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SICOT e-Newsletter

Issue No. 65 - February 2014

Editorial by Marius M. Scarlat  - Deputy Editor, International Orthopaedics

Made in China!

Sometimes in your life as a surgeon you have enchantment, you experience novelty, you understand more and eventually you see the "big picture"! That was exactly what happened when I visited the Orthopaedic Department of the Third Hospital of Hebei Medical University in Shijiazhuang, China, a few weeks ago.

In China there are many huge hospitals. They usually have no names but numbers! It’s a strange sensation for someone coming from Europe to visit the Number 3 hospital! It starts from the airport where the immigration officers have badges with quite visible numbers and continues in every restaurant where the menu is a list of pictures and numbers for each dish! Soup number 37 was delicious! It is however clear and precise because learning Chinese may take some time. You get easily trained in this analogic-digital conversion at the amusement of the hosts who are always friendly and smiling at your westerner adventures in the Far East! For surgeons from Europe or other developed nations, it is quite unusual to see abroad a highly trained unit performing very high-volume bone and joint trauma surgery with superior standards of quality and care, but also treating orthopaedic and chronic conditions in a way that provides a clear path between the pathology and the aetiological treatment, between the patient and the doctor, between the problem and the result. A very modern, huge, and fully functional facility indeed!

What exactly happened when I arrived in Shijiazhuang is difficult to describe. I was expecting to see quality work and some excellent surgeons. I had received some feedback about this unit because of the high volume of publications originating from Prof Yingze Zhang but the reality exceded my expectations.

This Department is one of the best trauma units that I have seen. It is a high volume and high-speed teaching Department! It’s not only outstanding but also gigantic. More than 1,200 beds are allotted to the Ortho-Trauma Department of the Third Hospital. And when I say TRAUMA, I mean not only ORTHOPAEDIC TRAUMA but also GENERAL TRAUMA, HAND SURGERY (which is a neighbouring Department), NEUROSURGERY and SPINE. Virtually all types of orthopaedic and trauma services are provided. Elective surgery is also performed and different joint replacements, revision and reconstruction, limb lengthening, chronic conditions, sports medicine and surgery, and so on. The equipment is modern and fully functional and we understand immediately that the ability to use C-arms, O-arms, neurostimulation and minimally invasive tools is related to the high-volume use of all these facilities.


The research team

What makes Prof Zhang’s department in particular so strong is the research unit. There are several services, and each service has qualified specialised surgeons who act also as teachers for students and residents and who lead different units of research. The directions of research are very modern and varied, including different techniques of minimally invasive traumatology, fracture classifications and standardization, reconstructive spine surgery, paediatric orthopaedics, infection, sports medicine and surgery.

I was invited to attend two difficult trauma cases performed by the team of Prof Zhang. I met the outstanding Zihyong Hou who is fixing fractures without opening like Lang Lang plays the piano, the Professor Wenyuan Ding who is the Spine Master, Wang Pengcheng who is the Vice-Dean and passionate about clinical research, or the excellent Chei Wen who is a Research Director. I met marvelous colleagues, passionate about treating patients and devoted to research and data collection, providing the best possible results and a great objective publication centre. I met the young researchers who are working on a huge epidemiological study that will include a multitude of fractures from all partner hospitals and will provide the big picture for  possible occurrences with orthopaedic trauma.

The book originating from Shijiazhuang is already available from Thieme Editions, in English. It is a beautiful collection of cases and possible types of fractures and all the classifications needed to standardize treatment algorithms. As the work goes on, the epidemiology scientific unit has collected over 420,000 different orthopaedic trauma cases from over 80 centres in China and they are currently working on the Second Edition that will probably become the largest repository of bone trauma occurrences and a major reference in the classification of fractures worldwide.

The hospital is perfectly organized and the patient’s circuit is clear. It converges to the nine-floor unit of orthopaedics that integrates the fourteen-floor modern building. The top floor is dedicated to the heart of the system – the operative area which has about forty fully equipped operating theatres and includes twenty-six rooms dedicated to orthopaedic trauma and scheduled surgery. We may admit that this is huge, however, when you have the opportunity to take a guided tour of the facility every case becomes particular and the big picture is reduced to the individual suffering of each patient, to the dedication of each medical and surgical team, and to the devotion of the anaesthesiologists who keep monitoring and following each difficult case. As a referral centre the University Hospital receives cases from all over the region, which is also huge and one of the most populated areas of China. It receives also difficult and complex polytrauma occurring in this highly industrialized part of the world and due to more and more traffic accidents arising from the surprisingly high motor vehicle density. The traditional bicycles have been replaced by modern SUV’s, limousines, sports cars and all kinds of automobiles that speed and agglutinate at the traffic lights. This landscape is new and the increase in motor vehicles goes hand in hand with more accidents. They are a new priority for the Trauma Department but also for the health authorities in the country.

The Chinese Orthopaedic School is growing very fast and keeps a high pace in its way to excellence. Surgeons travel abroad more and more, they publish more and more and the quality level of the medical conferences in China is continuously increasing. The barrier of the English language is outscored by the efforts in producing quality publications. We experience today in the orthopaedic science a net increase in publications originating in China and the reason is obvious now for me: outstanding Departments like this Unit from Shijiazhuang are not only producing strong and pertinent literature, new orthopaedic devices and tools, and scientific research, but are also educating young doctors, researchers, students. It is a system that works well, better, faster and keeps developing without any major help from abroad because today’s Chinese Orthopaedic School is able to educate doctors from college level to postdoctoral level and directly compete with top-quality departments from virtually any school in the world. The travelling fellows who can see different orthopaedic centres in Beijing, Shijiazhuang, Shanghai, Guangzhou or any other major University in the country can compare, from a practical point of view, with colleagues who have travelled to New York, Boston, Cleveland and Detroit.

During my short visit, the Orthopaedic team was celebrated by the Hospital for receiving the National Scientific and Technological Progress Awards and it was an intense moment of joy and acknowledgement in which all friends of orthopaedics were invited. I felt happy to be there and to see a place where the Hospital Manager congratulates the Head of Orthopaedics and encourages development.

This visit was a great moment for me personally and I warmly recommend to all potential visitors to go to Shijiazhuang to understand why Chinese Orthopaedics is growing so smart and so fast!