The November 1, 2017 issue of JBJS contains another in a series of “What’s Important” personal essays from orthopaedic clinicians. This “What’s Important” article comes from Dr. Cyril Mauffrey.
Having grown up in Hong Kong and Singapore, Dr. Mauffrey juxtaposes the economic growth in China over 35 years with the transformation during the last decade in the practice of orthoapedics in this land of 1.4 billion people. With both a personal and professional perspective, he explains how China has adapted orthopaedically—with the help of the Chinese Orthopaedic Association, AO Asia Pacific, and several pioneering individuals—to “standardize care and promote clinical excellence and innovation across the nation.”
If you would like JBJS to consider your “What’s Important” story for publication, please submit a manuscript via Editorial Manager. When asked to select an article type, please choose Orthopaedic Forum and include “What’s Important:” at the beginning of the title.
Because they are personal in nature, “What’s Important” submissions will not be subject to the usual stringent JBJS peer-review process. Instead, they will be reviewed by the Editor-in-Chief, who will correspond with the author if revisions are necessary and make the final decision regarding acceptance.
For any number of reasons, regulatory issues among them, orthopaedic innovations in China often have modest relevance for the practice of orthopaedics elsewhere in the world, but that doesn’t make them any less fascinating.
Case in point: According to Becker’s Spine Review, surgeons in China recently implanted the first-ever 3D-printed cervical disc in a 12-year-old boy. The surgeon, Dr. Liu Zhongjun, described the procedure as successful, although the patient will have to remain in a head frame with pins for three months.
The Becker’s story did not specify the material from which the cervical disc was printed, but 3D printing is capable of producing porous metal implants, and companies have reported success with 3D-printed implants made from thermoplastic materials.
One theoretical advantage of 3D-printed orthopaedic implants is that they can be customized based on digital images of a patient’s actual anatomy. That would conceivably result in a better fit, quicker recovery, and fewer complications.
Still, don’t expect to find a 3D prosthetic printer in your hospital anytime soon. Clinical studies required to ensure the safe and effective use of even the most promising new technologies take years. And even after such studies are completed, regulatory approval and coverage from payers is not guaranteed.
The Canadian Institutes of Health Research (CIHR) recently awarded a $500,000 grant to an international trauma study called INORMUS (International Orthopaedic Multi-center Study in Fracture Care). According to lead researcher Mohit Bhandari, MD, of McMaster University in Canada, the observational cohort study hopes to enroll 40,000 patients; its goal is to determine both patient and institutional factors in developing nations such as China and India that help predict complications within 30 days after a fracture or dislocation.”From the data on our initial 6,000 patients, we found that some people wait up to four days to have an open fracture treated,” Dr. Bhandari told Orthopedics This Week. He added that in rural India, 30-day mortality after a fracture arising from a major traffic accident is 2%. “While 2% may not sound shocking,” Dr. Bhandari said, “imagine that many people coming into a US hospital with only a fracture and being dead within 30 days.”
For more information about INORMUS, click here.
The number of manuscripts submitted to The Journal of Bone & Joint Surgery (JBJS) from physicians and researchers in China has been steadily increasing, but the overall acceptance rate is relatively low. While the quality of the research performed in China is rapidly improving, orthopaedic researchers in China recognize the need for education related to experimental design, manuscript preparation and manuscript review. In June 2014, Dr. Thomas Bauer, JBJS deputy editor for research, participated in a two-day workshop in Shanghai that focused on helping Chinese researchers prepare and submit high-quality journal manuscripts.
During an afternoon workshop, Dr. Bauer and three other experienced Chinese editors/reviewers provided “face-to-face” reviewing with individual researchers who had provided and presented draft manuscripts. Dr. Bauer’s subsequent lectures included recommendations with respect to selecting the most appropriate journal for a specific paper, the contents of each section of a scientific manuscript, tables and figures, and how to respond to a manuscript review. He also described the general review process at JBJS and discussed “misbehaving authors,” including issues related to attempted duplicate publication, fraud, image manipulation, and plagiarism.
Based on review of 50 manuscripts from China that had been rejected, Dr. Bauer tabulated the reviewers’ comments to identify the most frequent reasons for manuscript rejection. The most frequent criticism reflected insufficient information about the number of patients or specimens and the lack of an explanation for sample size. Dr. Bauer also illustrated several recent manuscripts from China that have been published in JBJS and in JBJS Case Connector. Several other speakers also discussed issues related to experimental design and statistics.
The lively discussion from the audience of more than 100 researchers reflected intense desire to publish the best possible work in JBJS. We anticipate a striking increase in the number and quality of manuscripts from China in the near future.
At a hospital in China, doctors took a very different approach to reattaching an amputated hand. Xiao Wei lost his right hand in an industrial accident, and his arm was severely compromised during the same accident. The dilemma that doctors faced was two-fold; saving the right hand and dealing with severe trauma to the rest of Wei’s arm. Their approach to salvaging his hand was to attach it to his ankle so the arteries and veins in the ankle would continue to supply blood to it. A month later, after his arm injuries healed and blood supply was sufficient, Xiao’s right hand was reattached to his arm. He is expected to regain full use of his hand.