Roles of combined femoral and acetabular anteversion in pathological changes of hip dysplasia and hip reconstructive surgery.

Combined femoral and acetabular anteversion is the sum of femoral and acetabular anteversion, representing their morphological relationship in the axial plane. Along with the increasing understanding of hip dysplasia in recent years, numerous scholars have confirmed the role of combined femoral and acetabular anteversion in the pathological changes of hip dysplasia. At present, the reconstructive surgery for hip dysplasia includes total hip replacement and redirectional hip preservation surgery. As an important surgery index, combined femoral and acetabular anteversion have a crucial role in these surgeries. Herein, we discuss the role of combined femoral and acetabular anteversion in pathological changes of hip dysplasia, total hip replacement, and redirectional hip preservation surgery.

Comparison of midterm efficacy of Kirschner wires and elastic intramedullary nails after closed reduction of Judet type 3 radial neck fractures in children: a multicenter study.

Objective: The objective of this study was to compare the midterm efficacy of Kirschner wires and elastic intramedullary nails after the closed reduction treatment of Judet 3 radial neck fractures in children. Methods: This was a retrospective multicenter study of patients diagnosed with Judet type 3 radial neck fractures who underwent closed reduction and internal fixation at four tertiary hospitals from January 2019 to December 2021. Gender, age, fracture type, operation time, follow-up time, x-ray results and complications were collected. The recovery of elbow joint between the two internal fixation methods, elbow motion and complications at the last follow-up were compared. Results: The average operation time of EIN group was statistical significantly increased compared with KW group. There were no significant differences in MEPS score and ROM 3 months after surgery between the two groups, but the ROR Angle of EIN group was statistical significantly increased compared with KW group 3 months after surgery. There were no significant differences in MEPS score, ROM and ROR at the last follow-up. The incidence of complications in EIN group was significantly lower than that in KW group. Conclusion: The use of elastic intramedullary nails fixation or Kirschner wires fixation in the treatment of radial neck fractures in children can both achieve satisfactory fracture reduction and healing. Compared with elastic intramedullary nails, the operation time of Kirschner wires fixation is shorter, and the internal fixation does not need to be removed under anesthesia again, but the complication rate is higher.

Effective time, correction speed and termination time of hemi-epiphysiodesis in children.

In children with asymmetric growth on the medial and lateral side of limbs, if there still remains growth potential, the guided growth technique of hemi-epiphysiodesis on one side of the epiphysis is recognized as a safe and effective method. However, when the hemi-epiphysiodesis start to correct the deformities, how many degrees could hemi-epiphysiodesis bring every month and when to remove the hemi-epiphysiodesis implant without rebound phenomenon are still on debate. This article reviews the current studies focus on the effective time, correction speed and termination time of hemi-epiphysiodesis.

A cobalt-doped hollow ZnS polyhedra@porous carbon shell composite anode for high-rate sodium-ion batteries.

Transition metal sulfides (TMSs) have drawn promising attention due to their low cost and high theoretical capacity for sodium storage. However, the critical issues of TMSs with huge volume changes and lower ionic/electronic conductivity are the major challenges for their practical application in sodium-ion batteries. Herein, we constructed cobalt-doped ZnS encapsulated in an N-doped carbon shell (denoted as Co-ZnS@NC), which effectively alleviates the volume expansion and improves sodium storage performance. The mechanism analysis and ion diffusion kinetics analysis (GITT, EIS, and CV) prove the acceleration of Na+ diffusion by the built-in electric field and buffer carbon layer in the Co-ZnS@NC, optimizing the cycle life and rate capability. The as-prepared Co-ZnS@NC has a high reversible capacity of 456.8 mA h g-1 after 1000 cycles at 1.0 A g-1 and superior rate capability (368.8 mA h g-1 at 20.0 A g-1), with Na metal as the counter electrode. Moreover, the assembled full cell shows a high energy density of 214.4 W h kg-1. This work provides insight on heteroatom doping for optimizing the rate capability of TMS anodes.

Comparison of the midterm result between Lag-Screw fixation and K-wires treating displaced medial epicondyle fractures in children.

Medial epicondyle fractures a prevalent injury, constituting 11% to 20% of all elbow fractures in children and adolescents. Common fixation strategies for displaced medial epicondylar fractures involve the use of K-wires and Lag-Screw fixation. The aim of this retrospective study was to compare 2 methods for treating medial epicondylar fractures in children. In this retrospective study, 26 children with displaced medial epicondyle fractures were included. Patients were divided into 2 groups after reduction: Lag-Screw (LS) group and K-wires group. We compared the operation time, range of motion (ROM), range of rotation (ROR), and Mayo elbow performance score (MEPS). A total of 26 patients were available for a long-term follow-up, with a mean age of 11.6 ±â€…2.5 years, follow up by 35.7 ±â€…5.7 months. The average operation time in K-wires group was shorter than the Lag-Screw group. The average ROM, ROR, and MEPS of the 2 groups are excellent in 3 months follow up after operation and maintained excellent results during the final follow-up. Regarding MEPS, ROM, and ROR, there was no significant difference between LS group and KW group. However, the LS group experienced fewer complications than the KW group. Both Lag-Screw and K-wires fixation for medial epicondyle fractures in pediatric patients yield favorable mid-term results when assessed in terms of ROM,ROR, MEPS. K-wires fixation, while having a shorter operation time and saving an additional anesthesia and surgery to remove the implants compare to fixed by Lag-Screw fixation, does come with a higher complication rate.

A modified method for reconstruction of posterior tibial tendon after resection of juvenile painful type II accessory navicular.

BACKGROUND: The surgical treatment of accessory navicular (AN) is divided into simple resection of AN and Kidner surgery used to reconstruct posterior tibial tendon (PTT) after AN resection. However, both of these procedures have certain disadvantages. Herein, we proposed a modified method to reconstruct PTT and compared the short-term clinical effect of our method with the modified Kidner procedure. METHODS: We collected data from 23 adolescent children with painful type II AN treated in our department between January 2015 and June 2020. The American Orthopedic Foot and Ankle Society Ankle-Hind foot (AOFAS-AH) Scores, the Meary Angle, and Pitch Angle of the lateral weight-bearing plain radiographs status were recorded before and after the operation to evaluate the treatment outcomes. RESULTS: In the modified Kidner surgery (MK) group, the median AOFAS-AH increased from 61 (59-68) to 87 (83-91) (P < 0.05); the Pitch angle of the lateral weight-bearing plain radiographs increased from 13.0 (8-18) to 17.4 (14-22), and the Meary angle decreased from 18.3 (14-24) to 14.2 (8-20) (P < 0.05). In the PTT preservation folded suture (FS) group, the median AOFAS-AH increased from 61 (59-68) to 87 (85-91) (P < 0.05); the Pitch angle of the lateral weight-bearing plain radiographs increased from 12.3 (7-18) to 18.4 (15-26), and the Meary angle decreased from 17.8 (13-23) to 5.7 (3-8) (P < 0.05). There was no significant difference in AOFAS-AH postoperative scores between the FS group and MK group; however, the improvement on Pitch and Meary angle of the lateral weight-bearing plain radiographs was significantly better in the FS group than in MK group (P < 0.05). CONCLUSIONS: For painful type II AN in juvenile patients, the insertion-preserving folding suture procedure had similar short-term results on AOFAS-AH scores but greater improvement in the Meary angle and the Pitch Angle than the modified Kidner method. LEVEL OF EVIDENCE: III.

Diagnosis and treatment of chronic osteomyelitis based on nanomaterials.

Chronic osteomyelitis is a painful and serious disease caused by infected surgical prostheses or infected fractures. Traditional treatment includes surgical debridement followed by prolonged systemic antibiotics. However, excessive antibiotic use has been inducing rapid emergence of antibiotic-resistant bacteria worldwide. Additionally, it is difficult for antibiotics to penetrate internal sites of infection such as bone, thus limiting their efficacy. New approaches to treat chronic osteomyelitis remain a major challenge for orthopedic surgeons. Luckily, the development of nanotechnology has brought new antimicrobial options with high specificity to infection sites, offering a possible way to address these challenges. Substantial progress has been made in constructing antibacterial nanomaterials for treatment of chronic osteomyelitis. Here, we review some current strategies for treatment of chronic osteomyelitis and their underlying mechanisms.

Post-traumatic heterotopic ossification in front of the ankle joint for 23 years: A case report and review of literature.

BACKGROUND: Heterotopic ossification (HO) refers to the formation of new bone in non-skeletal tissues such as muscles, tendons or other soft tissues. Severe muscle and soft tissue injury often lead to the formation of HO. However, anterior HO of the ankle is rarely reported. CASE SUMMARY: We report a patient with massive HO in front of the ankle joint for 23 years. In 1998, the patient was injured by a falling object on the right lower extremity, which gradually formed a massive heterotopic bone change in the right calf and dorsum of the foot. The patient did not develop gradual ankle function limitations until nearly 36 mo ago, and underwent resection of HO. Even after 23 years and resection of HO, the ankle joint was still able to move. CONCLUSION: It is recommended that the orthopedist should be aware of HO and distinguish it from bone tumor.

Percutaneous calcium sulfate injection versus localized scrape bone grafting: clinical effect comparison in titanium elastic nail treatment of pathological fracture of proximal humerus caused by unicameral bone cysts in children.

Objective: A retrospective study was conducted to compare the mid-term clinical efficacy between percutaneous calcium sulfate injection (PCSI) and localized scrape bone grafting (LSBG) in using titanium elastic nails treat humerus pathologic fractures caused by unicameral bone cysts in children. Methods: Humerus pathologic fracture patients with unicameral bone cysts in our pediatric orthopedic department from January 2015 to January 2020 were retrospectively analyzed. Patients were divided into two groups, namely the PCSI group and the LSBG group, based on the type of bone grafting material they received. Preoperative assessments were made in both groups using the Cyst Index and Cyst activity. During the perioperative phase, assessments were made regarding operative time, bleeding, postoperative VAS scores, and the frequency of reoperation within 2 years. Clinical outcomes were evaluated using the Capanna scale at the last follow-up, and the occurrence of re-fractures during the follow-up period. Results: A total of 22 patients were included, with a mean follow-up duration of 33.5 ± 5.8 months. No significant differences were found between the two groups in terms of Cyst Index and Cyst activity before the operation. The operative time, bleeding, and postoperative VAS scores in the PCSI group were found to be lower than those in the LSBG group (P < 0.05). The PCSI group also showed a higher frequency of reoperation within 2 years compared to the LSBG group (P < 0.05). However, no significant differences were observed between the two groups in terms of Capanna scale scores at the last follow-up and the incidence of re-fractures during follow-up. Conclusions: Both titanium elastic nails (TEN) combined with PCSI or LSBG were found to be safe and effective treatments for humerus pathologic fractures caused by unicameral bone cysts in children. PCSI is considered as a less invasive option with shorter operative times, less bleeding, and reduced postoperative pain, although it comes with the risk of multiple injections. On the other hand, LSBG is considered as a more invasive option for the treatment of active bone cysts but is associated with a lower recurrence rate.

Case report: Glucose 6-phosphate-isomerase deficiency combine with avascular necrosis of bilateral femoral head.

Background: Glucose 6-phosphate-isomerase deficiency (GPI) is an uncommon autosomal recessive genetic disorder characterized by chronic asphoric hemolytic anemia, jaundice, and hepatospleenomegaly of varying degrees. Avascular necrosis of the femoral head in children may be caused by Legg-calve-perthes disease or hematological diseases. However, to date, there is no literature reporting on femoral head avascular necrosis as a complication of GPI. Case presentation: Herein we report a 6-year-old child admitted with no pain and abnormal gait in both lower extremities for 3 years, the patient received a genetic inspection and radiology test. Full-exon detection and Sanger sequencing verification were performed on the children and their parents C. 553T>A homozygous missense mutation (NM_ 001289790, F 185 I) was found in exon 6 of the GPI gene, which was inherited from parents. The radiology test showed avascular necrosis of the bilateral femoral head. The patient received traction and wore a spica splint every night and non-weight bearing hip joint rehabilitation every day for 12 months, after which, the gait of the femoral head of this patient improved significantly, and follow up radiation results showed the area of avascular necrosis of the femoral head had decreased. Conclusion: Careful investigation of GPI children with abnormal gait is recommended to avoid misdiagnosis, GPI combined with avascular necrosis of the femoral head should be considered as a differential diagnosis in GPI children with abnormal gait.

Comparison of the midterm result between locking plate and elastic intramedullary nail treating oblique ulnar fracture Bado type I acute monteggia fracture in pediatric patients.

BACKGROUND: Acute Monteggia fracture (AMF) is defined as a fracture of the proximal ulna combined with a dislocation of the radial head, with less than 1 percent prevalence in pediatric patients with an elbow injury. This retrospective study aimed to compare the efficacy of two treatment methods for oblique ulnar fracture AMF Bado type I in children. METHODS: In this retrospective study, 28 children with oblique ulnar fracture acute Monteggia injury Bado I were included. Patients was divided into two groups: In the EIN group 16 patients were fixed with elastic intramedullary nail after reduction, and in the LCP group 12 patients were fixed with locking compression plate after reduction. Operation time and blood loss were recorded and the patients were assessed clinically by the Mayo Elbow Performance Score (MEPS), range of movement(ROM) and range of rotation(ROR). RESULTS: Twenty-eight patients were accessible for durable follow-up, with a mean age of 7.7 ± 1.3 years, follow up by 33.7 ± 5.1 months. The average operation time was 48.1 ± 9.2 min for the EIN group and 67.1 ± 7.2 min for the LCP group. The average blood loss was 8.2 ± 2.3 ml for the EIN group and 18.8 ± 3.8 ml for the LCP group. The average operation time and average blood loss in the EIN group are significant less than the LCP group. Mean MEPS, ROM, ROR in both group improved significantly before sugery to three months after surgery, and maintained very good results at last follow up. There is no significant difference between the EIN group and the LCP group in MEPS, ROM and ROR. CONCLUSIONS: Oblique ulnar fracture Bado type I acute monteggia fracture in pediatric patients fixed by EIN and LCP can both get good mid-term results measured by MEPS, ROM and ROR, Fixed by EIN have shorter operation time and less blood loss than fixed by LCP.

Resumption of school after lockdown in COVID-19 pandemic: Three case reports.

BACKGROUND: Students in the 9th grade of junior high school in Changsha were under a 75 d lockdown due to the coronavirus disease 2019 (COVID-19) pandemic. After the resumption of school post-lockdown, the 9th grade students in Changsha faced the entrance physical examination test for senior high school. CASE SUMMARY: We report on 3 cases of occult fracture on the same site in adolescents of the same grade since resumption of school after the lockdown from the COVID-19 pandemic. Three students in the 9th grade of junior high school who were facing the physical examination in 2 wk were diagnosed with an occult fracture of the distal femur. CONCLUSION: It is recommended that the students, parents, education providers and policy makers should all pay attention to the physical exercise of students when the resumption of school after lockdown occurs and they should be aware of occult fractures when the adolescents have pain after physical exercise.

Characteristics of surface electromyogram signals after Pemberton pelvic osteotomy combined with femoral osteotomy in children with unilateral developmental dysplasia of the hip.

This study aimed to assess the surface electromyogram (sEMG) signal characteristics of the muscle around the hip joint after Pemberton osteotomy in children with unilateral developmental dysplasia of the hip (DDH). A total of 21 children with unilateral DDH who had received Pemberton osteotomy were selected as the DDH group, and 21 healthy children of the same age were selected as the control group. The children in both groups were tested using sEMG, the Root mean square (RMS) values of the tensor fascia lata, rectus femurs, and medial head of the hamstring and gluteus maximum on both sides in standing and walking status were recorded. The value on the affected side in the DDH group was compared with the value on the healthy side himself and the value in the control group. The mean postoperative follow-up in the DDH group was 27.76 ± 24.30 months. The RMS value of the affected gluteus maximum muscle in the DDH group was significantly larger while standing (P < 0.05), the RMS value of bilateral tensor fascia lata muscle was significantly larger while walking (P < 0.05), and the RMS value of the affected hamstring muscle medial head was significantly less in the DDH group compared with the control group (P < 0.05). An asymmetry and compensatory increase in the sEMG activity of the muscles around the hip joint when standing and walking was noted in children with unilateral DDH who underwent Pemberton osteotomy combined with a femoral osteotomy. The rehabilitation training of the muscles around the hip joint after unilateral DDH should be strengthened.

Synovial chondromatosis of the hip joint in a 6 year-old child: A case report.

BACKGROUND: Synovial chondromatosis (SC) is a rare benign lesion first reported by Ambrose Pare in 1558. It is most common in the knee joint, followed by the hip joint and elbow joint. It is characterized by the presence of multiple pearl-like osteochondral bodies in the joint. The incidence in children is extremely low. CASE SUMMARY: We report a 6-year-old Chinese boy who presented to our hospital with left hip joint pain and claudication for more than one year. We performed total surgical resection of SC tissue in the left hip. A good prognosis was confirmed at the 6-wk follow-up. Pain and swelling symptoms were totally relieved, range of motion of his left hip returned to normal, and there was no clinical evidence of lesion recurrence at last follow-up. Our case is the youngest reported patient with SC occurring in the hip. CONCLUSION: SC is a rare disease and can be easily misdiagnosed. When we encounter children with hip pain and claudication, increased vigilance and a comprehensive physical examination and imaging examination should be considered, in order to avoid misdiagnosis and delayed treatment in patients.