Cerebral palsy (CP) is one of the most common causes of physical disability among children all over the world.It is often accompanied by hypophrenia,epilepsy,abnormal behaviors,visual auditory disorder,emotional disturbance,facial disfunction,developmental delay,malnutrition,poor lung function,hypoimmunity,and so on.Also hip abnormalities are important issues.The hip subdislocation,dislocation and pain largely influence the daily life of the patients.Early detection and therapy offer a great hand to ease the degree of disability and enhance rehabilitation effect.Surgical management and rehabilitation training have significant count on maintaining the hip function and improving daily life quality.The lesion severity,treatment timing,individual differences and cooperation degree of parents are main factors of prognosis.This contribution summarizes the symptoms,radiographic parameter changes and treatments of CP.

Objective To study the clinical features of acute limited neck motion in children and its differential diagnosis, and to improve doctors' awareness and the early diagnosis of the disease.Methods A total of 420 patients with acute limited neck motion as the chief complaint and atlantoaxial rotary subluxation as the first diagnosis between January 2005 and January 2014 in Nanjing Children's Hospital Affiliated to Nanjing Medical University were enrolled.The clinical manifestations, imaging and consultation data of the 420 patients were retrospectively analyzed.Results There were totally 248 male patients and 172 female patients.The ages ranged from 2 to 14 years old(the mean age was 7.2 years old) ,the course ranged from 2 hours to 2 days.Among 420 patients,353 patients were diagnosed as atlantoaxial rotatory subluxation.Forty-two patients were diagnosed as cervical intervertebral disc calcification.Seven patients were diagnosed as Tourette syndrome.Four patients were diagnosed as intracranial tumors.Three patients were diagnosed as cervical eosinophilic granuloma.Two patients were diagnosed as cervical spinal tuberculosis.Two patients were diagnosed as viral encephalitis.Two patients were diagnosed as benign paroxysmal torticollis.Two patients were diagnosed as Kawasaki disease.One patient was diagnosed as neuroblastoma.One patient was diagnosed as hemophilia A.One patient was diagnosed as drug adverse reaction of metoclopramide.According to Fielding clinical classification,204 patients were type Ⅰ, 122 patients were type Ⅱ,21 patients were type Ⅲ, and 6 patients were type Ⅳ.Conclusions Based on disease distribution of acute limited neck motion in children, atlantoaxial rotatory subluxation seems to be the predominant while non-atlantoaxial rotatory subluxation is not uncommon.Differential diagnoses should be considered to avoid misdiagnosis.For atlantoaxial rotatory subluxation, conservative treatment including continuous mandible occipital belt traction and brace has been proved to be very effective methods.

Objective To evaluate the clinical efficacy of percutaneous haemostat stroke-poking reduction and elastic intramedullary nailing for pediatric radial neck fractures of O'Brien types Ⅱ & Ⅲ.Methods From January 2014 to June 2016,38 children (23 boys and 15 girls) with radial neck fracture of O'Brien type u or Ⅲ were treated by percutaneous haemostat stroke-poking reduction and elastic intramedullary nailing in our department.We had 26 left and 12 right sides.Their ages ranged from 5 to 14 years,averaging 8.6 years.All fractures were fresh.According to O'Brien classification,22 cases were type Ⅱ and 16 type Ⅲ.The operation time,frequency of intraoperative C-arm fluoroscopy,frequency of percutaneous haemostat stroke-poking reduction,and union time were recorded.The elbow function was assessed one day before removal of internal implants according to the Métaizeau scoring system.Results All operations succeeded,lasting from 12 to 25 min (average,16.4 min).The frequency of intraoperative fluoroscopy ranged from 3 to 11 times (average,6.4 times);the frequency of intraoperative percutaneous reduction ranged from 1 to 4 times (average,2.3 times).The patients were followed up for 6 to 22 months (average,1 1.2 months).Postoperative X-ray films showed satisfactory alignment of the fracture ends.All fractures demonstrated clinical and radiographic evidence of complete healing after a mean time of 58 days (from 38 to 72 days).The Métaizeau scoring showed 33 excellent,4 good and one fair cases,yielding an excellent to good rate of 97.4％.Follow-ups revealed no infection,implants breakage,nonunion,fracture redisplacement,or iatrogenic radial nerve injury.Conclusions As percutaneous haemostat stroke-poking reduction can increase the probability of successful reduction at first attempt,reduce frequency of close reduction and X-ray exposure for both children and medical staff,and shorten operation time,the procedure is effective,simple,reliable and minimally invasive,leading to fewer complications.

The elastic stable intramedullary nailing ( ESIN ) technique is widely accepted by pediatric orthopedic surgeons for the following advantages: being minimally invasive, non-destructive on epiphyseal function, easy, rapid postoperative recovery, allowing early functional exercise and having low complication rate. It has become the mainstream technique for the treatment of long bone fractures in children. Although the concept of minimally invasive surgery for children with long bone fractures is constantly evolving and the surgical technique is becoming more and more mature, there are still some complications after ESIN operation, such as tendon and iatrogenic nerve injury, soft tissue irritation and infection, poor alignment after fracture or re-shift, delayed union and non-union, leg-length discrepancy, rotation and angular deformity, osteofascial compartment syndrome, and other clinical problems. These complications often occur due to the negligence of important biological principles, obvious technical errors and the negligence of the characteristics of local anatomy. The authors review the problems of ESIN technique in the treatment of humeral fractures, radius and ulna fractures, femoral fractures and tibial fractures of children, seeking to avoid the complications as much as possible and giving full play to the minimally invasive advantages of ESIN.

Objective: To summarize the clinical data of elastic stable intramedullary nailing(ESIN) in the treatment of long bone fracture of children in a single medical center, and to analyze the problems occurred after the ESIN surgery and corresponding solutions. Methods: A retrospective analysis was conducted regarding the clinical data of 2 133 pediatric long bone fractures conforming to inclusion and exclusion criteria from June, 2005 to December, 2017 in Department of Orthopedics, Children′s Hospital of Nanjing Medical University.There were 1 191 boys and 942 girls, aged from 23 months to 14 years with mean age of (5.7 ± 3.1)years.There were 1 866 cases treated with closed reduction with ESIN, while 267 cases were treated with small incision assisted reduction with ESIN.Postoperative problems have been statistically analyzed. Results: There were altogether 2 133 children, including 603 cases of femur, 311 cases of tibia, 8 cases of fibula, 219 cases of humerus, and 992 cases of ulna/radius.The postoperative complications mainly consist of 62 cases of needle tail irritation reaction, 21 cases of misalignments of fracture alignment, 11 cases of intramedullary nail deformity or angular deformity, 7 cases of limb shortening, 14 cases of limited joint activity, 4 cases of nerve injury, 2 cases of tendon injury, 14 cases of difficult nail removal, 4 cases of cortical cleavage, 8 cases of delayed union, 1 case of nonunion, 6 cases of varus/valgus deformity, 5 cases of epiphyseal injury, 6 cases of ESIN exposure, and 2 cases of metal debris of ESIN′ end. Conclusions The complications of treatment for children with long bone fractures by ESIN cannot be ignored.To master the important biomechanical properties, to get familiar with the local anatomy and to avoid obvious technical errors can reduce the occurrence of postoperative complications.

Objective:To analyze the curative effect of locking compression pediatric hip plate (LCH-PHP) in the treatment tumor-like lesions of femoral neck in children.Methods:From January 2012 to June 2019, 45 children with Erol type Ⅱ-Ⅳ tumor-like lesions of femoral neck were retrospectively analyzed, involving 32 males and 13 females, aged 2-14 years.Among them, 27 cases were simple bone cyst, 15 cases were fibrous dysplasia, 3 cases were Langerhans histiocytosis, and 17 cases were accompanied with pathological fracture.Patients without pathological fracture were divided into 2 groups according to different surgical methods: lesion removal and bone grafting+ LCH-PHP preventive fixation group (group A) and lesion removal and bone grafting group (group B). Patients with pathological fracture were divided into 2 groups according to the different surgical methods: lesion removal and bone grafting+ LCH-PHP fixation and reduction group (group C) and lesion removal and bone grafting group (group D). The loss of femoral neck-stem angle, healing time and Musculoskeletal Tumor Society (MSTS) scores were compared between group A and group B. Changes of femoral neck-stem angle were compared between group C and group D at postoperative 1 day and the last follow-up.Results:Forty-five patients were followed up for an average of 2.6 (1-4) years.The loss of femoral neck-stem angle in group A and group B were (0.50 ± 0.45)°, and (2.26 ± 1.64)°, which was significantly different ( t=-3.193, P<0.05). There were no significant differences in the healing condition, healing time and MSTS scores at the last follow-up between group A and group B(all P>0.05). In group C, the ipsilateral femoral neck-stem angle at the postoperative 1 day and the last follow-up were (133.67±4.53)°and (133.00±4.32)°, respectively, which was comparable ( P>0.05). In group D, the ipsilateral femoral neck-stem angle at the postoperative 1 day and the last follow-up were (133.36±7.82)°and (130.63±8.24)°, respectively, which was significantly different ( t=7.11, P<0.05). Conclusions:LCH-PHP fixation can effectively maintain the femoral neck-stem angle and prevent the occurrence of pathological fracture children with Erol Ⅱ-Ⅳ tumor-like lesions of femoral neck.

Objective To investigate the curative effect and feasibility of closed reduction with elastic intramedullary nailing and open reduction with Kirschner wire fixation in treatment of obviously displaced radial neck fractures in children. Methods From July 2006 to December 2007, 18 children with types Ⅱ and Ⅲ O' Brien radical neck fractures were admitted to Nanjing Children' s Hospital. Of all, six children received open reduction and fixation with Kirschner wire and six weeks of cast immobilization; the other 12 children received closed reduction and fixation with elastic intramedullary nail and three weeks of cast immobilization. The children were followed up for mean 12 months to investigate postoperative functional recovery of the elbow joint and presence of complications. Results All children achieved excellent clinical outcomes, without excessive radial bone growth, early closure of radial bone marrow, bone bridge formation or ectopic calcification around the joint. According to Tibone and Stoltz' s clinical evaluation methods, closed reduction with elastic intramedullary nailing had less trauma, faster recovery, fewer complications and better cosmesis than traditional open reduction with Kirschner wire fixation for children with obviously displaced radial neck fractures. Conclusion Closed reduction with elastic intramedullary nailing is a better option for obviously displaced radial neck fractures in children.

Objective:To compare the clinical effect of manual reduction and plaster fixation, closed reduction and percutaneous K-wire fixation, as well as open reduction plate and elastic intramedullary pin fixation in the treatment of unstable distal ulna and radius fractures in older children.Methods:The clinical data of 110 cases treated in Department of Orthopedics, Children′s Hospital of Nanjing Medical University from January 2014 to December 2017, for unstable fractures of the distal ulna and radius were retrospectively reviewed.There were 73 males, 37 females, aged from 10 to 14 years[(11.6±2.3) years old]. According to the different treatments, the 110 cases were divided into 3 groups which included manual reduction group (48 patients), closed reduction and percutaneous K-wire fixation group (35 patients, K-wire fixation group) and open reduction with plate and elastic stable intramedullary nail fixation group (27 patients, open reduction group). All cases were treated with plaster external fixation.After the fracture healing, the plaster was removed and then exercises were begun.The data of operative time, fracture healing time, displacement rate and wrist function after treatment were recorded in the three groups and compared statistically.Results:There was no significant difference in general data between 3 groups before operation (all P>0.05). For the manual reduction group, K-wire fixation group and open reduction group, the operation time was (20.2±8.4) min, (35.4±12.2) min and (68.5±20.4) min, respectively; the clinical fracture healing time was (42.1±3.8) d, (44.2±4.3)d and (48.4±5.3) d; the cost of treatment was (2 000.4±551.3) Yuan, (8 000.2±1 151.6) Yuan and (20 010.7±2 453.3) Yuan, respectively.There were significant differences in operation time and cost treatment among the 3 groups ( χ2=11.266, F=58.427, all P<0.05). The Berton score of excellent and good were 89.6% (43/48 cases), 91.4% (32/35 cases) and 92.6% (25/27 cases) 3 months later after surgery in the manual reduction group, K-wire fixation group and open reduction group.The mean follow-up was (11.2±3.7) months(range 6-18 months). In the manual reduction group, there were 6 cases with fracture displacement within 2 weeks after the manual reduction.There were 3 cases with symptoms of caudal irritation in K-wire fixation group, which happened in 1 case in the open reduction group.No complications such as nonunion and iatrogenic nerve injury were found during the follow-ups. Conclusion:There is no significant difference in the wrist function among the 3 methods for the treatment of distal radius and ulna fractures in older children.The manual reduction therapy has a high fracture displacement rate.The open reduction therapy causes maximal operative trauma and costs highly.The percutaneous K-wire method is minimally invasive and has shorter operative time and a lower fracture displacement rate.Therefore, percutaneous K-wire is the optimal treatment for distal ulna and radius fractures.