Objective To investigate cranial decompression under temporal muscle in very-low position with large bone flap combined with mild hypothermia for severe cranial trauma.Methods 88 severe brain injury patients (GCS ≤ 8 ) were randomly divided into two groups,mild hypothermia group( n =48) and non-mild hypothermia group ( n =40),both presented with cranial decompression under temporal muscle in very-low position with large bone flap.Data of patients,GCS increment,rate of brain cistern display,rate of pupil shrink and therapeutic effect were ananlyzed.Results The treatment group showed better effect compared with the oontrol group(P＜0.05).Condusion The therapy of cranial decompression under teniporal muscle in very-low position with large bone flap combined with mild hypothennia showed the advantage of depressing intracranial pressure,reducing crerebral edema and improving the therapeutic effect of severe brain injury patients.

Objective To explore the clinical outcomes of treating unstable intertrochanteric fractures with proximal femoral locking plate (PFLP) in the elderly patients.Methods From January 2010 to June 2015,380 elderly patients with unstable intertrochanteric fracture were treated with PFLP and successfully followed up at our department.They were 171 men and 209 women,from 60 to 89 years of age (average,68.7 years).By AO classification,there were 58 cases of AO31-A2.2,87 ones of 31-A2.3,130 ones of 31-A3.1,63 ones of 31-A3.2,and 42 ones of 31-A3.3.Operation time,incision length,length of hospital stay,fracture healing time,postoperative complications and hip joint Harris scores were recorded.Results This cohort was followed up for an average of 13.3 months (range,from 8 to 21 months).Their operation time averaged 53.2 min,X-ray exposure 12.2 times,intraoperative blood loss 92.7 mL,incision length 12.6 cm,postoperative drainage volume 54.7 mL,and length of hospital stay 9.2 days.Pulmonary infection was observed in 3 cases,fixation loosening in 8,fixation breakage in 2,hip varus in 9,and fracture nonunion in 4,yielding a total complication rate of 6.8％ (26/380).No operative incision infection was observed.The average fracture healing time was 11.8 weeks (range,from 7 to 48 weeks) after operation.The average Harris score one year postoperation for the 380 patients was 86.3 ± 6.1,significantly higher than the preoperative value (43.6±4.4) (P ＜0.05).There were 96 excellent,231 good,42 fair and 11 poor cases,giving an excellent to good rate of 86.1％.Conclusion Since PFLP has advantages of limited invasion,blood loss and complications,a high rate of fracture healing,and good functional recovery of the hip,it may be a good treatment for unstable intertrochanteric fractures in the elderly patients.

Objective:To investigate the prevalence of post-traumatic stress disorder(PTSD)symptoms in middle school students after Wenchuan earthquake.Methods:The PTSD Checklist-Civilian version( PCL-C),which included three symptom groups(A,B,and C),was used to assess the PTSD symptoms in 1960 middle school students in the disaster region through self-questionnaire.Results:(1)The general positive rate of PTSD symptoms was 78.3%,and that of B group was the highest(68.9%).(2)The rates of general PTSD and three symptom groups of PTSD were higher in girls,high grade students,minority groups,rural students,injured in earthquake and those who lost family property than in boys,low grade students,the Han nationality,urban students,not injured in earthquake and those who did not lost family property[such as,the general positive rate of PTSD symptoms:girls 82.2%,boys 73.9%,P<0.05].(3)The rates of severe PTSD symptoms in girls and rural students were higher than that in boys and urban students(27.9% vs.19.9%,26.7% vs.21.4%,Ps<0.05).Conclusions:PTSD symptoms are common among middle school students in earthquake region.Targeted measures should be taken to protect middle school students from PTSD in earthquake region.

Objective:To identify the risk factors for premature proximal femur physeal closure (PPC) in children treated surgically for femoral neck fractures.Methods:Data of 106 children with an open triradiate cartilage who were treated surgically for a femoral neck fracture were retrospectively analyzed. Age, gender, laterality, mechanism of injury, the type of fracture, initial displacement, time to reduction, fixation method, whether the implant crossed the physeal plate, reduction method, reduction quality and development of femoral head avascular necrosis (AVN) were collected. PPC of the proximal femur was assessed through postoperative 6-12 months radiographs.Results:A total of 106 patients with an open triradiate cartilage were followed up, with an average duration of 20.4±13.3 months (range, 6-86 months). The overall rate of PPC following paediatric femoral neck fractures treated surgically was 36.8% (39/106). Among the 39 patients with PPC, 25 were males and 14 were females; the average age at the time of injury was 9.7±3.6 years (range, 3-15 years); 23 patients were involved in left hips and 16 were in right; the mechanisms of injury included motor vehicle accident in 5 fractures, falling injury in 21, sports-related injury in 12 and other causes in 1 fracture; two hips were Delbet type I, and 26 hips and 11 hips were Delbet type II and III, separately; type II and III of initial displacement were involved in 26 and 13 patients, separately; the mean duration from injury to surgery was 3.3±2.8 d (range, 1-14 d); 2 hips were treated with Kirschner wires, 35 hips with screw fixation, and the remaining 2 hips underwent screw and plate fixation; 2 hips had the hardware crossing the proximal femoral growth plate, and the remaining 37 hips didn’t; 15 hips were treated by closed reduction and internal fixation, and the other 24 hips underwent open reduction and internal fixation; anatomical reduction was achieved in 14 patients, acceptable reduction in 24 hips and unacceptable reduction in 1 hip; 24 hips developed AVN at the latest follow-up and the remaining 15 hips didn’t. Statistical analysis indicated that age ( t=3.875, P< 0.001), the severity of initial displacement ( Z=-2.118, P=0.034) and the rate of AVN ( χ2=42.280, P< 0.001) in patients with PPC were significantly higher than those in patients without; Logistic regression analysis confirmed age ( OR=1.288, P=0.011) and AVN ( OR=40.336, P< 0.001) as risk factors for PPC. ROC curve analysis indicated 10 years was the cut off age to significantly increase the rate of PPC. The rate of PPC in patients aged over 10 years (63.6%, 21/33) was significantly higher than that (24.7%, 18/73) in those aged less than 10 years ( χ2=14.848, P< 0.001). Conclusion:Age over 10 years and AVN are risk factors for PPC in children with femoral neck fractures treated surgically.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.