Efeito da fotobiomodulação na reabilitação de pacientes com patologias traumato-ortopédicas: revisão integrativa / Efectos de la fotobiomodulación en la rehabilitación de pacientes con patologías traumatoortopédicas: revisión integrativa / Effects of photobiomodulationin the rehabilitation of patients with traumato-orthopedic pathologies: integrative review

Introdução: Fotobiomodulação corresponde à exposição de tecidos biológicos a baixos níveis de luz vermelha e infravermelha, esta terapia favorece a reabilitação de diferentes tecidos e que pode ser utilizada para a melhora da prática clínica nas diferentes atuações da fisioterapia, como por exemplo, no tratamento dos acometimentos musculoesqueléticos e inflamatórios. Objetivo: Identificar os benefícios da fotobiomodulação empregados na reabilitação de pacientes nas diferentes patologias traumato-ortopédicas. Metodologia:Trata-se de uma revisão integrativa com busca online nas plataformas de dados: Medline e PubMed. Os descritores foram: fotobiomodulação, taumato-ortopedia e reabilitação. As línguas selecionadas foram: Português, Inglês e Espanhol, entre os anos de 2018 a 2022.Resultados:A descrição dos achados nos ensaios clínicos analisados mostra que a terapia de fotobiomodulação apresenta diferentes usos na prática clínica e que seu uso produz efeito analgésico, anti-inflamatório e regenerativo nos distúrbios musculoesqueléticos. Conclusões:De acordo com a revisão dos artigos, pôde-se perceber que a terapia por fotobiomodulação confirma seus benefícios e eficácia, portando, se fazendo positiva na atuação traumato-ortopédica, gerando resultados significativos quando comparada a outros recursos (AU).

Introduction: Photobiomodulationcorresponds to the exposure of biological tissues to low levels of red and infrared light, this therapy favors the rehabilitation of different tissues and can be used to improve clinical practice in different actions of physiotherapy, such as, for example, in the treatment of musculoskeletal and inflammatory disorders. Objective: To identify the benefits of photobiomodulation used in the rehabilitation of patients with different traumato-orthopedic pathologies. Methodology:This is an integrative review with online search on data platforms: Medline and PubMed. The descriptors were: photobiomodulation, thaumato-orthopedics and rehabilitation. The selected languages were: Portuguese, English and Spanish, from 2018 to 2022. Results: The description of the discovers in the analyzed clinical trials shows that photobiomodulation therapy has different uses in clinical practice and that its use produces analgesic, anti-inflammatory and regenerative effects in musculoskeletal disorders. Conclusions:According to the review of the articles, it could be seen that photobiomodulation therapy confirms its benefits and effectiveness, therefore, becoming positive in the trauma-orthopedic performance, generating significant results when compared to other resources (AU).

Introducción: La fotobiomodulacióncorresponde a la exposición de tejidos biológicos a bajos niveles de luz roja e infrarroja, esta terapia estimula la rehabilitación de diferentes tejidos y puede ser utilizada para mejorar la práctica clínica en diferentes áreas de fisioterapia, como por ejemplo, en tratamiento de Trastornos musculoesqueléticos e inflamatorios. Objetivo: Identificar los beneficios de la fotobiomodulación utilizada en la rehabilitación de pacientes con diferentes patologías traumato-ortopédicas. Metodología: Esta es una revisión integradora con búsqueda en línea en plataformas de datos: Medline y PubMed. Los descriptores fueron: fotobiomodulación, taumato-ortopedia y rehabilitación. Los idiomas seleccionados fueron: portugués, inglés y español, entre los años 2018 a 2022. Resultados: La descripción de los hallazgos en los ensayos clínicos analizados muestra que la terapia de fotobiomodulación tiene diferentes usos en la práctica clínica y que su uso produce efectos analgésicos, antiinflamatorios y regenerador en trastornos musculoesqueléticos. Conclusiones: De acuerdo con la revisión de los artículos, se pudo apreciar que la terapia de fotobiomodulación confirma sus beneficios y efectividad, por lo tanto, tornándose positiva en el desempeño trauma-ortopédico, generando resultados significativos cuando se compara con otros recursos (AU).

Reduction of Post-Surgical Facial Edema Following Bromelain and Coumarin Intake in Traumatology: A Prospective Study with 100 Patients.

Background: Bromelain and coumarins are recognized as safe and effective therapeutic agents, used by individuals to treat ailments such as postoperative edema, inflammation and other diseases. Bromelain has been proven to be well absorbed by the body after oral administration, and it has no major side effects even after prolonged use. The purpose of this study is to evaluate the effectiveness of bromelain and other nutraceuticals in reducing post-surgical swelling, pain and the need of anti-inflammatory drugs in maxillofacial post-traumatic surgery. Methods: This prospective open-label study was conducted on patients undergoing surgery for trauma of the maxillofacial area. One hundred patients were selected and divided into two groups: one group who underwent therapy with bromelain, Aesculus hippocastanum and Melilotus officinalis and a control group that was not given the drug in postoperative therapy. Results: Patients in the experimental group showed a reduction of edema in the first and second postoperative weeks, a faster complete reduction of facial edema and a lower reduction in maximum mouth opening and needed less anti-inflammatory therapy to control pain. Conclusions: These findings seem to provide evidence that Brovas® may be effective in improving postoperative edema outcomes in patients undergoing surgical treatment of facial fractures.

Insuficiente aplicación de Medicina Natural y Tradicional en afecciones relacionadas con la ortopedia y la traumatología / Unsatisfactory Application of Natural and Traditional Medicine in Conditions Related with Orthopedics and Traumatology

La Medicina Natural y Tradicional aplica sus diferentes modalidades en la práctica médica moderna, segura, económica, inocua y simple; y con pocos efectos colaterales resuelve grandes problemas de salud en situaciones especiales o de desastres con recursos limitados. De ahí que el egresado de programas de especialización de las ciencias médicas cuenta con sólidos conocimientos para su aplicación, especialmente en las afecciones osteomioarticulares, donde la especialidad de ortopedia y traumatología tiene un papel primordial para identificar las causas y consecuencias de la insuficiencia de su aplicación en pacientes portadores de afecciones relacionadas con esta especialidad. A través de un estudio crítico reflexivo basado en el análisis y la síntesis, así como de la constatación de la validez de los puntos de vista asumidos como referentes en el proceso de superación del especialista de ortopedia y traumatología, se pudo mostrar cómo se ha concebido la superación profesional en el Hospital General Dr. Juan Bruno Zayas Alfonso, al integrar adecuadamente los conocimientos y las competencias. Esto se expresó en la elaboración e implementación de una estrategia de superación profesional, que permitió la actualización de relevantes conocimientos necesarios en el campo de la MNT para el desempeño de este profesional. Se concluyó que era insuficiente el nivel de conocimiento de los contenidos, como también los cursos ofertados para su desarrollo, lo que trajo como consecuencia una atención médica sin calidad(AU)

Natural and traditional medicine applies its different modalities in modern, safe, economical, innocuous and simple medical practice; with few collateral effects, it solves major health problems in special or disaster situations with limited resources. Hence, the graduate of specialization programs in medical sciences possesses solid knowledge for its application, especially in osteomyoarticular conditions, in which the specialty of orthopedics and traumatology has a key role in identifying the causes and consequences of its unsatisfactory application in patients with conditions related to this specialty. Through a reflexive and critical study based on analysis and synthesis, as well as the verification of the validity of the viewpoints assumed as referents in the process of improvement of the orthopedics and traumatology specialist, it was possible to show how professional improvement has been conceived at Hospital General Dr. Juan Bruno Zayas Alfonso, by adequately integrating knowledge and competences. This was expressed through the elaboration and implementation of a professional improvement strategy, which allowed updating relevant knowledge necessary in the field of natural and traditional medicine for the performance of this professional. The level of knowledge about the contents was concluded to be insufficient, while the courses offered for its development were so, which resulted in a medical care without quality(AU)

Estrategia de superación profesional para especialistas de Ortopedia y Traumatología en Medicina Natural y Tradicional / A Professional Improvement Strategy in Natural and Traditional Medicine for Orthopedics and Traumatology Specialists

Introducción: La Medicina Natural y Tradicional (MNT) tiene como objetivo integrar conocimientos de sus modalidades a la práctica médica, a partir de una adecuada selección y fundamentación científica. Desde su desarrollo en el proceso de superación profesional en especialidades como la Ortopedia y Traumatología logra atención médica de calidad, se ajusta a las condiciones sociohistóricas actuales y al desarrollo de nuevos estilos de actuación, mejora las relaciones interpersonales y fomenta los valores ético-morales en íntima interrelación con la comunidad. Objetivo: Exponer fundamentos que sustentan el diseño y la aplicación de una estrategia de superación profesional en especialistas de Ortopedia y Traumatología para la aplicación de la Medicina Natural y Tradicional. Métodos: Se realizó un estudio pedagógico, prospectivo, que utilizó métodos teóricos y empíricos. Para la elaboración de la Estrategia de Superación Profesional se utilizó la modelación, que posibilitó el proceso de concreción-abstracción con sus interrelaciones y vínculos con la aplicación de la Medicina Natural y Tradicional. Se asumieron los criterios utilizados por la Dra. C. Yerina Figueredo. La población fue de 43 especialistas de Ortopedia y Traumatología del Hospital Juan Bruno Zayas Alfonso, de Santiago de Cuba, entre julio y diciembre de 2021. Resultados: Se demostró alto nivel de satisfacción con la aplicación de la estrategia y la consulta de expertos evidenció mejora en el desempeño de estos profesionales. Conclusiones: La actualización en las modalidades de la Medicina Natural y Tradicional en la superación de los Especialistas de Ortopedia y Traumatología aportó un grupo de regularidades a la formación permanente y continuada, que enriquecen las ciencias de la educación médica(AU)

Introduction: Natural and traditional medicine aims at integrating knowledge within its modalities to medical practice, based on an adequate selection and scientific foundation. Since its development as part of the professional improvement process in specialties such as Orthopedics and Traumatology, it achieves quality medical care, adjusts itself to the current sociohistorical conditions and the development of new action styles, improves interpersonal relationships, as well as promotes ethical and moral values in close relationship with the community. Objective: To present the foundations that support the design and application of a professional improvement strategy with Orthopedics and Traumatology specialists for the application of natural and traditional medicine. Methods: A pedagogical and prospective study was carried out, using theoretical and empirical methods. Modeling was used for the elaboration of the professional improvement strategy, which made possible the concretion-abstraction process with its interrelations and links in view of the application of natural and traditional medicine. The criteria used by Yerina Figueredo, Ph.D., were assumed. The population was 43 Orthopedics and Traumatology specialists from Hospital Juan Bruno Zayas Alfonso, of Santiago de Cuba, between July and December 2021. Results: A high level of satisfaction with the application of the strategy was demonstrated and the consultation with experts evidenced an improvement in the performance of these professionals. Conclusions: The updating in the modalities of natural and traditional medicine for the training of Orthopedics and Traumatology specialists contributed a group of regularities to permanent and continuous training, which enriches the sciences of medical education(AU)

The kinesthetic diagnosis in a homeric item of pathological heartbeat: An overview in the history of ancient greek medicine.

The Iliad, by the Greek poet Homer, is a precious mine of examples of war traumatology. In the specific case of spear wounds in the chest, the death of the Trojan warrior Alcathous is particularly interesting from the point of view of the history of medicine and the evolution of cardiology and knowledge of the heart at the time of ancient Greece. In particular this paper aims to evidence and reconstruct the main anatomical and physiological knowledge of the heart at that time. Indeed, a historical-linguistic analysis of the Greek text prompts some reflections and thoughts on the heartbeat in pathological conditions and on the function of the heart as a hematopoietic organ. Furthermore, Homer's account is a critical text that highlights the relevance of the use of the senses in the ancient description of nosological pictures and it allows us an interesting and suggestive approach to reconstruction from the historical and historiographical point of view.

Equitable access to quality trauma systems in low-income and middle-income countries: assessing gaps and developing priorities in Ghana, Rwanda and South Africa.

Injuries in low-income and middle-income countries are prevalent and their number is expected to increase. Death and disability after injury can be reduced if people reach healthcare facilities in a timely manner. Knowledge of barriers to access to quality injury care is necessary to intervene to improve outcomes. We combined a four-delay framework with WHO Building Blocks and Institution of Medicine Quality Outcomes Frameworks to describe barriers to trauma care in three countries in sub-Saharan Africa: Ghana, South Africa and Rwanda. We used a parallel convergent mixed-methods research design, integrating the results to enable a holistic analysis of the barriers to access to quality injury care. Data were collected using surveys of patient experiences of injury care, interviews and focus group discussions with patients and community leaders, and a survey of policy-makers and healthcare leaders on the governance context for injury care. We identified 121 barriers across all three countries. Of these, 31 (25.6%) were shared across countries. More than half (18/31, 58%) were predominantly related to delay 3 ('Delays to receiving quality care'). The majority of the barriers were captured using just one of the multiple methods, emphasising the need to use multiple methods to identify all barriers. Given there are many barriers to access to quality care for people who have been injured in Rwanda, Ghana and South Africa, but few of these are shared across countries, solutions to overcome these barriers may also be contextually dependent. This suggests the need for rigorous assessments of contexts using multiple data collection methods before developing interventions to improve access to quality care.

[Organizational and hospital structure for the integrated care of orthogeriatic patients]. / Organisation und Klinikstruktur für die integrierte Betreuung orthogeriatrischer Patienten.

Numerous studies have shown that geriatric cooperation models in traumatology lead to significantly reduced morbidity and mortality rates. Even though national and international orthopedic and trauma societies recommend expanding these concepts to include nontrauma-related musculoskeletal diseases, unfortunately, to date only a few of these projects have been implemented. The present article deals with the necessary personnel and infrastructural implementation of a so-called orthogeriatric concept and puts the special features of this new type of treatment in direct comparison with known traumatological cotreatment concepts.

[The reasons for refusal and abandonment of treatment in the emergency surgery at the University Hospital Center of Bouake, Ivory Coast]. / Les raisons du refus et abandon de soins aux urgences chirurgicales du Centre Hospitalier et Universitaire de Bouaké, Côte d'Ivoire.

The refusal and abandonment of treatment is a behavior frequently observed in our daily practice. The purpose of this study was to describe the epidemiology and to identify the reasons for refusals and abandonment of treatment. We conducted a prospective study in the emergency surgery at the University Hospital Center of Bouake from 1st January 2018 to 31st December 2018. It involved all patients admitted with traumatic lesions who had refused or abandoned treatment. Data from 106 cases (16%) of refusal and abandonment of treatment out of 662 cases admitted with limb traumas were examined over this period. The average age of patients was 37 years. The study enrolled 77 men (72.6%). Tertiary sector workers accounted for 56.6% (n= 60) of cases. Lesions were dominated by closed fractures (82.1%; n= 87) and pelvic limbs were the most achieved (78.3%; n=83). Treatment was based on surgery (n=85; 80.2% ) and orthopaedic treatment (n=21; 19.8%). The cost of orthopedic treatment was estimated at 26 500 CFA francs (40 euros) while at 250 000 FCFA (380 euros) for surgical treatment. These costs varied as a function of implant prescribed and its location. Refusal of tratment was expressed by patients (n=30; 28.3%) and by parents (n=76; 71.7%). Reported reasons were dominated by financial problems (n=62; 58.5%), trust in traditional medicine (n=42; 39.6%), religious belief (n=2; 1.9%). The average time of refusal was 22 hours. Eighty eight point seven percent (n=94) of patients signed discharge while 11.3% (n=12) escaped. Refusal of care is a recurrent theme in our context and is due to inadequate health care management of people with limited financial resources.

Optimization of perioperative management of proximal femoral fracture in the elderly.

Proximal femoral fracture in elderly subjects is a major event that is life-threatening in the medium-to-long term. Advanced age, male gender and number of comorbidities largely account for high mortality and require geriatric expertise. Protein-energy malnutrition and bone demineralization increase mortality. Mortality can, on the other hand, be reduced by acting on two variables accessible to medical intervention: daily activities and nutritional status. Functional and neurocognitive assessment allow the risk of dependency to be evaluated, and global geriatric work-up can prevent sudden breakdown of homeostasis. In the emergency setting, pain is to be alleviated, polymedication and anticoagulation therapy checked, and instability (notably cardiac and pulmonary) and confusion syndrome screened for on geriatric and anesthesiologic opinions. Surgery should be implemented without delay, within 48hours of admission, preferably using multimodal anesthesia. The technique should be geared to allow early weight-bearing and mobilization. The most comprehensive care plan involves team-work between emergency physicians, surgeons, orthopedic specialists, anesthesiologists, geriatricians, pharmacists, rehabilitation specialists and nursing staff, to reduce mortality and readmission and improve functional results. Post-fracture coordination seeks to prevent falls and further fractures and to treat bone demineralization.

Investigation and Analysis of TCM Decoction Pieces and Prescription Drugs Dosage in Affiliated Orthopedics and Traumatology Hospital of Guangzhou University of TCM During Sep. 2015 - Sep. 2016 / 中国中医药信息杂志

Objective To statistically analyze the overdose of Chinese materia medica in Orthopedics and Traumatology Outpatient Clinic of The Affiliated Orthopedics and Traumatology Hospital of Guangzhou University of Traditional Chinese Medicine (hereinafter referred to as "our hospital"); To provide references for rational application of Chinese materia medica in orthopedics and traumatology department. Methods Totaiiy 1200 prescriptions during Sep. 2015 - Sep. 2016 in Orthopedics and Traumatology Outpatient Clinic were randomly selected. Based on the Chinese Pharmacopoeia (2015 Edition) and the second edition of the New Century textbook Chinese Medicine as references, the top 30 of the use of TCM decoction pieces were retrospectively analyzed. Results The top 30 of the use of TCM decoction pieces were 100% overdosed, among which 11 TCM decoction pieces were 50% overdosed; 95.93% prescriptions were with 18 kinds of Chinese materia medica. Conclusion Excessive use of Chinese materia medica prescriptions are common in Orthopedics and Traumatology Outpatient Clinic of out hospital, which causes waste of TCM resources and imposes patients' financial burden.

Effects of heparin and hyperbaric oxygenation on necrosis reduction in an animal model for degloving injuries / Efeitos da heparina e da oxigenação hiperbárica na redução de necrose de modelo animal para desluvamentos

ABSTRACT Objective: to evaluate the efficacy of the treatment with hyperbaric oxygen therapy or with topical and intralesional heparin in an animal model of degloving lesions. Methods: we conducted an experimental study with adult, male Wistar rats submitted to degloving of the left hind limb and divided into four groups according to the treatment: Group 1 (control) - without treatment; Group 2 (Heparin) - intralesional application at the time of surgery and topically, in the postoperative period, with heparin spray 10,000IU/mL; Group 3 (hyperbaric oxygenation) - daily sessions of 30 minutes in a hyperbaric chamber with 100% oxygen and 2 ATA pressure; Group 4 (positive control) - administration of a single dose of 45 mg/kg of intraperitoneal allopurinol. On the seventh day, we killed the animals, removed the cutaneous flaps and measured the total and necrotic areas, as well as computed the percentage of necrotic area. Results: the mean percentage of necrosis in the control group was 56.03%; in the positive control group it was 51.36% (p<0.45); in the heparin group, 42.10% (p<0.07); and in the hyperbaric oxygen therapy group, 31.58% (p<0.01) . Conclusion: both hyperbaric oxygen and heparin therapies were effective in reducing the percentage of necrosis in the model studied, although only the hyperbaric oxygenation showed statistical significance.

RESUMO Objetivos: avaliar a eficácia do tratamento com oxigenoterapia hiperbárica ou com heparina tópica e intralesional em modelo animal de desluvamentos. Métodos: estudo experimental, com ratos adultos machos Wistar, submetidos a desluvamento do membro posterior esquerdo e divididos em quatro grupos, de acordo com o tratamento: Grupo 1 (controle) - sem tratamento; Grupo 2 (Heparina) - aplicação intralesional no momento da cirurgia e tópica, no pós operatório, com spray de heparina 10.000UI/mL; Grupo 3 (oxigenação hiperbárica) - sessões diárias de 30 minutos em câmara hiperbárica com 100% de oxigênio e 2 ATA de pressão; Grupo 4 (controle positivo) - administração de dose única de 45mg/kg de alopurionol intraperitoneal. No sétimo dia os animais foram mortos e os retalhos cutâneos foram retirados e realizadas medidas das áreas total e necrótica, bem como cálculo da porcentagem da área de necrose. Resultados: a média da porcentagem de necrose do grupo controle foi 56,03%; no grupo controle positivo, 51,36% (p≤0,45); no grupo da heparina, 42,10% (p≤0,07) e no grupo da oxigenoterapia hiperbárica, 31,58% (p≤0,01). Conclusão: tanto a oxigenoterapia hiperbárica quanto a terapia com heparina mostraram-se eficazes na redução do percentual de necrose no modelo estudado, embora neste trabalho apenas a oxigenação hiperbárica tenha demonstrado significância estatística.

Cultivation of Traditional Chinese medicine thinking in tendon and muscle injury / 国际中医中药杂志

Traditional Chinese medicine thinking is the core method of diagnosis and treatment of traditional Chinese medicine. Thus, cultivating the clinical thinking of traditional Chinese medicine in the orthopeadics department has become the importance. TCM tendon and muscle injuries were well characterised by the TCM, becoming an important part of TCM orthopedics., The tendon and muscle injuries were used to explore the application and cultivation of traditional Chinese medicine thinking. This will help to improve the clinical curative effect, complement the modern Chinese medicine.

Assistência de enfermagem a idosos com traumas ósseos: uma revisão integrativa / Cuidados de enfermería para la tercera edad con fracturas óseas: una revisión integrativa / Nursing care to elderly with bone fractures: an integrative review

Objective: To describe the profile of the elderly victims of bone trauma and as how nursing has been active in assisting these clients. Method: integrative Review, held in LILACS database with the keywords: Elderly, Nursing and Trauma, in order to answer the following question: <<”What is the profile of the elderly who suffer from bone trauma and the role of nursing care to these customers?”>>. Results: people over 80 years old suffer more trauma primarily with neuromotor weaknesses, using multiple medications and comorbidities. Nursing care for the elderly is still traumatized poor because there was a significant incidence of iatrogenic complications. Conclusion: the risk factors for the occurrence of traumatic events in the elderly favor the loss of quality of life, increased functional dependence, burden for caregivers and institutionalization. The records of care provide visibility and ensure continuity of care in a qualified way...

Objetivo: Descrever o perfil dos idosos que foram vítimas de traumas ósseos e como a enfermagem tem atuado na assistência a estes clientes. Método: revisão integrativa, realizada na base de dados LILACS a partir dos descritores: Idoso, Enfermagem e Trauma, no intuito de responder a seguinte questão:<< “Qual o perfil dos idosos que sofrem traumas ósseos e qual o papel da enfermagem na assistência a estes clientes?” >>. Resultados: sofrem mais traumas os indivíduos prioritariamente acima de 80 anos, com debilidades neuromotoras, usando múltiplas medicações e com comorbidades. O cuidado de enfermagem aos idosos traumatizados ainda é deficiente, pois se observou uma incidência significativa de iatrogenias. Conclusão: os fatores de risco para a ocorrência de eventos traumáticos no idoso favorecem a perda da qualidade de vida, aumento da dependência funcional, sobrecarga aos cuidadores e institucionalização. Os registros dos cuidados prestados proporcionam visibilidade e garantem a continuidade do cuidado de forma qualificada...

Objetivo: Describir el perfil de los ancianos que fueron víctimas de traumas óseos y cómo la enfermería ha actuado en la asistencia a estos clientes. Método: revisión Integradora, realizada em la base de datos LILACS a partir de los descriptores: Anciano, Enfermería y Trauma, con el intuito de responder a la siguiente pregunta: << “Cuál es el perfil de los ancianos que sufren traumas óseas y cuál es el papel de la enfermería en la asistencia a estos clientes?”>>. Resultados: sufren más traumas individuos prioritariamente con más de 80 años, con debilidades neuromotoras, usando múltiples medicaciones y con comorbilidades. El cuidado de enfermería a los ancianos traumatizados todavía es deficiente, ya que se observa una incidencia significativa de iatrogenias. Conclusión: los factores de riesgo para la ocurrencia de eventos traumáticos en el anciano favorecen la pérdida de la calidad de vida, aumento de la dependencia funcional, sobrecarga a los cuidadores y institucionalización. Los registros de los cuidados prestados proporcionan visibilidad y garantizan la continuidad del cuidado de forma calificada...

Discussion on the theory of paying equal attention to sinew and bone in China osteosynthesis / 针灸推拿医学（英文版）

‘Paying equal attention to sinew and bone’ is an important principle in China osteosynthesis (CO). Traditional bone-setting manipulations not only pay high attention to fracture reduction, but also to sinew-regulating and soft tissues protection. The advantage of this principle has also been confirmed by modern medicine. To understand the principle better, it is essential to learn its historical origin, its important role in traumatology and its significant influence on modern orthopedics. In addition, we should inherit and further develop its theory, innovate and promote the development of CO constantly.

Biomechanics applied in traditional Chinese traumatology manipulation for treating cervical spine diseases / 医用生物力学

Traditional Chinese traumatology manipulation (TCTM) has some prominent advantage for treating cervical spine diseases in clinic, thus the biomechanical research on TCTM could possess important clinical and theoretical significance. The studies on biomechanical mechanism of TCTM for treating cervical spine diseases in recent years were reviewed from various aspects, and biomechanical issuessuch as the force measurement of TCTM, the different operation types of TCTM (i.e. tendon-soothing maneuver, bone setting manipulation), the TCTM effect on cervical tissues (i.e. vertebral body, intervertebral discs, muscles, blood vessels) were also investigated, trying to provide some biomechanics theoretical evidence and guidance for treating cervical spine diseases with TCTM in clinic.

Bone graft substitutes for the treatment of traumatic fractures of the extremities.

UNLABELLED: HEALTH POLITICAL AND SCIENTIFIC BACKGROUND: Bone graft substitutes are increasingly being used as supplements to standard care or as alternative to bone grafts in the treatment of traumatic fractures. RESEARCH QUESTIONS: The efficacy and cost-effectiveness of bone graft substitutes for the treatment of traumatic fractures as well as the ethical, social and legal implications of their use are the main research questions addressed. METHODS: A systematic literature search was conducted in electronic medical databases (MEDLINE, EMBASE etc.) in December 2009. Randomised controlled trials (RCT), where applicable also containing relevant health economic evaluations and publications addressing the ethical, social and legal aspects of using bone graft substitutes for fracture treatment were included in the analysis. After assessment of study quality the information synthesis of the medical data was performed using metaanalysis, the synthesis of the health economic data was performed descriptively. RESULTS: 14 RCT were included in the medical analysis, and two in the heath economic evaluation. No relevant publications on the ethical, social and legal implications of the bone graft substitute use were found. In the RCT on fracture treatment with bone morphogenetic protein-2 (BMP-2) versus standard care without bone grafting (RCT with an elevated high risk of bias) there was a significant difference in favour of BMP-2 for several outcome measures. The RCT of calcium phosphate (CaP) cement and bone marrow-based composite materials versus autogenous bone grafts (RCT with a high risk of bias) revealed significant differences in favour of bone graft substitutes for some outcome measures. Regarding the other bone graft substitutes, almost all comparisons demonstrated no significant difference. The use of BMP-2 in addition to standard care without bone grafting led in the study to increased treatment costs considering all patients with traumatic open fractures. However, cost savings through the additional use of BMP-2 were calculated in a patient subgroup with high-grade open fractures (Gustilo-Anderson grade IIIB). Cost-effectiveness for BMP-2 versus standard care with autologous bone grafts as well as for other bone graft substitutes in fracture treatment has not been determined yet. DISCUSSION: Although there were some significant differences in favour of BMP-2, due to the overall poor quality of the studies the evidence can only be interpreted as suggestive for efficacy. In the case of CaP cements and bone marrow-based bone substitute materials, the evidence is only weakly suggestive for efficacy. From an overall economic perspective, the transferability of the results of the health economic evaluations to the current situation in Germany is limited. CONCLUSIONS: The current evidence is insufficient to evaluate entirely the use of different bone graft substitutes for fracture treatment. From a medical point of view, BMP-2 is a viable alternative for treatment of open fractures of the tibia, especially in cases where bone grafting is not possible. Autologous bone grafting is preferable comparing to the use of OP-1. Possible advantages of CaP cements and composites containing bone marrow over autogenous bone grafting should be taken into account in clinical decision making. The use of the hydroxyapatite material and allograft bone chips compared to autologous bone grafts cannot be recommended. From a health economic perspective, the use of BMP-2 in addition to standard care without bone grafting is recommended as cost-saving in patients with high-grade open fractures (Gustilo-Anderson grade IIIB). Based on the current evidence no further recommendations can be made regarding the use of bone graft substitutes for the treatment of fractures. To avoid legal implications, use of bone graft substitutes outside their approved indications should be avoided.

Thromboprophylaxis following major skeletal trauma: a systematic review.

PURPOSE: Venous thromboembolic disease following skeletal polytrauma is a major issue for trauma surgeons, but there is no consensus of opinion regarding the optimal form of prophylaxis. The purpose of this paper was to compare the incidence of venous thromboembolic events (VTE) after major skeletal trauma managed with different prophylactic methods and their combinations. METHODS: A search of AMED, CINAHL, Cochrane Library, EMBASE and MEDLINE databases was performed from their inception to July 2010. A search of unpublished literature databases was undertaken. All randomised controlled trials assessing the incidence of VTE events between two or more forms of thromboprophylaxis for patient following major skeletal trauma were included. Two reviewers independently identified all eligible articles, extracted the data, and critically appraised all included publications using the Critical Appraisal Skills Programme tool. RESULTS: A total of 11 papers were identified. The findings of this study suggest that low molecular weight heparin (LMWH) may be superior to low dose heparin (LDH), and that LMWH should be used in addition to mechanical prophylaxis measures in patients following major skeletal trauma. There is limited evidence for the use of electrostimulation. There appeared to be no significant difference between the use of LDH compared to calf compression devices. However, the evidence-base was insufficient in both size and methodological quality. CONCLUSIONS: There is currently insufficient research to be able to inform trauma surgeons as to the optimal method of thromboprophylaxis for patients following major skeletal trauma.

Development of orthopaedic trauma in China / 中华创伤骨科杂志

Modern Chinese Orthopaedic traumatology has stemmed from the orthopaed ics of Traditional Chinese Medicine(TMC)and western orthopaedics.On the one hand,with a long history and its unique system of theory and treatment,TMC orthopaedics h as made a great con-tribution to the development of modern Chinese orthopaedic traumatology.On the other hand,the introduction and development of western medicine have dramatically pro moted the development of modern Chinese orthopaedic traumatology.Modern Chinese surgeons of orthopaedic trauma have accomplished numerous successful f irst cases in the world since 1950s an d have thus expanded their professional influence.At pr esent,the Chinese orthopaedic trau ma community has grown much stronger and established its ow n academic associations and journals.More and more de-partments of orthopaedic traumatology have been successively establis hed as an independent en-tity in large and middle-sized hospi tals in China.So far,the Chinese orthopaedic trauma com-munity,on the whole,has reached the international level,but there are q uite a lot to be improved in the aspect of treatment.To end the backwardness,in the future Chinese orthopaedic trauma community should make great efforts in education of orthopedists on comp rehensive knowledge,establishment of formal profession al training system,national standardization of orthopaedic procedures in clinical diagnosis an d treatment,active membership of re lative international aca-demic associations and increasing p rofessional exchanges with international counterparts,as well as in research and development of operative techniques and fixators.All these will be the main strategies and developmental trends in the future for Chinese orthopaed ic traumatology. [