The techniques and concepts in the field of orthopaedic trauma have been changed in these years by new ideas of osteosynthesis, minimal invasive surgery (MIS), computer assisted orthopaedic surgery (CAOS) and evidence based medicine (EBM). This paper briefly introduces the development trend in orthopaedic trauma through discussion of the papers exchanged in the 2nd Congress of Chinese Orthopaedic Trauma Association.

This issue features papers concerning intra articular fractures that covers surgical managements of fractures of tibial plateau at lower limbs, patella, calcaneus, glenoid cavity at upper limbs, Pilon fracture and Barton fracture. Fracture displacement, articular step off and injury of soft issue that are often associated with intra articular fractures, especially those caused by high energy, make the treatment all the more difficult. The key points for a successful treatment are accurate judgment of the severity of the injury, proper timing of the operation, application of minimally invasive skills, possibly maximum anatomic reduction and alignment of the fracture and maximum functional recovery. The author emphasizes that treatment of intra articular fractures should be individualized.

Proximal femoral fractures are one of the most challenging kinds of fractures in current orhopaedic traumatology.Theclinicalresearchononesortofthefractures,theintertrochanticfracture,however,isnotstrongenoughtomeetthechallenge.Thepreoperativeradiologicaldiagnosisshouldbeabletopreciselydetectthestabilityofintertrochanticfracturethroughpayingmoreattentiontotheevaluationoftheintegrityoftheinternalarcandcomminutionextentsoftheposteriorcortex.Currently,operativetherapyattheearlystageisthemaintreatmentforintertrochanticfractures,suchasdynamichipscrews(DHS),Gammanails,andproximalfemoralnails(PFN).Thecentralfixationbyintramedullarynailsisthefirstchoiceintreatingtheunstableintertrochanticfractures,especiallythereverseones.Theapplicationoffluoro-navigationandotherauxiliaryoperativetechniquesintheinternalfixationofproximalfemoralfractures,andtheclinicalresearchofEvidenceBasedMedicinewillimprove the diagnosis and treatment of intertrochantic fractures.

Shoulder surgery has rapidly grown into an independent branch of o rthopedics in the developed countries, but not in China, for only several large -scale Chinese hospitals have set up an independent department of shoulder surg ery. Advancement of arthroscopy and increasing application of displacement of ar tificial humeral head have enriched the treatment methods of shoulder problems s o that many of the previous contradictions can be resolved through surgery. This issue of Chinese Journal of Orthopaedic Trauma(CJOT) introduces some procedures and experience of the shoulder surgery, including operative managements of shou lder dislocation, fracture of shoulder blade, acromion impingement syndrome and shoulder instability. Surgeons should achieve as much as possible minimal invasi on and optimal functional recovery of the shoulder as long as they do not dramat ically increase the expenses of the patients.

As everyone knows, foot and ankle play a decisive role in human activities. In the recent ten years, management of lesions of foot and ankle has drawn increasing attention and interest of orthopedic scholars so that great progress has been made in this field, but there have still been many controversial issues. This review gives a brief introduction of the most up to date development and problems in the research of foot and ankle fractures, and also suggests some basic principles in treating such fractures.

The 2002National Annual Meeting org anized by the newly founded Chinese Orthopedic Trauma Association was held in Shenzhen in J une,with attendance of 180surgeons.Leaders of Chinese Orthopedic Society and many senior professors from the o rthopedic field also attended the me eting.The major topics of this 3-day meeting were“pelvic &acetabular fractures”and“open fractures”.5orthopedic trauma experts coming from Germany and US were invited to give pr esentations at the first day symposium,with the topics about radiologic al diagnosis,surgical approach and su rgical techniques of pelvic &acetab ular fractures.Precious experiences were exchanged in trauma resuscitation,management of open fractures and man agement of infection of bone and join t.225articles were received for this m eeting,with the contents covering e very part of the skeletal system.Clinically,the treatments reported at the meeting involved modern orthopedic surgical techniques and experiences in non -operative management.As for the basic research,application of tissue e ngineering in the orthopedic field w as discussed.45articles selected for oral presentation covered the management of pelvic &acetabular fractur es,choice of internal or external fixation in treatment of proximal femoral fractures,soft tissue management i n bone and joint infections,and clinical tria ls in the treatment of scapular fractures,proximal humeral fractures,d istal radial fractures and calcaneal fractures.The articles received also revealed that the methods adopted in clinical research should be improved and standardized in China so as to promote better natio nal comparison and exchange.[

Objective To assess the methods used to analyze the clinical outcomes in recent 180c linical reports in orthopaedic trauma in Chi na.Methods Statistical analysis was done with t he collection of the papers of2002Symposium of Chinese Orthopedi c Trauma Association in the aspects o f their research scope,object,case number,fracture classification,c riterion of follow -up and application of statistics.Results Of the total 225papers received by the symposium,180were clinical reports which reported more than ten thousand cases.The s cope of reports was wide and included majo r current methods of fracture treatm ent.The papers with statistical analysis were only 6.1%.Fracture classifica tions and criteria of follow up were v aried without a standard.No prospec tive report was found.Conclusion Current methods in clinical study on orthopaedic trauma should be improv ed.[

Impacted femoral neck fractures should be treated operatively as displaced fracture. Many authors suggested emergency operation. The principle of treatment of femoral neck fractures is anatomic reduction, fragmental compression,and rigid fixation. Closed reduction must be done in most cases. When close anatomic reduction can not be achieved, open reduction should be considered.Implants used recently consist of pins , screws,hook pins and gliding screws with side plate. Every implant has its own advantages, disadvantages and indications. The principle of treatment of femoral neck fractures in young patients is emergency operation (within 12h after trauma), anatomic reduction (open reduction when necessary), and rigid fixation with screws. Some authors stated the necessity of anterior capsularoctomy.

Osteoporosis is considered as the most important factor which causes the fracture of the femoral neck. Comminution of fracture and rigidity of fixation are greatly affected by the degree of osteoporosis. Femoral neck fractures in young patients are mainly caused by severe trauma. Although Garden classification is widely accepted in classifying femoral neck fractures, in the recent decades some doctors have found out some shortcomings in Garden classification in practical application. It has been suggested to classify the femoral neck fractures simply into displaced and undisplaced ones. Arthroplasty used to be thought as the choice of treatment of femoral neck fractures in the elderly. Application of arthroplasty must accord with the indications, not only with the age of the patient or the degree of the displacement of the fracture. There is no X ray diagnosis specially for the avascular necrosis of femoral head secondary to femoral neck fracture, other than Ficat Arlet grade system. MRI is considered to be the only method to diagnose the avascular necrosis of femoral head at an early stage and to defect its extent and location.

The coming of an aged society in China will surely greatly affect the chief concerns of health care. The Chinese orthopaedists should be prepared for the tasks imposed by the new situation. Once a fracture happens due to osteoporosis in a senile person, a series of problems will follow. This paper discusses the diagnosis and prevention of osteoporosis, preoperative assessment of the patient, proper application of internal fixation and combined treatment of fracture and osteoporosis. The critical point is how to improve the therapeutic effects and to reduce the operative risks.