa coefficient was 0.742, and the area under the ROC curve was 0.972.CONCLUSION:With high qualitative diagnostic value for myopia and a certain clinical significance for myopia monitoring, AL/CR value can be used to guide myopia prevention and control and other related ophthalmic clinical work.

Fracturas del extremo distal del radio en el esqueleto inmaduro: estudio epidemiológico en el Centro Hospitalario Pereira Rossell / Fraturas da extremidade distal do rádio no esqueleto imaturo: estudo epidemiológico no Hospital Pereira Rossell / Fracture of the distal end of the radius in children: epidemiological study at the Pereira Rossell Hospital Center

Objetivo principal: Conocer la epidemiologia de las fracturas del cuarto distal del radio en el esqueleto en crecimiento y el tratamiento realizado en el CHPR en los años 2017 y 2018. Objetivos específicos: Valorar re-desplazamiento, necesidad de re manipulación, complicaciones, re-fractura. Metodología: Estudio observacional descriptivo retrospectivo. Criterios de inclusión: pacientes de 0 a 14 años con fractura de radio distal (fisaria, metafisaria y suprametafisaria) valorados en el CHPR entre 1 enero del 2017 y 31 diciembre del 2018. Criterios de exclusión: pacientes con radiografía normal, fracturas en miembros con malformaciones, infecciones óseas, patología tumoral maligna o benigna. Obtención de datos: Valoración de radiografías de puño y antebrazo realizadas en el CHPR en 2017 y 18, iniciales y evolutivas. Se analizaron: edad, sexo, fecha fractura, topografía de la fractura, desplazamiento inicial, tratamiento, evolución radiográfica y complicaciones. Resultados: se incluyeron 662 pacientes. Siendo en su mayoría de género masculino (65%), con una media de 9 años, miembro derecho (61%), en los meses de verano (36%). En cuanto a la topografía se evidenció una frecuencia mayor en fracturas tipo rodete y metafisarias (31.72% y 31.57%), seguido por suprametafisaria (18.43%) y fisaria (18.28%). El tratamiento realizado fue ortopédico en el 86.56% de los casos, mientras que quirúrgico fue el 12.84%, en su gran mayoría con alambres de Kirschner (11,2%). El tiempo de inmovilización promedio fue de 6 semanas, con un porcentaje de complicaciones del 14.05% del total de las fracturas. Conclusiones: Se valoraron las características de los pacientes y fracturas de radio distal en el CHPR en los años 2017 y 18, siendo un total de 662 fracturas, en las que su mayoría se realizó tratamiento ortopédico con un índice de complicaciones que ronda el 14%, siendo mayor cuanto mayor es el desplazamiento inicial de la fractura.

Objetivo principal: Conhecer a epidemiologia das fraturas do quarto distal do rádio no esqueleto em crescimento e o tratamento realizado no CHPR nos anos de 2017 e 2018. Objetivos específicos: Avaliar re-deslocamento, necessidade de remanipulação, complicações, refratura. Metodologia: Estudo observacional descritivo retrospectivo. Critérios de inclusão: pacientes de 0 a 14 anos com fratura do rádio distal (fisário, metafisário e suprametafisário) avaliados no CHPR entre 1º de janeiro de 2017 e 31 de dezembro de 2018. Critérios de exclusão: pacientes com radiografias normais, fraturas em membros com malformações, osso infecções, patologia tumoral maligna ou benigna. Coleta de dados: Avaliação das radiografias de punho e antebraço realizadas no CHPR em 2017 e 18, inicial e evolutiva. Foram analisados: idade, sexo, data da fratura, topografia da fratura, deslocamento inicial, tratamento, evolução radiográfica e complicações. Resultados: 662 pacientes foram incluídos. Sendo maioritariamente do sexo masculino (65%), com média de 9 anos, membro direito (61%), nos meses de verão (36%). Em relação à topografia, foi evidenciada maior frequência nas fraturas da borda e metafisárias (31,72% e 31,57%), seguidas das suprametafisárias (18.43%) e fisárias (18.28%). O tratamento realizado foi ortopédico em 86.56% dos casos, enquanto cirúrgico em 12.84%, sendo a maioria com fios de Kirschner (11,2%). O tempo médio de imobilização foi de 6 semanas, com percentual de complicações de 14.05%. Conclusões: Foram avaliadas as características dos pacientes e fraturas do rádio distal no CHPR nos anos de 2017 e 18, com um total de 662 fraturas (0,9 por dia), em que a maioria foi submetida a tratamento ortopédico com índice de complicações que fica em torno de 14%, sendo maior quanto maior for o deslocamento inicial da fratura.

Title: Fractures of the distal end of the radius in the immature skeleton. Epidemiological study at the Pereira Rossell Hospital Center. Main objective: To know the epidemiology of fractures of the distal fourth of the radius in the growing skeleton and the treatment carried out in the CHPR in the years 2017 and 2018. Specific objectives: To assess re-displacement, need for re-manipulation, complications, re- fracture. Methodology: Retrospective descriptive observational study. Inclusion criteria: patients aged 0 to 14 years with distal radius fracture (physeal, metaphyseal and suprametaphyseal) evaluated at the CHPR between January 1, 2017 and December 31, 2018. Exclusion criteria: patients with normal radiographs, fractures in limbs with malformations, bone infections, malignant or benign tumor pathology. Data collection: Assessment of fist and forearm X-rays performed at the CHPR in 2017 and 18, initial and evolutionary. The following were analyzed: age, sex, fracture date, fracture topography, initial displacement, treatment, radiographic evolution and complications. Results: 662 patients were included. Being mostly male (65%), with an average of 9 years, right limb (61%), in the summer months (36%). Regarding the topography, a higher frequency was evidenced in rim and metaphyseal fractures (31.72% and 31.57%), followed by suprametaphyseal (18.43%) and physeal (18.28%). The treatment performed was orthopedic in 86.56% of the cases, while surgical was 12.84%, mostly with Kirschner wires (11.2%). The average immobilization time was 6 weeks, with a percentage of complications of 14.05%. Conclusions: The characteristics of the patients and fractures of the distal radius in the CHPR in the years 2017 and 18 were evaluated, with a total of 662 fractures (0.9 per day), in which the majority underwent orthopedic treatment with an index of complications that is around 14%, being greater the greater the initial displacement of the fracture.

Radiological Evaluation of Volar Cortical Angle in the Anatolian Population / Evaluación Radiológica del Ángulo Cortical Volar en la Población Anatoliana

SUMMARY: Distal radius fractures are the most common fractures of the upper limb. The most commonly used method in the repair of these fractures is volar locking plates. Recently, the frequency of removal of volar locking plates after surgery has increased. There are many factors in its reduction. Anatomically, incompatibility of the distal end of the radius with volar locking plates is one of them. In previous studies, different volar cortical angle (VCA) values were found in other races. For this reason, this study aimed to determine the mean values by making VCA measurements of the Anatolian population. The study was designed retrospectively. In the study, measurements were made on computed tomography (CT) images of the distal end of the radius of 53 men and 28 women. Radial width, intermediate volar angle, and radial volar angle were measured in the images. On average, the radius width was 23.35±1.96 mm, and the intermediate volar angle was 26.02±.3.83°, radial volar angle was 24±3.07°. Radial width, intermediate volar angle, and radial volar angle differed significantly by gender (p<0.001). A significant correlation was found between radius width, intermediate volar angle, and radial volar angle values (p<0.001). It has been determined that the Anatolian population has a different VCA value than the European, Asian, and other populations. When using volar locking plates in distal radius fracture surgery, volar locking plates should be selected by considering the average values of the races.

Las fracturas del radio distal son las fracturas más comunes del miembro superior. El método más utilizado en la reparación de estas fracturas son las placas de bloqueo volar. Recientemente, ha aumentado la frecuencia de extracción de placas de bloqueo volar después de la cirugía. Existen muchos factores en su reducción y anatómicamente, la incompatibilidad de la extremidad distal del radio con las placas de bloqueo volar es una de ellas. En estudios anteriores, se encontraron diferentes valores del ángulo cortical volar (VCA) en otras grupos. Por esta razón, este estudio tuvo como objetivo determinar los valores medios, realizando mediciones de VCA de la población de Anatolia. El estudio fue diseñado de manera retrospectiva. En el estudio, se realizaron mediciones en imágenes de tomografía computarizada (TC) de la extremidad distal del radio de 53 hombres y 28 mujeres. En las imágenes se midieron el ancho radial, el ángulo volar intermedio y el ángulo volar radial. En promedio, el ancho del radio fue de 23,35 ± 1,96 mm, el ángulo volar intermedio fue de 26,02 ± 3,83° y el ángulo volar radial fue de 24 ± 3,07°. El ancho radial, el ángulo volar intermedio y el ángulo volar radial difirieron significativamente según el sexo (p<0,001). Se encontró una correlación significativa entre los valores del ancho del radio, el ángulo volar intermedio y el ángulo volar radial (p<0,001). Se ha determinado que la población de Anatolia tiene un valor de VCA diferente al de las poblaciones europeas, asiáticas y otras. Cuando se utilizan placas de bloqueo volar en cirugía de fractura de la extremidad distal del radio, las placas deben seleccionarse considerando los valores promedio de los individuos de diferentes grupos.

Radial Nerve Supracondylar Block Versus Fracture Hematoma Block. Comparison of Their Efficacy in Cases of Fractures of the Distal Third of the Radius / Bloqueio supracondilar de nervo radial versus bloqueio de hematoma de fratura. Comparativo de sua eficácia em casos de fraturas do terço distal do rádio

Abstract Objective The present study compares the analgesic efficacy of two techniques to perform non-surgical reduction: fracture hematoma block and radial nerve supracondylar block. Methods Forty patients with fractures of the distal third of the radius, who required reduction, were selected in a quasi-randomized clinical trial to receive one of the anesthetic techniques. All patients signed the informed consent form, except for those who did not wish to participate in the study, had neurological injury, had contraindication to the procedure in the emergency room, or with contraindication to the use of lidocaine. To measure analgesia, the numerical pain rate scale was used at four different moments: preblock, postblock, during reduction, and after reduction; then three differences were calculated: the first between before and after blocking; the second between during reduction and after blockade; and the third between before blocking and after reduction. Results The fracture hematoma and supracondylar block groups showed the following mean values, respectively: 3.90 (1-10) and 3.50 (-6-10) in difference 1; 4.35 (-5-10) and 5.00 (-3-10) in difference 2; and 4.65 (1-10) and 3.80 (-3-10) in difference 3. Conclusion Both techniques proved to be efficient for analgesia, with mild superiority of hematoma block, but without statistical significance.

Resumo Objetivo O estudo compara a eficácia analgésica de duas técnicas para realizar redução incruenta: o bloqueio de hematoma da fratura e o bloqueio supracondilar de nervo radial. Métodos Quarenta pacientes com fraturas do terço distal do rádio, que necessitassem redução, foram selecionados em um ensaio clínico quasi-randomizado, para receber uma das técnicas anestésicas. Todos os pacientes assinaram o termo de consentimento ou assentimento, com exceção daqueles que não desejassem participar do estudo, tivessem lesão neurológica, com contraindicação ao procedimento na sala de emergências, ou com contraindicação ao uso da lidocaína. Para aferir a analgesia foi utilizada a escala numérica da dor em quatro momentos distintos: pré-bloqueio, pós-bloqueio, durante a redução e após a redução; em seguida, foram calculadas três diferenças: a primeira entre antes e após o bloqueio; a segunda entre durante a redução e após o bloqueio; e a terceira entre antes do bloqueio e após a redução. Resultados Os grupos do bloqueio de hematoma de fratura e bloqueio supracondilar apresentaram respectivamente os seguintes valores médios: 3.90 (1-10) e 3.50 (-6-10) na diferença 1; 4.35 (-5-10) e 5.00 (-3-10) na diferença 2; e 4.65 (1-10) e 3.80 (-3-10) na diferença 3. Conclusão As duas técnicas se provaram eficientes para analgesia, com discreta superioridade do bloqueio de hematoma, mas sem significância estatística.

A STUDY OF OUTCOMES OF DISTAL END RADIUS FRACTURES MANAGED BY EXTERNAL FIXATOR

BACKGROUND: Fractures of the distal radius continue to be the most common skeletalinjuries treated by the orthopedic surgeon. Unstable fractures of the distal part of the radiushave shown an inherent tendency towards loss of reduction after non-operative treatment.External skeletal fixation has been popular for the treatment of displaced, unstable fracturesof the distal part of the radius because it combines a minimally invasive procedure withreduction by ligamentotaxis.METHOD: A retrospective study of 70 patients of fracture of distal end radius treated withexternal fixator came to OPD at tertiary care hospital during the study period of 2 years fromJuly 2020 to June 2022, were included in the study after obtaining permission frominstitutional review board.RESULT: All 70 patients were assessed in the form of the functional and radiologicaloutcome based on Subjective evaluation by Modified Demerit Point System of Gartland andWerley (Functional) and Lidstorm and Frykman Criteria modified by Sarmiento(Anatomical). We obtained “excellent” results in 47.15%; “good” in 35.72% cases; “fair” in14.28% and “poor” in 2.85% cases with a mean G & W score of 6.35.CONCLUSION: Finding of this study shows that external fixator is an easy, cost effective,reliable and most suitable treatment in treating intraarticular and unstable extraarticular distalend radial fractures by the principle of ligamentotaxis.

Fracture in Humeroradial Synostosis: Description of Two Clinical Cases / Fratura em sinostose rádio-umeral: Descrição de dois casos clínicos*

Abstract Synostosis is a generic term to indicate the union of two originally separated bones. At the elbow, humeroradial or longitudinal synostosis causes significant disability, which varies depending on hand function, elbow positioning, adjacent joints mobility and contralateral limb function. It is estimated that, to date, a little more than 150 patients have been described with this deformity, which is more common in subjects with deficient ulnar formation or affected by conditions such as Antley-Bixler and Hermann syndromes. The lack of the elbow joint, with the formation of a longer bone due to humerus-radius fusion, results in stiffness. As such, it is assumed that fractures in this topography are not uncommon. However, since synostosis is rare, this lesion was only described twice in the literature. We report two patients with a fracture of the single bone formed by a humeroradial synostosis and Bayne type-IV ulnar formation failure. Both patients were treated surgically with success. We emphasize the need for adequate treatment to not compromise the daily activities of patients who are adapted to their deformity, thus avoiding worsening the function of a previously affected limb.

Resumo Sinostose é um termo genérico utilizado para indicar a união de dois ossos originalmente separados. No cotovelo, a sinostose rádio-umeral ou longitudinal causa importante incapacidade, que varia a depender da função da mão, da posição do cotovelo, da mobilidade das articulações adjacentes e da função do membro contralateral. Estima-se que um pouco mais de 150 pacientes foram descritos até hoje com essa deformidade, sendo mais frequente em portadores de deficiência de formação ulnar ou podendo fazer parte de síndromes como de Antley-Bixler e de Hermann. Devidoàrigidezcausadapelaausênciadaarticulaçãodocotovelo,queresultana formação de um osso mais longo com a fusão do úmero no rádio, presume-se que fratura nessa topografia não seja incomum. No entanto, pela raridade dessa patologia, tal lesão apresenta apenas duas descrições prévias na literatura. Relatamos os casos de dois pacientes com fratura do osso único formado pela sinostose entre o úmero e o rádio portadores de falha de formação ulnar do tipo IV de Bayne. Ambos os pacientes foram tratados de forma cirúrgica e evoluíram bem. Salientamos a necessidade do tratamento adequado para não comprometer as atividades da vida de um paciente já adaptado à deformidade, evitando piorar a função de um membro já alterado.

Radiographic morphometry of the distal end radius in Anatolian population / Morfometría radiográfica del extremo distal del radio en la población de Anatolia

SUMMARY: Distal radius fractures are one of the most common orthopedic injuries encountered by orthopedic surgeons. Correction of dorsal tilt and radial height is essential to restore normal biomechanics of the wrist joint. Comprehensive knowledge of the morphometry of the distal radius of the local population becomes critical for the treating surgeon. This study aims to report the morphometry of the distal radius in the Anatolian population and compare it with similar studies in other races and humans. Radiographs of one hundred and twenty-four people were included in the study. Four radiological parameters were examined on all radiographs: radial height, radial tilt, ulnar variance, and palmar tilt. Radial tilt was 23.35°±1.96; palmar tilt was 15.7°±2,87 radial height (mm) was 10.55±4.34, ulnar variance (mm) was 0.32±1.79. The highest rate of negative ulnar variance was found. According to the study's results, reference data varying by race for anatomical fit should be considered in treating DER injuries.

Las fracturas de la parte distal del radio son probablemente las lesiones ortopédicas más comunes que encuentran los cirujanos ortopédicos. La corrección de la inclinación dorsal y la altura radial es esencial para restaurar la biomecánica normal de la articulación de la muñeca. El conocimiento integral de la morfometría del radio distal de la población local es importante para el cirujano tratante. Este estudio tuvo como objetivo reportar la morfometría de la parte rdistal del radio en la población de Anatolia y compararla con estudios similares en otras razas y humanos. Se incluyeron ciento veinticuatro radiografías simples consecutivas de la articulación de la muñeca. Se examinaron cuatro parámetros radiológicos: altura radial, inclinación radial, variación ulnar e inclinación palmar. El ángulo de inclinación radial fue de 23,35±1,96; el ángulo de inclinación palmar fue de 15,7±, la altura radial (mm) fue de 10,55±4,34, la varianza ulnar (mm) fue de 0,32±1,79. Se encontró la tasa más alta de varianza ulnar negativa (43,5%). Los resultados de este estudio deben tenerse en consideración al tratar fracturas de la parte distal del radio, con datos de referencia que varían según la raza para el ajuste anatómico.

Exploration and consideration on establishing a core outcome set of Traditional Chinese Medicine clinical trials in distal radius fracture / 中国骨伤

There are inconsistencies in treatment outcomes, measurement instruments, and criteria for assessing clinical effectiveness in studies related to distal radius fractures (DRF), resulting in potential biases and failing to provide high-quality clinical evidence. To address these challenges, international researchers have reached a consensus on developing the core outcome indicator set for distal radius fractures(COS-DRF). However, it's important to note that the existing COS-DRF framework could not reflect the unique characteristics of Traditional Chinese Medicine (TCM) treatment. Currently, there are no established standards for treatment outcomes and measurement instruments specific to TCM clinical research, nor has a COS-DRF been established for TCM clinical studies in China. In light of these gaps, our research team aims to construct a core set of treatment outcomes for TCM clinical research on distal radius fractures. This involves compiling a comprehensive list of treatment outcomes and measurement instruments, initially derived from a thorough literature review and expert consensus, which will then undergo further refinement and updates based on real-world clinical experiences, incorporating feedback from 2 to 3 rounds of expert consensus or Delphi questionnaire surveys. Our goal is to establish a COS-DRF or CMS-DRF that aligns with the principles and practices of TCM, and provide high-quality evidence for clinical practice.

Analysis of the causes of soft tissue complications after volar locking plate for the treatment of dorsal displaced distal radius fractures / 中国骨伤

OBJECTIVE@#To investigate the causes of soft tissue complications in patients with dorsal displacement distal radius fractures (DRF) after volar locking plate surgery.@*METHODS@#From July 2016 to May 2021, 112 patients with dorsal displacement DRF were treated with volar locking plate surgery, including 45 males and 67 females. The average age was (46.24±10.08) years old, ranging from 18 to 85 years old. According to whether there were soft tissue complications after operation, they were divided into complication group (40 cases) and non complication group (72 cases). Compared with preoperation, the radial metacarpal inclination and ulnar deflection angle, wrist flexion activity and dorsal extension activity, and grip strength of patients after operation were significantly improved (P<0.05). Compared with the non complication group, the proportion of patients in the complication group whose age was>60 years, body mass index (BMI) more than 30 kg·m-2, smoking, diabetes, fracture type C, open fracture and operation time more than 90 min was higher (P<0.05). The age, BMI, smoking, diabetes, fracture AO classification, fracture type and operation time were analyzed by multifactor Logistic regression to determine the independent risk factors affecting the occurrence of postoperative soft tissue complications of patients, establish a nomogram prediction model, and evaluate the model.@*RESULTS@#At the latest follow-up, the excellent and good rate of wrist joint function recovery was 83.93% (94/112), and the excellent and good rate of fracture reduction was 84.82% (95/112). Multivariate Logistic regression analysis showed that age more than 60 years old, diabetes, fracture type C, open fracture and operation time more than 90 min were independent risk factors for postoperative soft tissue complications (P<0.05). The receiver operating characteristic (ROC), calibration curve and clinical decision curve of the nomogram prediction model showed discrimination, accuracy and validity were good.@*CONCLUSION@#Age more than 60 years, diabetes mellitus, fracture type C, open fracture, and operation time more than 90 min are all independent risk factors for soft tissue complications after DRF volar plate fixation. In clinical treatment, perioperative soft tissue management should be done in such patients to prevent complications.

Short-term efficacy of digitally-assisted traditional Chinese medicine manual reduction combined with 3D printed splint in the treatment of AO type-A distal radius fractures / 中国骨伤

Objective To explore the short-term efficacy of digitally-assisted traditional Chinese medicine manual reduction combined with 3D printed splint in the treatment of AO type-A distal radius fractures, and explore the quantification of traditional Chinese medicine manual reduction and personalized improvement of splinting. Methods The clinical data of 50 patients with AO type-A distal radius fractures, who received treatment at the outpatient department of Cangzhou Integrated Traditional Chinese and Western Medicine Hospital in Hebei Province, were retrospective analyzed. The patient cohort included 22 females and 28 males, with ages ranging from 25 to 75 years old. Among them, 27 cases presented with distal radius fractures on the left side, and 24 cases on the right side. The patients were categorized into two groups: treatment group (n=25) and control group(n=25). There were 13 males and 12 females in the treatment group, with an average age of (56.2±5.5) years old. Treatment approach for this group involved several steps. Initially, Mimics Research software was used to conduct comprehensive analysis of complete CT data from the affected limb, resulting in the creation of a three-dimensional model. Subsequently, 3D models of the bones and skin contours, stored as STL format files, were imported into the Materialise Magics 23.0 software for model processing and repair. This facilitated the simulation of reduction and recording of displacement data, effectively generating a "digital prescription" to guide and quantify traditional Chinese medicine manipulation procedures. Finally, a personalized 3D printed splint was applied for fixation treatment. There were 15 males and 10 females in the control group, with an average age of (53.32±5.28) years old. These patients were treated with manualreduction combined with traditional splinting. The clinical efficacy of the two groups was assessed in terms of fracture reduction quality, fracture healing time, Gartland-Werley wrist joint score and X-ray parameters (palminclination angle, ulnar deviation angle, radius height) at 6 weeks post-operatively. Results The treatment group exhibited a shorter duration for achieving clinical healing compared to the control group (P<0.05). Six weeks post-operatively, the treatment group demonstrated higher wrist joint function scores, and a higher proportion of excellent and good outcomes than the control group(P<0.05). The treatment group was superior to the control group in terms of imaging parameters 6 weeks post-operatively (P<0.05). Conclusion By quantifying skin contours through digital simulation prescription reduction, a personalized 3D printed splint is developed to effectively stabilize fractures, enhancing localized fixation while ensuring greater adherence, stability, and comfort. This innovative approach offers personalized treatment for AO type-A distal radius fractures and presents a novel, precise treatment strategy for consideration.

Dorsal plate assisted fixation of dorsal lunate fossa fracture of distal radius / 中国骨伤

OBJECTIVE@#To explore clinical efficacy of dorsal plate assisted fixation of dorsal lunate fossa fracture block of distal radius.@*METHODS@#From January 2019 to January 2022, 30 patients were treated with dorsal plate assisted fixation of dorsal lunate fossa fracture of distal radius, including 13 males and 17 females, aged from 42 to 68 years old with an average of (48.7±5.6) years old;According to Doi fracture classification, 24 patients were type 3 blocks and 6 patients were type 4 blocks. The degree of palmar angle of anterior and posterior distal radius was fixed by dorsal steel plate during operation. Fracture healing and functional recovery of wrist were observed after operation. Functional evaluation was performed by Gartland and Werley scoring system at 12 months after operation.@*RESULTS@#All patients were followed up from 12 to 13 months with an average of (11.3±0.9) months. All fractures healed for 4 to 5 months with an average of(4.7±0.8) months. Median palpal inclination of anterior and posterior distal radius fixed by dorsal plate was 5.30°(4.85°, 6.03°), 12.45°(11.98°, 13.43°) respectively, and had statistical difference( P<0.01). Gartland and Werley scores was (1.1±0.4) at 12 months afteropertaion, and 27 patients got excellent result and 3 good.@*CONCLUSION@#Dorsal plate assisted fixation of dorsal lunate fossa fractures is beneficial to reduction and stabilization of displaced dorsal fractures and restoration of palmar inclination.

Analysis of refractive parameters and theirs correlation with spherical equivalent in preschool children aged 3 to 6 years / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the distribution of refractive parameters and theirs correlation with spherical equivalent(SE)in preschool children aged 3 to 6 years, and evaluate the accuracy of each screening index in diagnosing refractive errors.METHODS: Cross-sectional study. A total of 791 preschool children, ranging from 3 to 6 years old, who consented to undergo mydriatic refraction were selected. Axial length(AL), corneal refractive power(K), and SE were measured after microcoria optometry and mydriatic optometry. Additionally, the corneal radius of curvature(CR)and the axial length/corneal radius of curvature(AL/CR)ratio were calculated.RESULTS: A total of 791 students participated in the study, out of which 400(50.6%)were male and 391(49.4%)were female. The mean values for AL, CR, AL/CR, and SE were 22.62±0.94mm, 7.81±0.29mm, 2.90±0.09, and +1.95±1.31D, respectively. AL, CR, and AL/CR increased with age. AL and CR were significantly higher in males than in females(all P&#x003C;0.001), while there was no statistically significant difference between AL/CR and SE in males and females(P=0.82, 0.19). The correlation coefficients of SE and AL/CR, AL and CR were -0.86, -0.50 and 0.16, respectively. The results of multiple linear regression analysis indicate that for each unit increase in AL/CR, there was a corresponding shift of 10.91 towards myopia in SE. The sensitivity of AL/CR in screening for myopia was 94.44%, with a specificity of 90.46% and a Youden index of 0.84. For screening myopia under microcoria optometry, the sensitivity was 100%, with a specificity of 66.09% and a Youden index of 0.66. The area under the curve was 0.967 and 0.809 when the ROC curves were plotted using AL/CR and AL as indicators for screening myopia, respectively.CONCLUSION: For large group screening activities where mydriatic optometry is not feasible, AL/CR is better for evaluating refractive status and identifying children with myopia and hyperopia reserve that are lower than normal for their age, compared to AL and microcoria optometry.

Prevalence and risk factors of tessellated fundus in Tianjin Medical University students / 中华眼底病杂志

Objective:To investigate the prevalence and risk factors of tessellation fundus (TF) among Tianjin Medical University students with different refractive statuses.Methods:A cross-sectional study. From September to December 2019, 346 students from Tianjin Medical University were randomly selected and underwent slit-lamp examination, non-cycloplegic auto-refraction, subjective refraction, best-corrected visual acuity, ocular biometric measurement, and non-dilation fundus photography. The differences in the prevalence of TF in basic characteristics and ocular biometric parameters were compared. Based on the equivalent spherical (SE), refractive status was divided into the non-myopia group (SE>-0.50 D) and the myopia group (SE≤-0.50 D). The myopia group was further divided into mild myopia group (-3.00 D<SE≤-0.50 D), moderate myopia group (-6.00 D<SE≤-3.00 D), and high myopia group (SE≤-6.00 D). According to the axis length (AL), the subjects were divided into AL<24 mm group, 24-26 mm group, and >26 mm group. The logistic regression was used to analyze the risk factors affecting TF. Trend tests were performed for each risk factor and TF.Results:Of the 346 subjects, 324 (93.6%, 324/346) were myopia, of whom 73 (21.1%, 73/346), 167 (48.3%, 167/346), and 84 (24.3%, 84/346) were mild myopia, moderate myopia, and high myopia, respectively; 22 (6.4%, 22/346) were non-myopia. There were 294 (85.0%, 294/346) students with TF in the macula, including 9 (40.91%, 9/22), 58 (79.45%, 58/73), 145 (86.83%, 145/167), and 82 (97.62%, 82/84) in non-myopia, low myopia, moderate myopia, and high myopia group, respectively; 52 (15.0%, 52/346) students were without TF in the macula. There were statistically significant gender differences ( χ2=4.47), SE ( t=6.29), AL ( t=-8.29), anterior chamber depth ( Z=-2.62), lens thickness ( Z=-2.23), and average corneal radius ( Z=-3.58) between students with and without TF in the macula ( P<0.05). Spherical equivalent and axial length were independent risk factors for TF and its severity ( P≤0.001). With an increasing degree of myopia, and increasing axial length, the risk of TF increased ( P for trend<0.001). Conclusions:The prevalence of TF is 85.0% among Tianjin Medical University students. TF is detected in the fundus of no myopia, mild myopia, moderate myopia and high myopia. The degree of myopia is higher, the AL is longer, the possibility of TF is higher.

Clinical efficacy of anterior radius head fracture combined with lateral ligament complex injury / 中华骨科杂志

Objective:To investigate the operation efficacy of anterior radius head fracture combined with lateral ligament complex injury.Methods:The patients with radial head fracture admitted from September 2017 to August 2021 were retrospectively analyzed, 51 males and 54 females, average age of 38.84±13.63 years (range of 16-70 years). Based on the radial head fractures of Mason classification of type II, the cases involving the anterior radius head fracture were divided into three subtypes according to the number of fracture blocks and the type of displacement: type A (53 cases): one part of the anterior radius head collapse fracture; type B (50 cases): two or more parts of the anterior radial head collapse fracture; type C (2 cases): anterior radius head dissociated and displaced fracture. All fractures were treated with open reduction and internal fixation. Among them, the lateral ligament complex of type B were elongated due to the injury but the continuity existed. Therefore, the lateral ligament complex in 21 cases were not repaired in the early period (unrepaired group); in recent years, 29 cases repaired the lateral ligament complex (repair group). The postoperative efficacy was evaluated by elbow range of motion, table-top relocation test, Mayo score, and Broberg Morrey score. the patients were evaluated at final follow-up, except table-top relocation test was recorded according to the actual completion time.Results:All operations were successfully completed. The mean follow-up was 14.08±1.52 months (range of 12-18 months). Type A: the flexion and extension range was 115.70°±6.35°; the completion time of the table-top relocation test was 75.68±11.90 days; the Mayo score was 93.72±2.40 point, and the Broberg Morrey score was 92.89±2.28 point. Type B: lateral ligament repair group (repaired group) 29 cases and unrepaired lateral ligament group (unrepaired group) 21 cases. The flexion and extension range of elbow in repaired group was 112.1°±4.4°, which was better than that in unrepaired group 105.8°±3.7° ( t=5.31, P<0.001). The completion time of table-top relocation test was 77.72±6.51 days in repaired group and 104.29±18.45 days in unrepaired group ( t=6.32, P<0.001). The Mayo score of the repaired group was 90.21±5.88 points and that of the unrepaired group was 87.14±5.26 points ( t=1.90, P=0.063), and there was no significant difference between the two groups. Broberg Morrey score of 90.93±6.43 points in the repaired group was better than 86.95±6.37 points in the unrepaired group ( t=2.17, P=0.035). Type C for 2 patients, the flexion and extension range of elbow were 107°and 106°; the completion time of table-top relocation test were 82 days and 98 days; the Mayo scores were 91 point and 87 point; Broberg Morrey scores were 93 point and 85 point. There was a patient developed myositis ossificans in unrepair group of tybe B. Conclusion:The elbow joint is stable when one part of the anterior radius head collapse fracture; there is a degree of instability in the elbow when two or more parts of the anterior radial head collapse fractures suggest to repair the lateral ligament complex. The elbow joint is extremely unstable when anterior radius head dissociated and displaced fractures, the lateral ligament complex should be repaired in time.

The short-term outcomes of congenital radioulnar synostosis patients treated with modified reverse Sauvé-Kapandji technique / 中华骨科杂志

Objective:To evaluate the short-term outcomes of modified reverse Sauvé-Kapandji technique in treating the congenital radioulnar synostosis.Methods:A retrospective analysis was performed on the data of 46 congenital radioulnar synostosis patients were treated with modified reverse Sauvé-Kapandji technique in Beijing Jishuitan Hospital from December 2018 to January 2020, including 38 males (45 sides), 8 females (9 sides), average age 6.6 (3.2, 8.1) years old. All the patients were classified as type III according to Cleary-Omer classification and were followed up for at least 1 year. All the patients were treated with same operation, in which 1.5 cm shaft was resected at the proximal radius, allogeneic graft tendon was used as interposition, and rotational osteotomy was performed in the middle of the ulnar shaft, with intramedullary needle or Kirschner wire fixation, depending on the intramedullary width of ulnar shaft. The radiological features were collected and recorded preoperatively and at the latest follow-up, together with the following evaluation indexes: modified Morrey tasks score, subjective function score, active forearm rotation range without compensation, active forearm rotation range with wrist joint compensation, and active forearm rotation range with wrist and shoulder joint compensation.Results:All patients were followed up for 14.6±3.4 months (range, 11.2-19.5 months). The uncompensated forearm rotation Angle was 0.0°±0.0° before surgery and 62.3°±23.7° after surgery. The forearm rotation angles before and after surgery with wrist compensatory surgery were 86.9°±29.4° and 133.2°±27.9°, respectively. The forearm rotation angles before and after surgery with wrist and shoulder joint compensatory surgery were 205.2°±42.7° and 245.2°±35.8°, respectively. There were statistically significant differences in the above indexes before and after surgery ( t=8.71, P<0.001; t=2.54, P=0.030; t=5.05, P<0.001). Ulnar union was observed in 31 patients (37 sides) after the operation, and the union duration was 6.1±2.3 months. There were 15 patients (17 sides) ulnar shafts faced with postoperative delayed union, the union duration was 8.4±1.6 months and were recovered after prolonging brace fixation and orthopedic shock wave treatment. The scores of subjective function and improved Morrey tasks of the 43 sides with good pseudo-joint were 12.1 (0.0, 20.8) and 0.7 (0.0, 1.0) points, respectively, which were improved compared with 33.9 (25.0, 41.6) and 3.2 (2.0, 4.0) points before surgery. The differences were statistically significant ( Z=-2.44, P=0.015; Z=-2.83, P=0.005). There were 11 forearms with postoperative pseudo-joint re-ankylosis, the average forearm rotation ranges without compensation was 11.4°±10.5°(range, 0°-30°), the average forearm rotation ranges with wrist compensation was 98.6°±15.9° (range, 80°-120°), the average forearm rotation ranges with wrist and shoulder compensation was 231.7°±16.9° (range, 210°-255°). The average subjective function scores was 26.7 (8.3, 39.6). The average modified Morrey tasks scores was 1.2 (0, 2), and there were no other postoperative complications. Conclusion:The reverse Sauvé-Kapandji technique showed a satisfying short-term outcome, and can be a new choice of treatment for type III congenital radioulnar synostosis.

Common types and treatment of elbow injuries in skiing or snowboarding / 中华创伤骨科杂志

Objective:To investigate the common types of elbow joint injuries in skiing or snowboarding and their treatment.Methods:A retrospective study was conducted to analyze the data of 90 patients with elbow injury caused by skiing or snowboarding who had been admitted to Department of Upper Limbs, Sichuan Orthopaedic Hospital from February, 2015 to February, 2022. There were 53 males and 37 females with an age of (31.8±8.4) years. The types of elbow injury, visual analogue scale (VAS), range of motion (ROM) of the elbow and Mayo elbow performance score (MEPS) of the patients were recorded before treatment and at the last follow-up.Results:Of the patients, 18 were treated conservatively (3 simple Mason type I radial head fractures and 15 O'Driscoll type I coronal process fractures) and 72 surgically. Their follow-up time was (31.3±18.7) months. The fractures all healed by the time of the last follow-up. Simple elbow fracture was observed in 63 patients, simple elbow dislocation in 2 patients, fracture plus dislocation in 25 patients. The posterior dislocation was the most common (22 cases). Among the elbow fractures, radial head fracture occurred in 27 patients, ulnar coronoid process fracture in 41 patients, proximal ulnar fracture in 13 patients, and distal humeral fracture in 28 patients. Collateral ligament injuries were complicated in 65 cases. In the patients undergoing conservative treatment, their VAS, elbow ROM, and MEPS were all improved significantly from 4.7±1.4, 92.2°±14.4° and 63.9±6.5 before treatment to 0.4 (0,1.0), 110.6°±0.6°, and 92.2±3.9 at the last follow-up ( P<0.05); in the patients undergoing surgical treatment, their VAS, elbow ROM, and MEPS were also all improved significantly from 5.6±1.7, 24.3°±18.4°, and 26.9±12.2 before surgery to 0.6 (0,1.0), 97.4°±14.0° and 86.6±7.1 at the last follow-up ( P<0.05). After surgery, 8 patients presented with neurological symptoms and 7 patients developed heterotopic ossification. Conclusions:In skiing or snowboarding, the coronoid process of the ulna is the most vulnerable to fracture. In the elbow injuries due to skiing or snowboarding, posterior dislocation is the most common type which is often accompanied by injuries to the medial and lateral collateral ligaments. For simple Mason type Ⅰ radial head fractures and O'-Driscoll type Ⅰ coronoid process fractures in which the elbow is stable, conservative treatment can be adopted; surgical treatment is indicated for the other injuries.

Operative versus nonoperative treatment of isolated Mason type Ⅱ radial head fracture / 中华创伤骨科杂志

Objective:To compare the outcomes of isolated Mason type Ⅱ radial head fracture between operative and non-operative treatments.Methods:A retrospective study was conducted to analyze the data of patients who had been treated for isolated Mason type Ⅱ radial head fracture either operatively or nonoperatively at Department of Trauma and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University from January 2017 to October 2020. The patients were divided into a non-operative group and an operative group according to their treatment method. After 1:1 propensity score matching method was used to match the patients in the 2 groups, a total of 58 pairs of patients were successfully matched. In the operative group, there were 24 males and 34 females with a mean age of (40±14) years and a body mass index of (23.7±3.4) kg/m 2; in the non-operative group, there were 22 males and 36 females with a mean age of (42±13) years and a body mass index of (23.5±3.9) kg/m 2. Elbow flexion-extension, forearm rotation, Mayo elbow performance score (MEPS), Quick-disabilities of the arm, shoulder and hand (q-DASH) score and complications were compared between the 2 groups. Results:There was no significant difference in the baseline data between the 2 groups, indicating comparability ( P>0.05). All the patients were followed up for (24±9) months. At the last follow up in the operative and the non-operative groups, respectively, the elbow flexion-extension was 134° (132°, 136°) and 134°(131°, 136°), the forearm rotation 176° (174°, 179°) and 178° (175°, 179°), the MEPS 100 (100, 100) and 100 (100, 100), the q-DASH score 0 (0, 0) and 0 (0, 0), showing no significant differences between the 2 groups in the above items ( P>0.05). Elbow pain was reported respectively in 4 (6.9%) and 6 (10.3%) patients in the operative and non-operative groups, showing no significant difference between the 2 groups ( P>0.05). Conclusion:The outcomes of operative and non-operative treatments of isolated Mason type Ⅱ radial head fracture are comparable.

Preliminary application of a novel distraction reductor in the surgical treatment of unstable distal radius fractures with metaphyseal volar comminution / 中华创伤骨科杂志

Objective:To evaluate a novel distraction reductor in the surgical treatment of unstable distal radius fractures with metaphyseal volar comminution.Methods:From January 2019 to December 2020, 27 patients with unstable distal radius fracture complicated with metaphyseal volar comminution were treated at Department of Orthopaedics, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences. They were 6 males and 21 females, with an age of (69.4±9.4) years. All fractures were unilateral and closed, involving the right side in 17 cases and the left side in 10 cases. All patients were treated by internal fixation with an anatomical locking plate through the volar approach and the novel distraction reductor was used to reduce the fracture ends. Regular imaging examinations were performed to evaluate the reduction, maintenance and union of fractures after surgery. One year after operation, the curative efficacy was assessed by evaluation of the range of wrist motion, Disabilities of the Arm, Shoulder and Hand (DASH) score, Gartland-Werley score and Bartra radiology score.Results:All the operations went on successfully with a duration of (92.3±8.9) min. All the incisions healed primarily. The follow-up time was (15.9±2.9) months. The radial height, palmar tilt, ulnar inclination and articular surface step-off immediately after operation [(11.23±1.51) mm, 12.10°±3.44°, 20.54°±3.44°, and (0.95±0.42) mm] were not significantly lost compared with those one year after operation [(11.22±1.55) mm, 12.07°±3.44°, 20.51°±3.33°, and (0.93±0.40) mm] (all P>0.05). One year after operation, the range of wrist motion was good with dorsiflexion of 59.7°±5.5°, palm flexion of 63.0°±9.1°, pronation of 66.5°±5.5°, supination of 61.2°±5.6°, radial deviation of 22.7°±4.8°, and ulnar deviation of 30.3°±6.1°; DASH score was 13.5±5.5; Bartra radiology score was 88.6±6.5, giving an excellent and good rate of 88.9% (24/27);Gartland-Werley score was 2.7±2.1, giving an excellent and good rate of 92.6% (25/27). Follow-ups observed no poor fracture healing, internal fixation failure, tendon or nerve injury or traumatic arthritis. Conclusion:In the surgical treatment of unstable distal radius fractures with metaphyseal volar comminution, the novel distraction reductor can lead to ideal reduction of displaced fractures and effectively correct the shortening caused by volar cortex comminution to achieve satisfactory functional effects in clinic.

Comparison of three surgical fixation methods for fracture of distal radial metaphyseal diaphyseal junction in children / 中华创伤骨科杂志

Objective:To compare the effects of anterograde elastic stable intramedullary nailing (ESIN-A), retrograde K-wires fixation (KW-R) and retrograde precision shaping of elastic stable intramedullary nailing (ESIN-RPS) in the treatment of fractures of distal radial metaphyseal diaphyseal junction (DRMDJ) in children.Methods:A retrospective study was conducted to analyze the data of 112 eligible children with DRMDJ fracture who had been treated at Department of Orthopedics, Children's Hospital, Anhui Medical University and Department of Orthopedics, The People's Hospital of Fuyang City,Anhui Medical University, from January 2016 to May 2022. There were 64 males and 48 females, with an age of (8.4±2.3) years. The children were divided into 3 groups according to different surgical fixation methods: group ESIN-A of 36 cases, group KW-R of 52 cases, and group ESIN-RPS of 24 cases. The operation time, intraoperative bleeding, fluoroscopy times, alignment rates and residual angulations by the anteroposterior and lateral X-ray films immediately after reduction were compared among the 3 groups. The Gartland-Werley evaluation of wrist function and complications were compared at the last follow-up.Results:There was no statistically significant difference in the preoperative general data among the 3 groups, indicating comparability ( P>0.05). In the operation time, group KW-R [(71.2±9.2) min] > group ESIN-A [(65.1±13.1) min] > group ESIN-RPS [(51.7±17.1) min]; in the fluoroscopy times, group KW-R [(13.9±6.3) times] > group ESIN-A [(9.0±2.8) times] > group ESIN-RPS [(6.4±2.0) times]; in the alignment rates by the anteroposterior and lateral X-ray films immediately after reduction, group ESIN-RPS (93.1%±4.6% and 95.2%±3.3%) > group KW-R (82.1%±11.0% and 88.1%±7.4%) > group ESIN-A (80.4%±9.9% and 86.7%±6.9%); in the residual angulations by the anteroposterior and lateral X-ray films immediately after reduction, group ESIN-RPS (3.3°±1.8° and 2.9°±2.1°) < group ESIN-A (5.2°±1.0° and 5.0°±3.2°) < group KW-R (6.6°±1.6°and 7.5°±2.7°). Pairwise comparisons in the above items were statistically significant ( P<0.05). In group ESIN-A, the incision length [(1.8±0.3) cm] was significantlylonger than that in group ESIN-RPS [(1.4±0.2) cm], and the intraoperative blood loss [(8.3±2.2) mL] significantly larger than that in group ESIN-RPS [(5.5±1.6) mL] ( P<0.05). One year after operation, the excellent and good rate by the Gartland-Werley evaluation of wrist function in groups ESIN-RPS, ESIN-A and KW-R, respectively, were 95.8% (23/24), 86.5% (31/36) and 86.1% (46/52), showing no statistically significant difference between the 3 group ( P>0.05), and the major incidence of complications in group KW-R (25.0%, 13/52) and in group ESIN-A (25.0%, 9/36) were significantly higher than that in group ESIN-RPS (4.2%, 1/24) ( P<0.05). Conclusion:In the treatment of DRMDJ fractures in children, compared with ESIN-A and KW-R, ESIN-RPS is an effective choice due to its advantages of shorter operation time, less intraoperative blood loss, less radiation, better alignment, and fewer complications.