Picometer-Scale Atomic Shifts Governing Subdisordered Structures in Diamond.

Diamond is considered the most promising next-generation semiconductor material due to its excellent physical characteristics. It has been more than three decades since the discovery of a special structure named n-diamond. However, despite extensive efforts, its crystallographic structure and properties are still unclear. Here, we show that subdisordered structures in diamond provide an explanation for the structural feature of n-diamond. Monocrystalline diamond with subdisordered structures is synthesized via the chemical vapor deposition method. Atomic-resolution scanning transmission electron microscopy characterizations combined with the picometer-precision peak finder technology and diffraction simulations reveal that picometer-scale shifts of atoms within cells of diamond govern the subdisordered structures. First-principles calculations indicate that the bandgap of diamond decreases rapidly with increasing shifting distance, in accordance with experimental results. These findings clarify the crystallographic structure and electronic properties of n-diamond and provide new insights into the bandgap adjustment in diamond.

Construction of a nursing assessment framework for patients in anaesthesia recovery period: A modified Delphi study.

AIM: To construct a nursing assessment framework for patients in anaesthesia recovery period. DESIGN: A three-round modified Delphi method was employed to capture the consensus of 22 panellists. METHODS: The initial items in the nursing assessment framework for patients in anaesthesia recovery period were developed based on the mini-clinical evaluation exercise (mini-CEX). A panel of 22 experts participated in this study. The panellists have more than 10 years of experience in either clinical anaesthesia, or post-anesthesia nursing, or operating room nursing, or surgical intensive nursing. Between March and April 2023, the panellists evaluated and recommended revisions to the initial framework. RESULTS: This study resulted in the development of a nursing assessment framework for patients in anaesthesia recovery period. The initial version of the framework consisted of six dimensions with 27 items. Six items were modified after the first round of consultation. After the second round, five modifications and four deletions were made based on expert opinion. The third round resulted in a convergence of expert opinion. The framework, which consists of 24 items across five dimensions, was refined. The five dimensions are as follows: History-taking, Physical assessment, Clinical judgement, Organizational efficiency and Humanistic concern. CONCLUSION: The nursing assessment framework for patients in anaesthesia recovery period was reached consensus between the 22 experts' opinions. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: The assessment framework constructed in this study could be used for the process evaluation of post-anesthesia nursing. The framework may guide perianesthesia nurses in the timely and effective assessment of patients during this critical phase of care. It may be used for perianesthesia nursing education or to evaluate nurses' assessment skills. REPORTING METHOD: The study is reported in accordance with the Guidance on Conducting and Reporting DElphi Studies (CREDES) recommendations. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Enhanced electrocatalytic performance for oxygen evolution reaction via active interfaces of Co3O4arrays@FeOx/Carbon cloth heterostructure by plasma-enhanced atomic layer deposition.

Oxygen evolution reaction (OER) is a necessary procedure in various devices including water splitting and rechargeable metal-air batteries but required a higher potential to improve oxygen evolution efficiency due to its slow reaction kinetics. In order to solve this problem, a heterostructured electrocatalyst (Co3O4@FeOx/CC) is synthesized by deposition of iron oxides (FeOx) on carbon cloth (CC) via plasma-enhanced atomic layer deposition, then growth of the cobalt oxide (Co3O4) nanosheet arrays. The deposition cycle of FeOxon the CC strongly influences thein situgrowth and distribution of Co3O4nanosheets and electronic conductivity of the electrocatalyst. Owing to the high accessible and electroactive areas and improved electrical conductivity, the free-standing electrode of Co3O4@FeOx/CC with 100 deposition cycles of FeOxexhibits excellent electrocatalytic performance for OER with a low overpotential of 314.0 mV at 10 mA cm-2and a small Tafel slope of 29.2 mV dec-1in alkaline solution, which is much better than that of Co3O4/CC (448 mV), and even commercial RuO2(380 mV). This design and optimization strategy shows a promising way to synthesize ideally designed catalytic architectures for application in energy storage and conversion.

Bedside handover with structured and relayed forms in a postanesthesia care unit: A pre- and post-implementation study.

BACKGROUND: Early postoperative patients are vulnerable. Poor communication between health care professionals may seriously damage patients' wellbeing. There is a risk of information loss when bedside handover is performed. OBJECTIVES: To investigate whether the implementation of structured and relayed forms to shift-to-shift bedside handovers improve the frequency of appropriate handover elements and reduces the incidence of adverse events and postoperative length of stay for patients in a postanesthesia care unit. METHODS: This quality improvement project was conducted in a postanesthesia care unit of a tertiary stomatological hospital in China. The study population was patients under surveillance in the postanesthesia care unit for >12 h. A pre- and post-implementation approach was employed. The pre-implementation of unstructured bedside handovers and the post-implementation of bedside handovers with structured and relayed forms were compared. The indicators measured were appropriate handover elements, adverse patient events, and postoperative hospital stay. RESULTS: There were 387 and 395 morning handovers observed pre- and post-implementation of bedside handovers with structured and relayed forms, respectively. Of the 21 elements that should be delivered, 17 elements were noted to be improved. No improvement was found in the incidence of adverse events and postoperative hospital stay. CONCLUSIONS: Bedside handovers with structured and relayed forms increased the incidence of appropriate handover elements. The use of structured and relayed forms did not affect on the incidence of adverse events and postoperative hospital stay. Individualized relayed handover forms may be developed and implemented according to the characteristics in which they are administered.

Translation, Cross-Cultural Adaptation, and Psychometric Properties of the Chinese Version of the Surgical Fear Questionnaire.

PURPOSE: To translate the Surgical Fear Questionnaire into Chinese, to culturally adapt, and test the validity and reliability of the Chinese version of the Surgical Fear Questionnaire. DESIGN: The translation and cultural adaptation process followed Sousa's guidelines, including the evaluation of this scale by the selected participants and content validity measurement by experts. A cross-sectional design was employed to the psychometric properties evaluation phase. METHODS: A convenience sample of 336 participants from three hospitals was recruited between July 2019 and December 2019. Internal consistency reliability, construct validity, and convergent validity with the Hospital Anxiety and Depression Scale were analyzed. FINDINGS: Confirmatory and exploratory factor analyses of the Chinese version of the Surgical Fear Questionnaire yielded a two-factor solution, with each factor comprised of four items, which were the same as the original English scale. The Chinese version showed a moderate correlation with the two domains of the Hospital Anxiety and Depression Scale. Cronbach's alpha and McDonald's Omega in the present sample showed excellent internal consistency. CONCLUSIONS: The Chinese version of the Surgical Fear Questionnaire is a reliable and valid instrument to assess the fear before surgical procedures under general anesthesia.

Ultrathin interfacial modification of Li-rich layered oxide electrode/sulfide solid electrolyte via atomic layer deposition for high electrochemical performance batteries.

Herein, Li-rich layered oxides (LLOs) are modified by sulfide solid electrolyte Li10GeP2S12 (LGPS) with high ionic conductivity to enhance the diffusion of Li+ and an ultrathin Al2O3 layer is interposed between LLOs and LGPS through the atomic layer deposition (ALD) technique to inhibit the development of the highly resistive space-charge layer, the side reactions and structure transition of the composites, thus excellently promoting the electrochemical properties of the composites in liquid electrolyte. Among the different ALD cycles of Al2O3, 10 cycles of ultrathin Al2O3 layer achieves the greatest electrochemical performance. The beginning discharge capacity of LLOs@Al2O3/LGPS composites comes up to 233.4 mA h g-1 with a capacity retention of 90.6% and a voltage retention of 97.3% after 100 cycles at 0.2 C. The composites also exhibit the optimal rate capability and a high energy density of 581 Wh kg-1 at 1 C. The galvanostatic intermittent titration technique test indicates that the composites (LLOs@Al2O3/LGPS) possess the greatest Li+ diffusion coefficient (1.58 × 10-10 cm2 s-1) compared to LLOs (0.85 × 10-10 cm2 s-1) and LLOs/LGPS (1.10 × 10-10 cm2 s-1). More importantly, charge curves at the beginning of the initial charge and electrochemical impedance spectroscopy curves clearly reveal the inhibition of the development of the highly resistive space-charge layer.

Prevention of Nasal Ala Pressure Injuries With Use of Hydroactive Dressings in Patients With Nasotracheal Intubation of Orthognathic Surgery: A Randomized Controlled Trial.

PURPOSE: To compare a hydroactive dressing to an adhesive tape standard of care in the prevention of nasal ala pressure injuries associated with nasotracheal intubation during orthognathic surgery. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: The study took place in a tertiary hospital of stomatology in China. Patients undergoing general anesthesia with nasotracheal intubation during orthognathic surgical procedures were invited to participate. METHODS: Participants were divided into 2 groups: in the experimental group, a hydroactive dressing was applied to the nasal ala before the surgical procedures; the control group received standard prevention with a type of tape. Skin assessments were performed on the wards up to 72 hours after the procedures. Demographic information and potential contributing factors associated the development of nasal ala pressure injuries were collected from patients' electronic medical records. Pressure injury development was staged using National Pressure Injury Advisory staging guidelines. Pressure injury incidence was compared between groups using the χ test and odds ratio. RESULTS: The sample comprised 450 participants, 225 in each group. The incidence of nasal ala pressure injuries development was 14.222% and 4.444% in the 2 groups, respectively (P = .000). The odds ratio was 3.565 (95% confidence interval, 1.707-7.443). CONCLUSIONS: The study findings indicate that the incidence of pressure injuries of nasal ala skin protected by hydroactive dressings was lower than the standard preventive method. Hydroactive dressings should be considered as a prevention method to reduce device-related skin injuries associated with nasotracheal intubation.

An Investigation Into the Disease Profile and Healthcare Costs of Inpatients Treated at a Major Oral and Maxillofacial Surgical Center.

OBJECTIVE: This study is a retrospective review which reported on the treatment records of oral and maxillofacial inpatients treated at a medical institution with the largest scale of oral and maxillofacial specialist services in China, to reflect on disease profile, healthcare model characteristics and the medical status of oral and maxillofacial surgery in China. PATIENTS AND METHODS: Information on 25,825 patients hospitalized between 2008 and 2013 was collected to analyze the mean length of stay (LOS) and preoperative LOS, expenditure patterns, and payment status. RESULTS: The overall mean LOS and preoperative LOS were 10.0 ±â€Š4.9 days and 4.3 ±â€Š2.1 days, respectively. The main costs composed of surgery charges and material costs (47.4%). The proportion of nonlocal patients was 76.34% and the majority of patients used their basic medical insurance (57.74%), and the proportion of patients self-paying showed the largest increase over time. Rising charges for inpatients in this institution did not cause an aggravation of medical cost burden of residents. Cost burden of oral and maxillofacial malignancy surgery patients was higher than in developed countries. CONCLUSIONS: The overall mean LOS and preoperative LOS were higher than that of similar patients globally. Compared with medicine and material costs, medical income is lower and the value of medical personnel labor is not fully appreciated. The proportion of patients who actually enjoy the benefits of the basic medical insurance in China is lower than the coverage.

In-situ simulation for nursing students' professional competence development in postanesthesia care: A quasi-experimental study.

AIM: To evaluate the differences in professional competence development between nursing students in routine clinical practice and those who experienced four additional in-situ simulations. BACKGROUND: The amount of clinical practice time available to nursing students is limited. Occasionally, clinical settings do not provide all of the content that nursing students are expected to acquire. In high-risk clinical scenarios, such as the postanesthesia care unit, clinical practice may not provide sufficient context for students to develop the professional competence. DESIGN: This was a non-blinded, non-randomized, quasi-experimental study. The study was conducted in the postanesthesia care unit of a tertiary hospital in China between April 2021 and December 2022. Nursing students' self-assessed professional competence development and faculty-assessed clinical judgment were used as indicators. METHODS: A total of 30 final year undergraduate nursing students were divided into two groups according to the time they arrived at the unit for their clinical practice. Nursing students in the control group followed the routine teaching protocol of the unit. Students in the simulation group received four additional in-situ simulations during the second and third weeks of their practice in addition to the routine program. Nursing students self-assessed their postanesthesia care unit professional competence at the end of the first and fourth weeks. At the end of the fourth week, the nursing students were evaluated on their clinical judgment. RESULTS: Nursing students in both groups scored higher on the professional competence at the end of the fourth week than at the end of the first week and there was a trend of higher competence improvement in the simulation group than in the control group. For clinical judgment, nursing students in the simulation group scored higher than the control group. CONCLUSIONS: In-situ simulation contributes to the development of professional competence and clinical judgment of nursing students during their clinical practice in the postanesthesia care unit.

Application of Nano-Crystalline Diamond in Tribology.

Nano-crystalline diamond has been extensively researched and applied in the fields of tribology, optics, quantum information and biomedicine. In virtue of its hardness, the highest in natural materials, diamond outperforms the other materials in terms of wear resistance. Compared to traditional single-crystalline and poly-crystalline diamonds, nano-crystalline diamond consists of disordered grains and thus possesses good toughness and self-sharpening. These merits render nano-crystalline diamonds to have great potential in tribology. Moreover, the re-nucleation of nano-crystalline diamond during preparation is beneficial to decreasing surface roughness due to its ultrafine grain size. Nano-crystalline diamond coatings can have a friction coefficient as low as single-crystal diamonds. This article briefly introduces the approaches to preparing nano-crystalline diamond materials and summarizes their applications in the field of tribology. Firstly, nano-crystalline diamond powders can be used as additives in both oil- and water-based lubricants to significantly enhance their anti-wear property. Nano-crystalline diamond coatings can also act as self-lubricating films when they are deposited on different substrates, exhibiting excellent performance in friction reduction and wear resistance. In addition, the research works related to the tribological applications of nano-crystalline diamond composites have also been reviewed in this paper.

Development of the professional competence and professional self-concept of undergraduate nursing students during the clinical practice period: A cross-lagged panel analysis.

AIM: To explore the relationship of the development of professional competence and professional self-concept of undergraduate nursing students during the clinical practice period. BACKGROUND: Clinical practice is one of the most important aspects of nursing education. Nursing students combine theoretical knowledge, psychomotor skills and emotions in a professional socialization process through clinical practice sessions. DESIGN: A two-time point longitudinal design was performed. A cross-lagged model was employed to analyze the relationship between the development of professional competence and professional self-concept of undergraduate nursing students during their clinical practice period. METHODS: A total of 210 undergraduate nursing students were included in this study. The questionnaire was distributed two months and six months after their clinical practice started. Professional Self Concept of Nurses Instrument and Professional Competence Scale for Undergraduate Nursing Students were the two main instruments. RESULTS: Both the professional competence and professional self-concept of Undergraduate nursing students increase at the end of the sixth month compared with the end of the second month after their clinical practice started. The results of the cross-lagged analysis showed that the professional self-concept was partially responsible for the development of professional competence. The effect of professional competence on the development of professional self-concept, in contrast, was not found in this study. CONCLUSIONS: Clinical nursing educators should pay greater attention to the development of the professional self-concept of undergraduate nursing students. More attention should be paid to creating a supportive clinical learning environment to facilitate the improvement of undergraduate nursing students' professional self-concept and professional competence.

Chemical Vapor Deposition of <110> Textured Diamond Film through Pre-Seeding by Diamond Nano-Sheets

Diamond films prepared by chemical vapor deposition will exhibit different surface morphologies, which are determined by the texture and the structural perfection of the deposited diamond. In general, its surface morphology can be controlled by adjusting the deposition conditions. In the present work, <110> textured diamond film was deposited on single crystalline silicon through pre-seeding by diamond nanosheets, rather than controlling the deposition conditions. The employed diamond nano-sheets were prepared by cleavage along a plane, exhibiting good crystallinity. Before chemical vapor deposition, the as-prepared diamond nano-sheets were pre-seeded on the surface of single crystalline silicon as nucleation sites for diamond growth. SEM and XRD results show that the prepared diamond films have a <110> texture. FIB observation reveals that diamonds homogeneously grow on the pre-seeded diamond nano-sheets during chemical vapor deposition, achieving the diamond film with <110> texture. Our work provides a new strategy to prepare <110> textured diamond film.

Effects of Y2O3 and LiAl5O8 on the Microstructure and Optical Properties of Reactively Sintered AlON Based Transparent Ceramics.

Sintering aid was very crucial to influence the microstructure and thus the optical property of the sintered optical ceramics. The purpose of this work was to explain the difference between the sintering aids of Li+ and Y3+ on Al23O27N5 (AlON) ceramic via reaction sintering method. The effects of LiAl5O8 (LA) and Y2O3 on the sintering of Al2O3-AlN system were carefully compared, in terms of X-ray diffraction (XRD), microstructure, density, X-ray photoelectron spectroscopy (XPS) and optical transmittance. According to the XPS and XRD lattice analysis, the chemical structure of the materials was not obviously affected by different dopants. We firstly reported that, there was obvious volume expansion in the Y3+ dopped AlON ceramics, which was responsible for the low transparency of the ceramics. Obvious enhancements were achieved using Li+ aids from the results that Li: AlONs showing a higher transparency and less optical defects. A higher LA content (20 wt%) was effective to remove pores and thus obtain a higher transmittance (~86.8% at ~3.5 µm). Thus, pores were the main contributions to the property difference between the dopant samples. The importance of sintering aids should be carefully realized for the reaction sintering fabrication of AlON based ceramics towards high transparency.

Constructing a three-dimensional nano-crystalline diamond network within polymer composites for enhanced thermal conductivity.

In order to meet the requirement of thermal performance with the rapid development of high-performance electronic devices, constructing a three-dimensional thermal transport skeleton is an effective method for enhancing the thermal conductivity of polymer composites. In this work, a three-dimensional porous diamond framework was prepared by depositing nano-crystalline diamond on alumina foam which was impregnated with epoxy to obtain a nano-crystalline diamond@alumina foam/epoxy composite. The epoxy composite with nano-crystalline diamond@alumina foam demonstrated a thermal conductivity of 2.21 W m-1 K-1, which was increased by 1063% in comparison with pure epoxy. The thermal conductivity of the epoxy composite measured under various conditions and heat transport applications demonstrates that it possesses excellent thermal transportation and stability properties. This work provides a new idea to significantly enhance the thermal transportation properties of epoxy composites in the application of advanced packaging materials.

[Manipulative reduction and small splint fixation combined with micromovement exercise for treatment of humeral shaft fractures].

OBJECTIVE: To investigate the therapeutic efficacy of bone-setting manipulative reduction and small splint fixation combined with micro-movement theory exercise for treatment of humeral shaft fractures. METHODS: From March 2011 to February 2014, 64 cases of humeral shaft fractures were treated by bone-setting manipulative reduction and small splint fixation including 28 males and 36 females with an average age of 38.1 years old ranging from 22 to 67 years old. According to the classification of AO/OTA, there were 10 cases of type A1, 12 cases of type A2,11 cases of type A3,10 cases of type B1,12 cases of type B2, 7 cases of type B3, 2 cases of type C1, 1 case of type C2, 1 case of type C3. After close reduction early functional exercise performed according to micro-movement theory. All patients had no other parts of the fractures, neurovascular injury, and serious medical problems. Patients were followed up for fracture healing, shoulder and elbow joint function recovery, and curative effect. RESULTS: All patients were followed up from 10 to 12 months with an average of 10.3 months. Of them, 2 cases had a small amount of callus growth at 3 months after close reduction, so instead of operation; 2 cases appeared radial nerve symptoms after close reduction ,so instead of operation. Other patients were osseous healing, the time was 8 to 12 weeks with an average of 10.2 weeks. After osseous healing, according to Constant-Murley score system ,the average score was (93.5 ± 3.2) points, the result was excellent in 29 cases, good in 29 cases, fair in 6 cases, excellent and good rate was 90.3%; according to the Mayo score system, the average score was (93.7 ± 4.2) points, the result was excellent in 35 cases, good in 23 cases, fair in 6 cases, excellent and good rate was 91.9%. CONCLUSION: Bone-setting manipulative reduction and small splint fixation combined with micromovement theory exercise for treatment of humeral shaft fractures has advantage of positive effect, easy and inexpensive method, the treatment has relevant scientific basis and practical value, it can effectively reduce complications, promote patients early recovery.

Minimal Invasive Percutaneous Osteosynthesis for Elderly Valgus Impacted Proximal Humeral Fractures with the PHILOS.

There is a growing concern about elderly valgus impacted proximal humeral fractures. The aim of this study was to evaluate the treatment and clinical outcomes following minimal invasive percutaneous plate osteosynthesis (MIPPO) with the proximal humeral internal locking system (PHILOS) for the treatment of elderly valgus impacted proximal humeral fracture. Between May 2008 and May 2012, 27 patients (average age 67.3, range 61-74) with valgus impacted proximal humeral fractures were enrolled in the study. The patients were treated with MIPPO using PHILOS-plate through the anterolateral delta-splitting approach. Rehabilitation exercises were done gradually. The NEER score and Constant-Murley score were used to evaluate shoulder function. All the patients were followed up by routine radiological imaging and clinical examination. There were 15 cases of II-part greater tuberosity fractures, 10 cases of III-part greater tuberosity fractures, and 2 cases of IV-part fractures according to the NEER classification. The surgery was successful in all patients with an average follow-up of 20.8 (range: 11-34) months. The fractures united in an average of 7.2 (6-14) weeks without implant loosening. According to NEER score, there were 17 excellent, 7 satisfactory, 2 unsatisfactory, and 1 poor. The mean Constant-Murley score was 89.4 ± 4.35. No complication including axillary nerve damage, postoperative nerve or vessel damage, infections, DVT, or death was observed. In conclusion, the MIPPO technique with the PHILOS through the anterolateral delta-splitting approach seems to be a safe and easy treatment for elderly valgus impacted proximal humeral fractures. A case-control study and longer follow-up time are needed.

[Operative treatment of Dubberley type 3B capitulum-trochlea fractures].

OBJECTIVE: To investigate the method and effectiveness of operative treatment of Dubberley type 3B capitulum-trochlea fractures. METHODS: Between January 2009 and December 2012, 8 cases of Dubberley type 3B capitulum- trochlea fractures were treated. There were 2 males and 6 females with an average age of 55 years (range, 43-65 years). The injury was caused by falling in 6 cases, electric bicycle accident in 1 case, and traffic accident in 1 case. All fractures were fresh and closed injury. No neural or vascular injury was found. The time between injury and operation was 3-15 days (mean, 5.9 days). Olecranon osteotomy was performed by a posterior midline skin incision of the elbow; 3.0 mm Herbert compression screws placed from posterior to anterior, 2.4 mm L shape locking compression plate designed for distal radius or 2.7 mm anatomical locking compression plate designed for distal humerus and 1.0 mm Kirschner wires or 3.0 mm Herbert screw for the transverse and coronal plane in the subchondral of anterior articular surface were used for fixation; and the lateral and medial collateral ligaments were repaired. RESULTS: All incisions healed by first intention. The patients were followed up 12-18 months (mean, 14.5 months). The X-ray films showed that fracture healing was achieved at 12-24 weeks (mean, 15 weeks) in 7 cases. Fracture nonunion and partial bone resorption in the capitellum were observed in 1 case. No failure of internal fixation, ulnohumeral joint instability, or traumatic arthritis occurred. At last follow-up, the range of motion of injured elbow was 0-40° in extension (mean 25.0°), 100-135° in flexion (mean, 116.3°), 60-70° in pronation (mean, 61.3°), and 80-90° in supination (mean, 81.3°). The elbow function score was 64-96 (mean, 81.1) according to the Broberg-Morrey evaluation criteria; the results were excellent in 2 cases, good in 4 cases, and fair in 2 cases with an excellent and good rate of 75%. The visual analogue scale (VAS) score was 0-3 (mean, 1). CONCLUSION: For Dubbelley type 3B capitulum-trochlea fractures, an early anatomic reconstruction of capitellar and trochlea, repair of the medial and lateral collateral ligament, and early active mobilization can obtain good functional

[Arthroscopic surgery for the treatment of stiff elbow].

OBJECTIVE: To investigate the clinical results of arthroscopic surgery for the treatment of stiff elbow. METHODS: From October 2010 to December 2012, 27 patients with stiff elbow were treated with arthroscopic debridement and joint capsular releasing. There were 18 males and 9 females, ranging in age from 24 to 54 years old, with an average of 35.7 years old. Analgesia and rehabilitation were necessary after operation. Mayo criteria system was used to evaluate therapeutic effects. RESULTS: All the patients were followed up, and the duration ranged from 12 to 18 months, with a mean of 13.5 months. The mean maximum flexion angle of patients improved from preoperative (61.5 ± 30.1) degrees to postoperative (102.5 ± 20.1) degrees; and the mean maximum extension angle improved from preoperative (34.8 ± 12.1) degrees to postoperative (16.3 ± 16.1) degrees; the average total range of motion improved from preoperative (34.2 ± 21.0) degrees to postoperative (84.9 ± 9.2) degrees. According to the Mayo criteria system, the average score increased from preoperative 60.5 ± 13.4 to postoperative 88.7 ± 6.3; ten patients got an excellent result, 13 good and 4 fair. CONCLUSION: Arthroscopic surgery to treat elbow stiffness has such advantages as minimal invasion, less blood loss, fast recovery, and clear visualization, which is effective to improve elbow joint functions with less complications.

[Cannulated screw combined with buttress plate for the treatment of transarticular shear fractures of the distal humerus].

OBJECTIVE: To investigate the clinical outcomes of cannulated screw combined with buttress plate in treating transarticular shear fractures of the distal humerus. METHODS: From July 2008 to December 2011, 17 patients with shear fractures of the distal humerus were treated with cannulated screw combined with buttress plate. Among them, included 10 males and 7 females aged from 20 to 59 years old (mean 36.5). All the fractures were classified into type I (8 cases), type II (1 case), type III (3 cases) and type IV (5 cases) according to Bryan-Morrey and McKee classification. According to AO/ASIF classification, 10 cases were type 13B3.1, 7 cases were type 13B3.3; according to Dubberley classification, 5 cases with type 1A, 2 cases with type 1B, 2 cases with type 2A, 2 cases with type 2B, 4 cases with type 3A, 2 cases with type 3B. There were 12 cases with fresh injuries, 4 cases with old injuries. All fractures were closed injuries. Complications and range of motion of elbow were observed, and clinical efficacy were evaluated by Broberg-Morrey standard. RESULTS: All patients were followed up with a mean time of 21.3 months (ranged, 18 to 24). All fractures obtained bone healing from 10 to 15 weeks with a mean of 12.5 weeks. No malunion or delayed healing occurred. Two cases occurred ossification in lateral collateral ligament attachment. 2 cases occurred heterotopic ossification in the capitellum in front of capsule joint. The range of elbow extension was (16 +/- 7) degrees, flexion was (115 +/- 9) degrees, the average are of pronation and supination was (65 +/- 5) degrees and (60 +/- 5) degrees respectively. According to Broberg-Morrey standard, there were excellent in 7 cases, good in 8 cases, fair in 2 cases, and average score was 92.44 +/- 4.64. CONCLUSION: For transarticular shear fractures of the distal humerus, classification should be performed according to preoperative X-ray and CT, cannulated screw and buttress plate combined and early function rehabilitation could recover elbow function.

[Manipulative reduction and small splint fixation for treatment of three-part fractures of proximal humerus: a case-control study].

OBJECTIVE: To study Chinese medicine treatment in the three-part of the proximal humerus fractures. METHODS: From January 2009 to February 2012, 118 cases of proximal humerus three-part fractures were used two methods of operation and manipulation treatment,that were all acute and closed. In operation group: there were 22 males and 37 females,the mean age of the patients was (65.80 +/- 10.62) years (ranged from 45 to 83 years), and the interval from injury to hospital was (22.58 +/- 22.11) hours (ranged from 1 to 96 hours), used open reduction and locking plate fixation surgery. In manipulation group: there were 21 males and 38 females, the mean age of the patients was (65.98 +/- 11.10)years (ranged from 45 to 85 years), and the interval from injury to hospital was (20.85 +/- 22.63) hours (ranged from 1 to 107 hours), used manipulative reduction and small splinting external fixation. All patients were evaluated with shoulder pain, function, activity and anatomical indicators after treatment. RESULTS: All patients were followed up for 3 to 12 months with an average of 8.2 months. According to Neer Score, the total scores was 85.47 +/- 6.15 in operation group, 84.95 +/- 5.70 in manipulation group. The satisfaction rate of the operation group were 88.20%, and the manipulation group were 86.40%. The difference was not statistically significant between two groups (P > 0.05). CONCLUSION: The two treatment were able to achieve satisfactory results. The manipulative reduction and splinting treatment has the advantage of avoiding the risk of surgery, less blood damage, ensureing the efficacy, and reducing costs. It can effectively treat the proximal humerus three-part fracture.