Epidemiological profiles and intervention strategies of limb deformities in China: A nationwide study based on the largest orthopedic database in China.

Background: Limb deformities are almost associated with varying degrees of disability, which severely affects the quality of life and social participation. However, the epidemiological profiles of limb deformities remain underreported. As the world's largest developing country with regional economic disparities, China faces unique challenges in the diagnosis and management of limb deformities. The Qin Sihe Orthopaedic Surgery Database is currently the most comprehensive database of limb deformity in China, which has the largest case volume, the widest disease spectrum, and the broadest geographical coverage, provides an invaluable resource for studying limb deformity patterns in China and other developing countries. Objective: To analyze 37763 limb deformity cases from the Qin Sihe Orthopaedic Surgery Database, and to summarize the etiology distribution, disease spectrum, gender, age, geographical distribution, gait abnormalities and treatment strategies of limb deformities in China. Methods: Descriptive epidemiological methods were used to analyze the data of Qin Sihe Orthopaedic Surgery Database from May 25th, 1978 to December 31st, 2023 containing 37763 cases of Limb deformities. The data on patients' gender, age, etiology distribution, disease spectrum, geographical distribution, gait abnormalities and surgical methods etc will be statistically analyzed. Results: Among 37763 patients, 21815 (57.77 %) were male and 15948 (42.23 %) were female, aged 1-84 years old, covering 33 provinces, municipalities and autonomous regions in China and some international regions. Etiologies included 239 neurogenic, traumatic, congenital and metabolic diseases, among which neurogenic diseases took the dominant portion: 24430 (64. 7 %) cases of post-polio sequelae, 5088 (13. 4 %) cases of cerebral palsy. Lower limb deformities(35,869 cases,95 %) was significantly more than upper limb deformities (646 cases, 1.7 %). The surgical interventions included soft tissue release and tendon lengthening (e. g. Achilles tendon lengthening, 8282 cases, 21.93 %), osteotomy (e.g. supracondylar femoral osteotomy, 7740 cases, 20.50 %), and arthrodesis (e. g. talocalcaneal arthrodesis, 6873 cases, 18.20 %). The fixation methods included Ilizarov external fixation (5611 cases), combined external fixation (5612 cases), combined internal fixation (1805 cases) and plaster or brace immobilization (24735 cases). Conclusion: The causes of limb deformities in China are diverse, and the diseases involves multiple disciplines. Cases are predominantly male and young., Polio sequelae deformity remains the main malformation diseases, but the proportion of cerebral palsy, limb deformities after trauma, lower limb deformities after spina bifida and genetic metabolic diseases are increasing. This study provides important real-world data for the classification of etiological classification, precise diagnosis and treatment, and public health policy formulation of limb deformities in China. The translational potential of this article: This study is the most comprehensive big data analysis to date on the causes and treatment of limb deformities in China. The research results have revealed the main epidemiological characteristics of limb deformities in China, which is helpful for formulating more effective disability prevention and control strategies at the clinical diagnosis and public health levels in the future. Based on this data, a big data model for lower limb deformities may be gradually established, and the disease prevention and treatment system for limb deformities can be improved. According to the different types and causes of the diseases, the prevention and treatment level of limb deformities can be enhanced, and the disability rate caused by limb deformities can be reduced. In the future, the application depth of artificial intelligence-assisted diagnosis and interdisciplinary collaboration mechanisms can be further expanded.