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Şahbat Y, Akgülle AH. Letter to the Editor regarding: The fate of the malrotated elbow supracondylar fractures in children: is varus really a problem? Sanpera, I., Salom, M., Fenandez-Ansorena, A. et al. Int Orthop. 2024 Apr 6. INTERNATIONAL ORTHOPAEDICS 2024; 48:1931-1932. [PMID: 38668905 DOI: 10.1007/s00264-024-06200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Yavuz Şahbat
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey.
- Department of Orthopaedic Surgery and Traumatology, Erzurum City Hospital, Erzurum, Turkey.
| | - Ahmet Hamdi Akgülle
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
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Schlauch AM, Manske MC, Leshikar HB, Davids JR. Posttraumatic Cubitus Varus: Respect the Columns. J Pediatr Orthop 2024; 44:e518-e529. [PMID: 38515131 DOI: 10.1097/bpo.0000000000002671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Posttraumatic cubitus varus is a multiplanar deformity that results from an improperly reduced supracondylar humerus fracture. The prevention of posttraumatic cubitus varus hinges on the stable restoration of all 3 columns of the distal humerus while avoiding malrotation. The collapse of any column leads to varying degrees of deformity in the coronal, sagittal, and/or axial plane. The purpose of this article is to explain the pattern of the deformity and use this to summarize preventative tactics for avoiding its described sequelae. We also summarize, illustrate, and present case examples for the various osteotomies used to correct the deformity, and speculate future directions.
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Affiliation(s)
- Adam M Schlauch
- Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program/St. Mary's Medical Center, San Francisco
| | - Mary Claire Manske
- Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, CA
| | - Holly B Leshikar
- Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, CA
| | - Jon R Davids
- Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, CA
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Sanpera I, Salom M, Fenandez-Ansorena A, Frontera-Juan G, Pizà-Vallespir G. The fate of the malrotated elbow supracondylar fractures in children: is varus really a problem? INTERNATIONAL ORTHOPAEDICS 2024; 48:1453-1461. [PMID: 38580779 DOI: 10.1007/s00264-024-06153-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/14/2024] [Indexed: 04/07/2024]
Abstract
PURPOSE To evaluate the functional and cosmetic effects of elbow supracondylar fractures (SCF) in children with residual rotational deformity. METHODS Retrospective review cohort of patients with evidence of malrotation after treatment for SCF. An analysis of the postoperative X-ray of 305 consecutive SCF type 3 treated surgically during five years identified 46 elbows with rotational deformity that fulfilled the selection criteria and were recalled for review; only 27 patients agreed to participate. Patients were evaluated clinically and radiographically. Clinically, the elbow and shoulder ROM were assessed. The postoperative fracture rotation (PFR) was radiologically measured using the Berdis method. Results were categorized according to Flynn criteria, and functional outcomes were evaluated with the QuickDASH questionnaire. On final assessment, a radiograph of both elbows was obtained, and measures were compared. Descriptive analysis was made calculating median, range, proportions, and confidence intervals. Non-parametric tests were used to test the association between variables. RESULTS The group had a median age of four years and a median follow-up of 52 months. Shoulder rotation was asymmetrical in 13 patients; six patients presented a change on carrying angle > 5° (4 varus/2 valgus). The higher the residual rotation, the higher the chances of an altered shoulder rotation (for each degree of PFR, the shoulder rotation was changed to 0.4°). However, there was a low correlation between the amount of rotation and the final carrying angle (r = 0.37). According to Flynn's criteria, over 95% had excellent or good results. CONCLUSION There was a weak correlation between varus and rotational malalignment. Patients with moderate residual malrotation could be expected to have a good outcome even if some shoulder rotation changes persist.
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Affiliation(s)
- Ignacio Sanpera
- Paediatric Orthopaedic Department, Hospital Universitari Son Espases, Ctra. Valldemossa, 79, 07120, Palma, Spain.
| | - Marta Salom
- Orthopaedic Department, Hospital Universitario La Fe, Valencia, Spain
| | - Ana Fenandez-Ansorena
- Paediatric Orthopaedic Department, Hospital Universitari Son Espases, Ctra. Valldemossa, 79, 07120, Palma, Spain
| | - Guillem Frontera-Juan
- Unitat de Reçerca, Hospital Universitari Son Espases, Universitat Illes Balears, Palma, Spain
| | - Gabriel Pizà-Vallespir
- Paediatric Orthopaedic Department, Hospital Universitari Son Espases, Ctra. Valldemossa, 79, 07120, Palma, Spain
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Sanpera I, Salom M, Fenandez-Ansorena A, Frontera-Juan G, Pizà-Vallespir G. Answer to the letter concerning the work: the fate of the malrotated elbow supracondylar fractures in children: is varus really a problem? INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06227-z. [PMID: 38797761 DOI: 10.1007/s00264-024-06227-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Ignacio Sanpera
- Paediatric Orthopaedics, Hospital Universitari Son Espases, Universitat Illes Balears, Crta Valldemosa, 79, Palma, 07120, Spain.
| | - Marta Salom
- Orthopaedic Department, Hospital Universitario La Fe, Valencia, Spain
| | - Ana Fenandez-Ansorena
- Paediatric Orthopaedics, Hospital Universitari Son Espases, Universitat Illes Balears, Crta Valldemosa, 79, Palma, 07120, Spain
| | - Guillem Frontera-Juan
- Unitat de Reçerca, Hospital Universitari Son Espases, Universitat Illes Balears, Palma, Spain
| | - Gabriel Pizà-Vallespir
- Paediatric Orthopaedics, Hospital Universitari Son Espases, Universitat Illes Balears, Crta Valldemosa, 79, Palma, 07120, Spain
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Rehm A, Linardatou Novak P, Newton AC, Clegg R, Ashby E. Reliability of Gordon Lateral Rotation Percentage and Prabhakar Percentage of Metaphyseal Overhang for Pediatric Supracondylar Humerus Fracture; Is it Clinically Reliable for John Hopkins Classification Coronal Fracture Subtypes? J Pediatr Orthop 2024; 44:e377-e378. [PMID: 38131353 DOI: 10.1097/bpo.0000000000002604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Andreas Rehm
- Department of Paediatric Orthopaedics Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Ayla C Newton
- Department of Paediatric Orthopaedics Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rachael Clegg
- Department of Paediatric Orthopaedics Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elizabeth Ashby
- Department of Paediatric Orthopaedics Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Şahbat Y, Bekiroğlu GN, Çat G, Gündoğdu M, Ağirdil Y, Çayir H, Onay T, Akgülle AH. Reliability of Gordon Lateral Rotation Percentage and Prabhakar Percentage of Metaphyseal Overhang for Pediatric Supracondylar Humerus Fracture; Is it Clinically Reliable for John Hopkins Classification Coronal Fracture Subtypes? J Pediatr Orthop 2023; 43:603-607. [PMID: 37694552 DOI: 10.1097/bpo.0000000000002512] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Rotational malalignment is a common problem in pediatric supracondylar humerus fractures (SCHF). Several techniques have been described to evaluate the true rotation value. Although the Prabhakar and Gordon techniques are used frequently, their superiority to each other in terms of measurement quality is unknown. QUESTIONS/PURPOSES The aim of this study was to investigate the clinical compatibility of the 2 techniques and to evaluate whether they are suitable for all subtypes. METHODS This cross-sectional study included 40 patients with SCHF (including subtypes; Typical, Medial Oblique, Lateral Oblique, and High fracture pattern). The Gordon lateral rotation percentage and Prabhakar percentage of metaphyseal overhang were measured twice by 4 experienced Orthopedics and Traumatology surgeons at 8-week intervals. The interobserver and intraobserver reliability were examined using the intraclass correlation coefficient. RESULTS The interobserver reliability for Gordon and Prabhakar technique was 0.816 and 0.762 for the first measurement and 0.811 and 0.811 for the second measurement, respectively.The medial oblique fracture pattern was determined to have the best interobserver agreement among the subtypes. The result was excellent for the medial and lateral oblique subtypes, good for the typical fracture pattern, and fair for the high fracture pattern. The intraobserver reliability for Gordon and Prabhakar technique was excellent, 0.924 and 0.922, respectively. CONCLUSION The main finding of this study was that the Gordon and Prabhakar techniques have similar interobserver and intraobserver reliability. Although the Gordon technique tends to have higher interobserver reliability, the difference was clinically insignificant. These measurements should not be relied upon in cases of SCHF with a high fracture pattern because of the different anatomic features of that region. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yavuz Şahbat
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Görkem Çat
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Mert Gündoğdu
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yücel Ağirdil
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Hüseyin Çayir
- Department of Radiology, Marmara University Pendik Training and Research Hospital, Unit of Radiation Health, Istanbul, Turkey
| | - Tolga Onay
- Department of Orthopaedic Surgery and Traumatology, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Hamdi Akgülle
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
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Şahbat Y, Baysal Ö, Ağırdil Y, Polat M, Büyüktopçu Ö, Shammadli Z, Erol B, Akgülle AH. Is radiological rotation measurement affected by the fracture pattern in pediatric supracondylar humeral fractures? Acta Radiol 2023; 64:2748-2756. [PMID: 37592919 DOI: 10.1177/02841851231189881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND In supracondylar humerus fractures (SCHF), the most frequently used method to calculate rotation is the Gordon lateral rotation percentage (GLRP) defined by Gordon et al. However, this technique includes only typical fractures (49%-80% of all fractures) from the Johns Hopkins (J-H) fracture classification system. PURPOSE The aim of the study was to investigate (1) is Gordon criteria useful for John Hopkins subgroups of supracondylar fractures and (2) is Gordon criteria affected by internal and external rotation. MATERIAL AND METHODS This study was designed using four pediatric left humerus bones obtained from the Sawbone© company. For each bone, an osteotomy was made to mimic each of the J-H coronal fracture patterns. The cut bones were placed in a wooden rotation apparatus. The GLRP measurements were taken by five blinded observers. RESULTS In the repeated measurements of the observers, <20° rotation typical and <30° medial oblique and lateral oblique fracture pattern were measured as within the limits of an acceptable amount of rotation according to the Gordon criteria. However, for high fracture pattern (HFP), ≤30° internal rotation and <60° external rotation were determined to be within the acceptable rotation criteria according to the Gordon criteria. CONCLUSIONS All fracture patterns have different characteristics; however, based on the data of this study, the Gordon criteria can be used safely for typical, medial oblique, and lateral oblique fracture patterns but it is necessary to lower the acceptable rate of 50% for HFP.
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Affiliation(s)
- Yavuz Şahbat
- Department of Orthopaedics and Traumatology, Marmara University, Istanbul, Turkey
| | - Özgür Baysal
- Department of Orthopaedics and Traumatology, Marmara University, Istanbul, Turkey
| | - Yücel Ağırdil
- Department of Orthopaedics and Traumatology, Marmara University, Istanbul, Turkey
| | - Murat Polat
- Department of Orthopaedics and Traumatology, Marmara University, Istanbul, Turkey
| | - Ömer Büyüktopçu
- Department of Orthopaedics and Traumatology, Marmara University, Istanbul, Turkey
| | - Ziya Shammadli
- Department of Orthopaedics and Traumatology, Marmara University, Istanbul, Turkey
| | - Bülent Erol
- Department of Orthopaedics and Traumatology, Marmara University, Istanbul, Turkey
| | - Ahmet Hamdi Akgülle
- Department of Orthopaedics and Traumatology, Marmara University, Istanbul, Turkey
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Greve F, Müller M, Wurm M, Biberthaler P, Singer G, Till H, Wegmann H. Standalone Axial Malrotation after Pediatric Supracondylar Fracture Does Not Seem to Be an Indication for Immediate Postoperative Revision Surgery. CHILDREN 2022; 9:children9071013. [PMID: 35883997 PMCID: PMC9322951 DOI: 10.3390/children9071013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022]
Abstract
Rotational spurs as evidence for post-surgical malrotation are frequently observed when treating pediatric supracondylar humeral fractures (SCHFs). This study aimed to investigate the long-term outcome of a pediatric cohort with unrevised axial malrotation and to discuss the indication for revision surgery. Postoperative radiographs of children treated for SCHFs over eight years were retrospectively analyzed. Children with radiological signs of malrotation (von Laer malrotation quotient) were invited for a follow-up clinical and radiological examination. Among 338 treated children, 39 (11.5%) with a mean age of 5.3 years (range 1.8–11.7 years) showed radiological signs for postoperative malrotation and were not revised and therefore invited to participate in the study. Twelve patients (31%) with a mean age of 11.3 years (range 8.8–13.8 years) took part in the follow-up examination after a mean of 7.1 years (range 5.4 to 11.3 years). The mean postoperative van Laer malrotation quotient was 0.15 (range 0.11–0.2). At follow-up, the range of motion of the elbow joint was not significantly different compared to the contralateral side. Apart from the humeral ulnar angle (p = 0.023), there were no significant differences in the radiological axes. The Flynn criteria were excellent and good in 90% of the cases. The mean was 1.7 points indicating excellent subjective results. Standalone postoperative malrotation did not lead to an adverse long-term outcome in a small cohort of pediatric patients with SCHFs and did not indicate immediate postoperative revision surgery. However, further investigations with larger cohorts should verify whether additional criteria such as stability of the osteosynthesis and signs for increasing valgus or varus displacement in the follow-up radiographs should get more importance in decision making.
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Affiliation(s)
- Frederik Greve
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.M.); (M.W.); (P.B.); (H.W.)
- Correspondence: ; Tel.: +49-89-41402126
| | - Michael Müller
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.M.); (M.W.); (P.B.); (H.W.)
| | - Markus Wurm
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.M.); (M.W.); (P.B.); (H.W.)
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.M.); (M.W.); (P.B.); (H.W.)
| | - Georg Singer
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, 8063 Graz, Austria; (G.S.); (H.T.)
| | - Holger Till
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, 8063 Graz, Austria; (G.S.); (H.T.)
| | - Helmut Wegmann
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (M.M.); (M.W.); (P.B.); (H.W.)
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Chen G, Cui L, Shi J, Zhang P, Li J, Wang Z, Song J, Wang B. Humerus trochlear angle (HTa)-a possible alternative for Baumann angle in the reduction of supracondylar humerus fractures. BMC Musculoskelet Disord 2021; 22:950. [PMID: 34781909 PMCID: PMC8594185 DOI: 10.1186/s12891-021-04717-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The supracondylar humerus fractures are the most common fracture in children's elbows. Generally, close reduction and percutaneous pinning can provide satisfactory outcomes after adequate reduction. Baumann angle is commonly used to evaluate reduction quality, however, it may fail to assess reduction well when the elbow is in flexion and/or when the patient is young. We conducted this study to evaluate the potential value of the humerus trochlear angle (HTa) for the reduction evaluation and compare it with the Baumann angle. METHODS We retrospectively reviewed supracondylar humerus fractures in our trauma center from 2016 to 2019. Patients were grouped as followed: in the HTa group, an arthrogram was used to evaluate the HTa angle and reduction (HTa, defined by the intersection of the axis of the humerus shaft and the tangent of the articular surface of the trochlear); In the Baumann group, the Baumann angle was used to assess the reduction. Baumann angle ratio (BA of injured side/BA of contralateral side) was calculated to evaluate the reduction quality between groups. Flynn's grading criteria were utilized to evaluate both function and cosmetic outcomes in two groups during the follow-up. Operation time, fluoroscopy shots, complications and Flynn's grading scores were compared between groups. RESULTS A total of 57 patients with an average age of 4.62 years and follow-up duration of 21.49 ± 5.40 months were included in the analysis. The gender and age distributions were similar in the two groups. Fluoroscopy shots in the HTa group were significantly less than in Baumann group (16.17 ± 0.73 vs. 21.85 ± 0.78, p < 0.0001), and operation time were also less in HTa group (45.78 ± 1.96 min vs. 62.21 ± 1.58 min, p < 0.0001). Baumann ratio showed no significant difference between the two groups (1.002 ± 0.023 in the Baumann group and 1.01 ± 0.023 in HTa group, p < 0.0001). Length of hospitalization, complications, and Flynn's grading scores were similar between groups. The HTa angle was positively correlated with Baumann angle in the HTa group (R-value is 0.71 and P = 0.0002). CONCLUSIONS There was no significant difference in reduction quality and Flynn's scores between HTa and Baumann groups. Furthermore, HTa was associated with shorter operation time and less radiation exposure in this investigation. Therefore, HTa may be a convenient and reliable parameter that could guide the reduction of supracondylar humerus fractures, especially for young children.
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Affiliation(s)
- Gang Chen
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China
| | - Lu Cui
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China
| | - Jiaqi Shi
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China
| | - Peng Zhang
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China
| | - Jun Li
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China
| | - Zijian Wang
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China
| | - Jun Song
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China.
| | - Bangjun Wang
- Department of Orthopedic Trauma, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Jinzhou Road 136, Xiangyang, Hubei, People's Republic of China.
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