Fifty Years of Cervical Myelopathy Research: Results from a Bibliometric Analysis

We performed bibliometric analysis of the research papers published on clinical cervical spondylotic myelopathy (CSM) in the last 50 years. We extracted bibliometric data from Scopus and PubMed from 1970 to 2020 pertaining to clinical studies of CSM. The predominant journals, top cited articles, authors, and countries were identified using performance analysis. Science mapping was also performed to reveal the emerging trends, and conceptual and social structures of the authors and countries. Bibliometrix R-package was deployed for the study. The total numbers of clinical studies available in PubMed and Scopus were 1,302 and 3,470, respectively. The most cited article was published by Hilibrand AS, as observed in Scopus. Regarding the conceptual structure of the research, two main research themes were identified, one involving symptomatology, scientific-scale-based objective evaluation of symptoms, and surgical removal of the offending culprit, while the other was based on patho-etiology, relevant diagnostic modalities, and the surgery commonly performed for CSM. In terms of emerging trends, in recent times there is an increasing trend of scale-based objective evaluations, along with investigations of advanced nonoperative management. The United States is the most productive country, whereas Canada tops the list for inter-country collaboration. The trend of research showed a shift toward noninvasive procedures.

Epidemiology of pelvic fractures in adults: Our experience at a tertiary hospital / 中华创伤杂志(英文版)

PURPOSE@#Pelvic fractures are severe injuries and are often associated with multiple system injuries, exacerbating the overall outcome. In India, the incidence of pelvic fractures is on a rise due to suboptimal roads and traffics but related literature regarding the overall epidemiology of these injuries is scarce and scanty. Our aim was to study the epidemiology of patients admitted with pelvic fractures at a level 1 trauma centre in India.@*METHODS@#A 16-month (between September 2015 and December 2016) prospective observational study was carried out on trauma patients with pelvic fractures at a level 1 trauma centre of a tertiary care hospital. Demography of patients, mechanism of injuries and complications were recorded prospectively.@*RESULTS@#We observed 75 patients who presented with pelvic fractures, where 56 were males and 19 were females. Mean age of the study population was 37.57 years. Road traffic accidents were the most common mode of injuries. Lateral compression injuries were the most common pattern. Associated injuries frequently encountered were lower extremities and acetabulum fractures, blunt abdominal trauma, urogenital injuries and head injuries. Out of the 75 patients, 52 were treated surgically and 23 were managed by conservative methods. Associated injuries of the extremities, head, abdomen and urogenital system indicated a longer hospital stay.@*CONCLUSION@#Pelvic fractures, although belong to a relatively rare trauma subset, cause a high morbidity and mortality with considerable burden on the economy. Proper road safety training and driving etiquettes along with its strict implementation in true sense and spirit are the need of the hour.

Pediatric Femoral Neck Fractures: Our 10 Years of Experience

BACKGROUND: Femoral neck fractures are rare injuries in children, but the high incidence of long term complications make it an important clinical entity. The aim of this retrospective study was to analyze the clinical outcomes of pediatric femur neck fractures that we managed over a 10 year period. METHODS: The study included 36 children (20 boys and 16 girls) who sustained femoral neck fractures and completed a minimum follow-up of one year. The children were treated either conservatively, or by open reduction and internal fixation (ORIF), or closed reduction and internal fixation (CRIF). The outcomes were analyzed using Ratliff criteria and a detailed record of complications was kept for all patients. RESULTS: The mean age of included patients was 10 years (range, 3 to 16 years) and the average follow-up was 3.2 years (range, 1.1 to 8.5 years). Based on Delbet's classification system, there were 0 type I (transepiphyseal), 16 type II, 11 type III, and 9 type IV fractures. There were 8 undisplaced fractures, 4 of which later displaced after being managed initially in a hip spica. A satisfactory outcome was obtained in 27 (75%) children. Avascular necrosis (AVN) was the most common complication. It was seen in 7 of our patients, all of whom had an unsatisfactory outcome. Other complications included three cases each of coxa vara, non-union, and arthritic changes; and one case each of infection, primary screw perforation of head, and premature epiphyseal closure. Complications were lowest in the group treated by ORIF. Only 2 patients managed exclusively by conservative treatment ultimately achieved a satisfactory outcome. CONCLUSIONS: We believe that internal fixation of pediatric femoral neck fractures is preferred whenever feasible because conservative treatment carries a high risk of failure of reduction. Aggressive operative treatments aimed at anatomical reduction should be the goal and there should be no hesitation in choosing ORIF over CRIF. Outcome of patients is influenced primarily by development of AVN which occurs as an independent entity without much relation to the mode of treatment carried out.

Double segmental tibial fractures--an unusual fracture pattern / 中华创伤杂志(英文版)

A case of a 50-year-old pedestrian who was hit by a bike and suffered fractures of both bones of his right leg was presented. Complete clinical and radiographic assessment showed double segmental fractures of the tibia and multisegmental fractures of the fibula. Review of the literature revealed that this fracture pattern was unique and only a single case was reported so far. Moreover, we discussed the possible mechanisms which can lead to such an injury. We also discussed the management of segmental tibial fracture and the difficulties encountered with them. This case was managed by modern osteosynthesis technique with a pleasing outcome.