The outbreak of Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged and spread rapidly throughout the world. As of February 29, 2020, 79 389 cases of COVID-19 have been reported, and the outbreak is linked to 2838 deaths. The population is generally susceptible to the disease, and differences in incubation periods after infection exist among individuals. These two aspects of COVID-19 pose significant challenges to pediatric orthopedic diagnosis and treatment. As a dedicated center for managing pediatric cases of SARS-CoV-2 in Shanghai, our hospital has mobilized all branches and departments to undertake joint actions for scientific prevention and control, precise countermeasure and comprehensive anti-epidemic efforts. Combined with our experience, we have consulted the relevant national regulations and the latest research advances and have formulated the prevention and control measures of SARS-CoV-2 infection, including outpatient, emergency, inpatient and surgical cares, for clinical practices of pediatric orthopedics according to the physicochemical properties of SARS-CoV-2. It may serve as practical references and recommendations for managing SARS-CoV-2 infection in other pediatric specialties and in other hospitals.

BackgroundThis study aimed to identify the threshold for success in supracondylar humeral fracture surgery by describing the learning curve for beginners and exploring the relationship between the learning curve and the prognosis of supracondylar fractures of the humerus.MethodsSurgical information was collected of the first 100 humeral fractures treated by four pediatric orthopedic surgeons. The relationship between operation time, wire placement success rate, and surgical experience was determined using the restricted cubic strip (RCS). The inflection point in the curve and other risk factors that may affect fracture prognosis were collected and subjected to multiple logistic regression to clarify the relationship between the learning curve and prognosis of supracondylar fractures of the humerus. After the training, the four fresh surgeons were interviewed in the form of questionnaires to get feedback from the trainees.ResultsA total of 400 supracondylar fractures of the humerus from four pediatric orthopedists were included in the study. On an RCS analysis, 65 surgical experiences were the inflection point of the learning curve. Before and after these 65 surgical experiences, there were significant differences in the patients' anatomical reduction (186 vs. 122, P < 0.001), conversion to incision (33 vs. 6, P = 0.008), and supervising physician guidance (28 vs. 2, P < 0.001). In the multiple logistic regression analysis, functional recovery after supracondylar fractures of the humerus was significantly associated with surgical experience, intraoperative conversion to incision, and post-operative infection. Four surgeons and a supervisor were interviewed. They believed that self-confidence establishment requires the experience accumulation of about 30 operations. The most critical surgical technique is the reduction of fractures.ConclusionsAlthough the accumulated experience of 30 operations can establish the self-confidence of trainers, fresh surgeons must accumulate experience with 65 operations to master closed reduction and internal fixation for supracondylar fractures. Surgical experience significantly impacts the post-operative recovery of patients with fractures.Level of EvidenceLevel III.

Study Design: Retrospective cohort study. Objectives: To review our treatment experience and to investigate the process of this disease. Methods: Clinical data of AARF patients, who received closed reduction, was retrospectively reviewed. Patients were divided into 2 groups according to the length of delay (Group I: 1 month ≤ delayed time < 3 months), Group II (delayed time < 1 months). The correlation between the length of delayed time and clinical recovery (CR), radiological recovery (RR), and total recovery time were measured. The atlantodental interval (ADI), lateral mass-dens interval (LDI) and lateral joint space (LJS) were compared at admission and final follow-up. Results: 30 children (12 girls and 18 boys) with AARF had received conservative treatment. The mean age at initial treatment was 8.13-year-old, ranging from 5 to 14. The mean follow-up time was 26.93 months (range, 6-87 months). The average length of delayed time was 28.53 days (range, 2-80 days). When the LDI, LJS, and ADI differences are compared at admission and the final visit, the differences are reduced significantly on LDI and LJS. A positive correlation is observed between the length of the delay and CR time and total recovery time (r = 0.63, p = 0.00 and r = 0.47, p = 0.01) respectively. Conclusions: Pediatric AARF patients who have a delay time < 3 months can be treated with closed reduction successfully. The longer the delayed time, the longer the traction time, but the cervical collar time is almost the same. The LDI and LJS on the anteroposterior of X-rays are convenient to estimate the progress of this condition during the treatment.

Background: The Chinese government has taken strong prevention and control measures against the COVID-19 pandemic, and has achieved phased victory in the fight against it. The outbreak of COVID-19 pandemic provides an opportunity to study the influence of governmental prevention and control response on orthopedic trauma in children.Methods: We collected and reviewed data on orthopedic trauma from the first half of 2018, 2019, and 2020. The data were divided according to the time of prevention and control response level in 2020. By comparing the relevant data from orthopedic emergency and operating rooms from the past three years, the influence of governmental pandemic prevention measures on orthopedic trauma in children was analyzed. Results: A total of 36301 children were included in the study cohort. Before the prevention and control response, the data of the orthopedic emergency department in 2020 was the same as the previous two years. Under the first-level response, the number of fractures, open injuries, radial head subluxation, and surgery were significantly reduced, and the severity of patients with surgery was also significantly reduced. Under the second-level response, the number of operations began to increase, and the severity of the disease also began to rise. Under the third-level response control, the number of fractures, open injuries, and operations have returned to the levels of the previous two years. The severity of the operation has also returned to its previous level. The number of subluxations of the radial head is still different from before.Conclusion: The pandemic of COVID-19 has affected the social activities of Shanghai residents and reduced the incidence of orthopedic trauma in children. With the control of the pandemic, the living conditions of Shanghai residents have basically recovered.

Background: The Chinese government has taken strong prevention and control measures against the COVID-19 pandemic, and has achieved phased victory in the fight against it. The outbreak of COVID-19 pandemic provides an opportunity to study the influence of governmental prevention and control response on orthopedic trauma in children.Methods: We collected and reviewed data on orthopedic trauma from the first half of 2018, 2019, and 2020. The data were divided according to the time of prevention and control response level in 2020. By comparing the relevant data from orthopedic emergency and operating rooms from the past three years, the influence of governmental pandemic prevention measures on orthopedic trauma in children was analyzed. Results: A total of 36301 children were included in the study cohort. Before the prevention and control response, the data of the orthopedic emergency department in 2020 was the same as the previous two years. Under the first-level response, the number of fractures, open injuries, radial head subluxation, and surgery were significantly reduced, and the severity of patients with surgery was also significantly reduced. Under the second-level response, the number of operations began to increase, and the severity of the disease also began to rise. Under the third-level response control, the number of fractures, open injuries, and operations have returned to the levels of the previous two years. The severity of the operation has also returned to its previous level. The number of subluxations of the radial head is still different from before.Conclusion: The pandemic of COVID-19 has affected the social activities of Shanghai residents and reduced the incidence of orthopedic trauma in children. With the control of the pandemic, the living conditions of Shanghai residents have basically recovered.Level of Evidence: Retrospective study Level II