Case Of Fracture Research Articles

Identifying proximal humerus fractures: an algorithmic approach using registers and radiological visit data.

The aim of this study was to investigate how reliably proximal humerus fractures can be identified from different administrative datasets without manual review. Using the national medical registers, namely the Care Register for Health Careand the Register for Primary Health Care Visits, as well as the regionalradiological image archive PACS, we developed algorithms for automated identification of proximal humerus fractures. In addition to these sources, we used data from patient records as well as from the self-reports gathered by the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) to establish a gold standard of fractures for validating the algorithms. This gold standard included proximal humerus fractures for a cohort of 11,863 post-menopausal women living in the Kuopio region between 2004 and 2022. We report the national registers' yearly accuracy in identifying proximal humerus fractures. During the studied 19-year period, the registers' coverage initially improved but then settled at 75%. We show that the image archive provides almost complete coverage of radiographs for the fracture cases, but excluding false positives poses a challenge. In addition, we propose a simple approach that combines register and radiography visit data to improve the accuracy of automated fracture identification. Our algorithm improves the coverage from 74 to 81% and reduces the false discovery rate from 8 to 7% compared to the traditional register analysis. The proposed approach enables a more reliable way of identifying proximal humerus fractures from administrative data. This study contributes to the objective of automatically tracking all types of fragility fractures in large datasets.

The Rapid Escalation of Fractures and Hospital Admissions from Electric Bicycle Injuries in the United States: An Analysis of National Injury Data from 2019 to 2023.

To examine the characteristics, trends, and attributes of fractures sustained by electric bicycle riders and assess the recent healthcare burden in terms of hospital admissions. Design: Retrospective review. National sample of 100 emergency departments (EDs) in the United States (US). The National Electronic Injury Surveillance System (NEISS) was queried for ED presentations with fractures related to e-bicycles between January 1st 2019 and December 31st 2023. The clinical narrative associated with each case was reviewed to exclude cases unrelated to fractures sustained by e-bicycle riders. NEISS data is a probability sample of US hospitals; each observed sample has an associated weight enabling a population estimate for each individual sample. Sample weights were determined by NEISS using factors that influence likelihood of selection such as hospital size and geographic locations. US population projections (weighted cases) of fractures and admissions were obtained by summing the weights of raw, unweighted NEISS sampled injuries. Pearson's chi-squared tests were applied to determine differences in injury characteristics among subjects who were admitted to the hospital and those who were not admitted. A total of 22,432 e-bicycle fractures occurred in the US from 2019 to 2023, which was a weighted population estimate from 520 raw, unweighted NEISS samples. The number of fractures and admissions increased by 2,371% and 3,146% in 2023, respectively, compared to 2019. Collision with a motor vehicle occurred in nearly one-fourth of fractures, and motor vehicle involvement was significantly associated with hospital admission (36.4% v. 25.1%; p=0.01). Overall, 27.7% of e-bicycle fractures were admitted to the hospital. Upper leg fractures had the highest association with admission (90.7% admission rate) but only consisted of 2.7% of all fractures. The most common fracture location in riders aged <18 was the wrist, while the 35-55 age group and >55 age group were most likely to possess upper trunk fractures (cervical spine, thoracic spine, ribs, sternum). The 18-34 age group and 35-55 age group most commonly sustained fractures involving motor vehicles (29.7% and 28.7%, respectively), but the 18-34 age group possessed a significantly higher rate of overall admission among all age groups (p=0.04). There has been a substantial increase in fractures and resource utilization as a result of hospital admissions from e-bicycle riding from 2019-2023. The majority of fractures occurred above the waist, although lower extremity injuries more commonly resulted in admission, and riders aged 35-55 sustained the largest proportion of injuries. Prognostic Level III.

Functional outcomes, of open reduction and internal fixation of danis-weber type b ankle fractures.

Objective: To evaluate the functional outcomes, of open reduction and internal fixation of Danis-Weber Type B Ankle Fractures in adults. Study Design: Descriptive Cross sectional Study. Setting: Surgical Department of a Medical Facility. Period: January 2023 to November 2023. Methods: In all, 152 participants were examined in this study. The OMAS score and Visual Analogue Score were used to categorize the functional results (VAS). Documentation was also done on the age distribution, gender distribution, and kind of trauma. Regarding the length of the fracture, functional outcomes were stratified, and statistical analysis was used to ascertain significance. Results: Out of 152 patients, 63.15% were male and 36.84% was female. The mean age of the patients was 47.57±8.5 years. Out of the 152 patients, 69 (45.39%) patients had an excellent functional outcome, 24 (15.78%) patients had a good outcome, 44 (28.94%) patients had fair outcome, and 15 (9.86%) patients had poor outcome. Falls from height were responsible for 42 (27.63) cases of fractures, while road traffic accidents (RTA) accounted for 110 (72.36%) of them. There were no appreciable variations in functional results when stratification based on fracture duration was applied. Conclusion: Our research results demonstrated that open reduction and internal fixation (ORIF) is an efficacious method in the treatment of Danis-Weber Type B ankle fractures. Most patients treated with ORIF achieved excellent to good functional performance, indicating remarkable regained range of motion and joint stability. This surgical technique provides an opportunity to bring all the fractured bone segments to their desired anatomical positions to promote healing, thus avoiding the risks of malunion or chronic instability. In addition, the results also indicate that ORIF is aimed at restoring normal function and additionally promotes early mobilization of patients which in turn improves their post-surgical outcomes. These findings emphasize that ORIF is effective and the treatment of choice for this category of ankle fractures and it gives very good results in restoring optimal function.

Preliminary application of human-computer interaction CT imaging AI recognition and positioning technology in the treatment of type C1 distal radius fractures

To explore the accuracy of human-computer interaction software in identifying and locating type C1 distal radius fractures. Based on relevant inclusion and exclusion criteria, 14 cases of type C1 distal radius fractures between September 2023 and March 2024 were retrospectively analyzed, comprising 3 males and 11 females(aged from 27 to 82 years). The data were assigned randomized identifiers. A senior orthopedic physician reviewed the films and measured the ulnar deviation angle, radial height, palmar inclination angle, intra-articular step, and intra-articular gap for each case on the hospital's imaging system. Based on the reduction standard for distal radius fractures, cases were divided into reduction group and non-reduction group. Then, the data were sequentially imported into a human-computer interaction intelligent software, where a junior orthopedic physician analyzed the same radiological parameters, categorized cases, and measured fracture details. The categorization results from the software were consistent with manual classifications (6 reduction cases and 8 non-reduction cases). For non-reduction cases, the software performed further analyses, including bone segmentation and fracture recognition, generating 8 diagnostic reports containing fracture recognition information. For the 6 reduction cases, the senior and junior orthopedic physicians independently analyzed the data on the hospital's imaging system and the AI software, respectively. Bone segments requiring reduction were identified, verified by two senior physicians, and measured for displacement and rotation along the X (inward and outward), Z (front and back), and Y (up and down) axes. The AI software generated comprehensive diagnostic reports for these cases, which included all measurements and fracture recognition details. Both the manual and AI software methods consistently categorized the 14 cases into 6 reduction and 8 non-reduction groups, with identical data distributions. A paired sample t-test revealed no statistically significant differences (P>0.05) between the manual and software-based measurements for ulnar deviation angle, radial ulnar bone height, palmar inclination angle, intra-articular step, and joint space. In fracture recognition, the AI software correctly identified 10 C-type fractures and 4 B-type fractures. For the 6 reduction cases, a total of 24 bone fragments were analyzed across both methods. After verification, it was found that the bone fragments identified by the two methods were consistent. A paired sample t-tests revealed that the identified bone fragments and measured displacement and rotation angles along the X, Y, and Z axes were consistent between the two methods. No statistically significant differences(P>0.05) were found between manual and software measurements for these parameters. Human-computer interaction software employing AI technology demonstrated comparable accuracy to manual measurement in identifying and locating type C1 distal radius fractures on CT imaging.

Basic Medical Emergency Treatment for Maxillofacial Injuries

Introduction: Maxillofacial trauma presents unique challenges due to the complex anatomy of the face, encompassing vital structures. Beyond physical injuries, these cases significantly impact a patient's appearance and function, necessitating a multidisciplinary approach. Challenges: Maxillofacial trauma often co-occurs with other injuries, particularly head, chest, and extremity trauma. This increases complexity, with head injuries observed in 7.6-8.9% of facial fracture cases, frequently associated with lower Glasgow Coma Scores. Cervical spine injuries and airway obstruction are significant concerns. Management: While trauma management has significantly improved mortality rates, maxillofacial injuries in polytrauma patients remain a challenge. Their proximity to the brain, spine, and airway necessitates modifications to standard ABC assessments. These modifications often incorporate DRSABCDE, a comprehensive evaluation that includes airway clearance with C-spine control, breathing, ventilation, oxygenation, circulation, disability-neurologic status, exposure-environment, and body temperature. Each component of DRSABCDE is crucial in the initial management of maxillofacial trauma. Conclusion: Continuous education and training in triage, communication, and advanced life support (e.g., BLS-AED, ACLS, PHTLS, BTLS, ATLS) are crucial and empowering for healthcare professionals managing maxillofacial trauma in polytrauma patients. This ongoing learning equips them with the necessary skills and knowledge to handle these complex cases effectively.

Midface Trauma - a Clinical Case of Complex Fracture of the Zygomatic-Alveolar Complex

Traumatic injuries of the maxillofacial region occupy one of the leading places in terms of prevalence among traumas. Injuries of this localization belong to the category of the most severe and complex injuries, posing a significant threat to the health and life of the patient, due to the fact that fractures of the bones of the facial skeleton are often accompanied by various injuries of the organs of vision, sinuses and brain. Injuries of the zygomatic bone isolated and in more than half of cases fractures of the zygomatic bone accompanied by injuries of the walls of the maxillary sinus, nasal and orbital bones, and the eyeball. Of these, 15% accompanied in combination with fractures of the maxillary sinus walls. The article presents a clinical case of transportation trauma of a patient because of a traffic accident as a passenger. Upon admission to the hospital, after a comprehensive examination, the diagnosis: Fracture with displacement of the anterior lateral wall of the right Maxillary sinus, the inferior and lateral wall of the right Orbit. Fracture of the Zygomatic arch with angular deformation. Contusion and abrasions of soft tissues of the right half of the face, right para-orbital tissue. Then successfully performed the operation - Repositioning of bone fragments in fractures Operation repositioning of the zygomatic bone fracture and Osteosynthesis of the anterior wall of the Maxillary sinus on the right side with a titanium perforated plate and isolated from the PRP membrane.

Shape-matching-based fracture reduction aid concept exemplified on the proximal humerus-a pilot study.

Optimizing fracture reduction quality is key to achieve successful osteosynthesis, especially for epimetaphyseal regions such as the proximal humerus (PH), but can be challenging, partly due to the lack of a clear endpoint. We aimed to develop the prototype for a novel intraoperative C-arm-based aid to facilitate true anatomical reduction of fractures of the PH. The proposed method designates the reduced endpoint position of fragments by superimposing the outer boundary of the premorbid bone shape on intraoperative C-arm images, taking the mirrored intact contralateral PH from the preoperative CT scan as a surrogate. The accuracy of the algorithm was tested on 60 synthetic C-arm images created from the preoperative CT images of 20 complex PH fracture cases (Dataset A) and on 12 real C-arm images of a prefractured human anatomical specimen (Dataset B). The predicted outer boundary shape was compared with the known exact solution by (1) a calculated matching error and (2) two experienced shoulder trauma surgeons. A prediction accuracy of 88% (with 73% 'good') was achieved according to the calculation method and an 87% accuracy (68% 'good') by surgeon assessment in Dataset A. Accuracy was 100% by both assessments for Dataset B. By seamlessly integrating into the standard perioperative workflow and imaging, the intuitive shape-matching-based aid, once developed as a medical device, has the potential to optimize the accuracy of the reduction of PH fractures while reducing the number of X-rays and surgery time. Further studies are required to demonstrate the applicability and efficacy of this method in optimizing fracture reduction quality.

Challenges in Managing Cephalic Arch Stenosis: A Case of Stent Fracture and Lessons Learned

Challenges in Managing Cephalic Arch Stenosis: A Case of Stent Fracture and Lessons Learned

Profile of Patients with Decreased Bone Density Aged Over 50 Years Old with Cases of Femoral Neck Fracture, Thoracic Vertebral Compression Fracture, Lumbar Vertebral Compression Fracture, and Distal Radius Fracture in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, in 2019-2020

Highlights: Decreased bone density often progresses to osteoporosis, where osteoporosis is a degenerative disease characterized by low bone mass, bone tissue damage, and bone microarchitecture disorders that can lead to an increased risk of bone fracture. Fractures often found in low bone density consist of fractures of the femoral neck, the thoracic and lumbar vertebrae, and distal radius fractures. Abstract Introduction: Human life expectancy will increase over time, as will various chronic degenerative diseases, one of which is fracture caused by decreased bone mass density. This study described fracture features associated with decreased bone mass density in patients over 50 years old. Methods: This study took place at the Polyclinic of Orthopaedics and Traumatology Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, using a quantitative design with a cross-sectional approach. The sample in this study consisted of 56 medical records collected using a questionnaire processed with Microsoft Excel. Results: This study used 56 samples. Femoral neck fractures had the highest number of decreased bone mass density fractures (69.7%). The most common body mass index (BMI) found with fractures was obese patients (32.2%). Most fractures were experienced by females (64.3%). The location of the highest incidence of fractures was found in domestic accidents (66.1%) with low-energy trauma (67.9%). Conclusion: Most of the fractures caused by decreased bone density in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, were femoral neck fractures, with females being the most common gender. These fractures were also the most common in obese patients, and the highest incidence was found in domestic accidents with low-energy trauma.

The Impact of Modifier-22 on Reimbursement Following Acetabular Fracture Fixation.

The 22-modifier in the Current Procedural Terminology (CPT) system indicates increased surgical procedure complexity, aiming to secure greater reimbursement for surgeons. This study investigated the 22-modifier on reimbursement amounts after acetabular fracture fixation. Design: Retrospective cohort study. Academic Level I Trauma Center. Included were patients with third party reimbursement for acute acetabular fracture (AO/OTA 62A-C) fixation through an open approach from 2005 to 2021 as identified using CPT codes 27226, 27227 and 27228. Chart review identified procedures where the 22-modifier for obesity or fracture complexity was applied. A cohort without the 22-modifier matched by diagnosis, primary CPT code and insurance carrier was made for comparison. The primary outcome measure was the difference in financial reimbursement when the 22-modifier was used. Secondary outcomes were the difference in billed charges and operative time. A total of 785 cases were initially identified with 747 meeting the inclusion criteria, and 73 having the 22-modifier applied. After removing surgeries that did not receive compensation from their insurance, 52 of these patients were compared to 52 matched cases without a 22-modifier. The 22-modifier group and the non-modifier group had no significant difference in reimbursed amounts ($4,112.71 USD vs. $3,851.00, p = 0.644). However, patients in the 22-modifier group had significantly greater billed charges ($8,007.35 vs. $7,120.94 USD; p = 0.0096), longer operative times (301.7 vs. 240.2 minutes, p < 0.001) and greater body mass index (BMI) (43.1 vs 29.3 kg/m2; p < 0.001). Despite increased complexity and greater billed charges, the use of a 22-modifier in acetabular fracture cases did not result in improved collected reimbursements, and reimbursement is equal to when the 22-modifier is not used. Policymakers and insurers should revise reimbursement structures to better align reimbursements for acetabular fixation with surgical complexity. Level III.

Long Bone Fractures in Cats and Dogs: Characteristics and Available Treatment in Algiers: A Retrospective Study of 66 Fractures

Background: Fractures in domestic carnivores are frequently seen in veterinary medicine in the world and are mostly due to impacts inflicted by car injury, trauma, or falls. Fracture type and pattern influence treatment choice. No data are available on long bone fracture in Algiers to provide young veterinarians in developing countries with information on these fractures and their practical treatment options. Methods: Cases of long bone fractures were identified from files of patients presented for surgical consultation at the Surgical Department of the Higher National Veterinary School of Algiers. Characteristics, such as age, sex, circumstances and fracture classification were analysed. The type of selected treatment was also noted, as was the follow-up, when possible. Result: A total number of 66 fractures was recorded. Cats were more affected than dogs representing 70.7% versus 29,3% of the animals showing limb fractures (n=58). The proportions of males and females were respectively 65.9% and 34.1% in cats and 70.6% and 29.4% in dogs. Young animals under 12 months of age represented 82,9% of cats and 64.7% of dogs. Fall from a height was the primary cause in both cats and dogs (51.2% and 58.8%). Fracture of the femur was the most common fracture (51.1% in cats and 47.4% in dogs). Femoral fractures in cats were present on the proximal bone end in over 50 percent of cases. Among these, Eighty-three percent affected the head and/or neck of the bone. Most fractures were closed. Open fractures (23.4% in cats and 5.3% in dogs) affected the lower bones. Animals were treated by pinning, femoral head ostectomy, casting and, amputation (on open fractures of grade II and III). Assessing clinical outcome revealed that recovery in animals having undergone intramedullary pinning or cross pinning and femoral head ostectomy was estimate good in 96,43% of cases in cats and 77.78% in dogs.

Trapdoor Fracture in a Child Following a Domestic Accident: Case Report

The trapdoor fracture is a subtype of orbital fracture and is considered a rare condition that occurs primarily in children and adolescents. The treatment consists of surgery to access and remove the trapped tissue in the floor of the orbit that prevents the movement of the eyes on the affected side. The aim of this article is to present a case of a trapdoor fracture in a 4-year-old child who suffered a domestic accident and underwent surgery under general anesthesia to release the muscles trapped in the orbital floor. The postoperative outcome was considered excellent, with complete recovery of visual and aesthetic functions, without the need for reconstruction of the fractured region with any type of fixation material.

Novel Case of Ipsilateral Supracondylar Fracture with Distal Radio-Ulna Fracture with Acute Compartment Syndrome: A Rare Case Report

Introduction: Fractures involving the supracondylar or distal end radius are the most common fracture in pediatric population. Although they have similar mechanisms of injury, i.e., hyperextension, they occur in isolation and combined supracondylar and distal end radius injuries in the same limb are extremely uncommon. We are reporting an extremely rare clinical presentation of a child with ipsilateral supracondylar fracture with fracture of distal end radius and ulna associated with acute compartment syndrome (ACS). Case Report: A 13-year-old male had sustained trauma to left upper limb due to fall from tree. He was initially treated elsewhere with suturing of wound over his forearm and was brought to our emergency room after 12 h with complaints of swelling and severe pain in left arm, forearm, and hand. On clinical examination, there was tense swelling over the left arm, forearm, and hand. Passive stretch pain was present. Limb was warm, there were multiple blisters present over the flexor aspect over anti-cubital fossa of the left limb. On vascular and neurological evaluation, sensation was decreased compared to other limb over the volar aspect of the hand and forearm, also the pulses were feeble. The patient was immediately sent for Doppler of the left upper limb which showed biphasic flow. X-rays revealed ipsilateral left supracondylar humerus fracture (Type 4 according to Gartland Classification) with distal end radius and distal ulna fracture. As the patient had developed ACS which was evident from the tense swelling and passive stretch pain, we decided to urgently operate the patient with fasciotomy followed by fracture fixation. Wound was closed by shoelace suturing technique, and then, split-thickness skin grafting was done. K-wires were after a period of 6 weeks and gradual range of motion exercises was started. Conclusion: Ipsilateral supracondylar with distal end radius with ACS is a rare entity. ACS should be given priority and fasciotomy must be done properly so as to ensure adequate decompression of intercompartmental pressure. This should be followed by fixation of the fractures. If appropriate intervention is done urgently, good results can be achieved even in such challenging injuries. Keywords: Supracondylar fracture, acute compartment syndrome, fasciotomy, distal end radius, pediatrics.

Age- and sex-specific incidence rates and future projections for hip fractures in Zimbabwe

IntroductionPopulation ageing in Africa is increasing healthcare demands. Hip fractures require multidisciplinary care and are considered an indicator condition for age-related health services. We aimed to estimate current hip fracture...

Approach to junctional fractures in spine: A systematic review and meta-analysis.

The management of thoracolumbar burst fractures presents a challenge due to the absence of consensus on the most effective surgical approach. Surgeons commonly employ anterior, posterior, or combined anterior-posterior instrumentation methods to achieve fracture reduction, stabilization, and neural canal decompression. Despite the availability of these techniques, there is a lack of comparative studies evaluating their efficacy. This gap in the literature underscores the necessity for research to thoroughly assess and compare the various surgical approaches for thoracolumbar spine fractures. The present study aims to compare and critically evaluate the different approaches to surgical management of thoracolumbar spine fractures in order to identify the best treatment. A literature search was performed in 13 electronic databases for articles published between 2000 and August 31, 2023. Two separate reviews were conducted to ensure thoroughness and reliability in article selection. Ultimately, thirteen articles meeting the inclusion criteria were chosen, comprising nine non-randomized control trials (NRCTs) and four randomized control trials (RCTs). To assess the risk of bias in the NRCTs, the Newcastle-Ottawa scale was utilized, while the ROB-b tool was applied to evaluate the RCTs. Thirteen studies meeting the predefined inclusion and exclusion criteria were selected, comprising nine non-randomized control trials and four randomized control trials. A meta-analysis was conducted, revealing that patients undergoing the posterior approach tended to experience longer surgery durations (anterior vs posterior=5.38) and higher blood loss (anterior vs posterior=26.21) compared to those undergoing the anterior or combined anterior-posterior approaches. Additionally, immediate postoperative improvement in kyphotic correction (anterior vs posterior=2.15 and anterior - posterior vs posterior-2.97) was observed in the posterior approach group. However, follow-up assessments indicated a subsequent loss of kyphotic angle in this group (anterior vs posterior=1.41 and anterior - posterior vs posterior-2.00).The systematic review comprises only seven studies comparing anterior and posterior approaches and three studies evaluating posterior and combined approaches. Furthermore, the utilization of different clinical scales across the studies complicates drawing definitive conclusions. Also, heterogeneity of the population, including variations in comorbidities, types of fractures, follow-up duration, timing of intervention, surgeon expertise, and surgical techniques were noted across the included studies. Additionally, there is variability in sample sizes, ages, genders, and follow-up periods. Most of the included studies in the present study were performed on ventral cord compression and kyphosis correction cases rather than simple junctional fracture cases. Each surgical approach possesses its own set of advantages and disadvantages. However, the lack of consensus and standardized protocols underscores the need for further research to establish definitive guidelines for surgical decision-making in thoracolumbar spine fractures.

Global Trends in the Incidence and Primary Causes of Femoral Fractures, Excluding Femoral Neck Fractures: A Global Epidemiological Study.

Fractures pose a significant global health challenge, with varying incidence trends and causes across demographics and regions. This study aims to analyze global patterns in the incidence and primary causes of femoral shaft fractures. Data from the Global Burden of Disease database were analyzed for femoral fractures (excluding femoral neck fractures) by age, gender, and socio-demographic index regions. The estimated annual percentage change (EAPC) was calculated to assess trends in the incidence of femoral shaft fractures. Global femoral fracture cases increased from 8,559,886 in 1990 to 11,566,429 in 2021, a rise of 35.12%. However, the incidence rate dropped from 160.49 to 146.57 per 100,000 (EAPC: -0.35). Males consistently had higher rates, reaching 155.53 per 100,000 in 2021. The 15-49 age group recorded the most cases, while individuals aged 75 and older saw the largest rise in incidence, from 445.91 to 603.32 per 100,000. In 2021, Slovenia (616.1 per 100,000), Croatia (568.51 per 100,000), and Czechia (434.77 per 100,000) reported the highest rates, while Malawi, Kiribati, and Liberia had the lowest (<63 per 100,000). Leading causes were mechanical forces, motor vehicle injuries, and pedestrian injuries, with notable regional disparities. Although the global incidence rate of femoral shaft fractures has declined, it has risen significantly among older adults, increasing their burden. Understanding regional variations in causes is crucial for developing targeted public health interventions to address this growing issue.

Shifting Patterns in Mandibular Fracture Cases Pre and during COVID-19 Pandemic: An Examination through Retrospective Analysis

This study investigates the shifting patterns of mandibular fracture cases at RSUD Dr. Soetomo before and during the COVID-19 pandemic. A retrospective descriptive analysis was performed on a population of 78 patients treated for mandibular fractures at RSUD Dr. Soetomo between 1st September 2019 and 2nd September 2020. The sample was selected based on predetermined inclusion and exclusion criteria, with data collected from medical records. The analysis focused on changes in incidence, demographic profiles, mechanisms of injury, anatomical locations, characteristics, and treatment approaches. These findings provide insights into the impact of the COVID-19 pandemic on trauma care management and the adaptability of healthcare systems during global health crises.

Long-Term Comparative Outcomes of Short Implants Versus Maxillary Sinus Elevation in Posterior Maxilla Rehabilitation.

Background: Vertical atrophy of the maxilla has traditionally been treated with sinus lift procedures and implant placement, performed in one or two surgical stages. Subsequently, the transcrestal sinus lift technique was introduced, offering distinct advantages in terms of indications and reduced morbidity. Most recently, short implants have emerged as a valid alternative to these procedures, even in cases of severe horizontal resorption, allowing for direct placement in many cases. This study was designed to assess the clinical outcomes of short implant placement in alveolar ridges with severe bone atrophy, compared with conventional-length implants placed in areas undergoing conventional sinus elevation. Methods: A retrospective split-mouth study was conducted to compare conventional sinus elevation with standard-length implants versus short implants for addressing vertical bone atrophy in the posterior maxilla. The primary variable was the variation in the marginal bone level. The secondary variables were implant survival and complications. The evaluation of the statistical significance of the difference in categorical variables was accomplished by Chi-squared test or Fisher's exact test. The comparison between the study groups in continuous variables was performed using Wilcoxon test. The statistical significance was set at p-value < 0.05. Results: The study sample consisted of 24 patients and a total of 73 dental implants. The lateral sinus elevation group (LSEG) included 39 implants, while the short implants group (SIG) included 32 implants. All prostheses were screw-retained. Changes in marginal bone levels indicated a marginal bone loss of less than 0.5 mm in both groups, with no statistically significant difference. In the LSEG, two cases of mucositis were identified, attributed to improper use of an interdental brush. Additionally, two cases of prosthetic screw fracture were reported in the LSEG as technical complications. Conclusions: Long-term outcome data have provided evidence that the use of short implants is comparable to a state-of-the-art procedure (sinus grafting and placement of implants) regarding implant survival, marginal bone remodeling, and complication rates.

Arthrodesis in the treatment of ankle osteoarthritis due to neglected malleolar fractures in the elderly.

Neglected malleolus fracture cases, among other conditions in which arthrodesis is inevitable, usually present with pseudoarthrosis of the malleolus and impaired ligament balancing. The study aimed to summarize the clinical data results of neglected malleolus fractures accompanied by ankle instability. The retrospective study was conducted at Adana City Training and Research Hospital. The files of the patients diagnosed with nonunion malleolus fractures admitted between January 1, 2018, and July 30, 2023, were analyzed. In addition to the demographics, the type of malleolus fracture, the technique used in arthrodesis surgery, use of graft, union status, presence of early and late complications, visual analog scale (VAS), and Maryland Foot Score (MFS) scores at preoperative, 3-, 6-, and 12-month postoperative visits were recorded. There was a total of 11 files available for analysis. The mean age of the cases was 70.55 ± 5.03, ranging between 65 and 82. The records showed that the patients ignored the need for surgical treatment for an average of 10.64 ± 3.5 months. In terms of the technique, 4 were treated using the Ilizarov only, 3 with the intramedullary nails, 3 with plates and screws, and the remaining Ilizarov and plate. The average duration of the union was 6.27 ± 2.99 months. The mean VAS scores for preoperative, postoperative 3rd, postoperative 6th, and postoperative 12th months were 7.55 ± 0.78, 5.55 ± 2.31, 3.45 ± 2.27, and 2.45 ± 1.44, respectively. The mean Maryland Foot Scores (MFS) for preoperative, postoperative 3rd, postoperative 6th, and postoperative 12th months were 21.82 ± 6.85, 51.27 ± 15.39, 61.18 ± 20.21, and 70.82 ± 5.27, respectively. This study has shown that no matter how difficult the case, if the appropriate implant and basic arthrodesis principles are followed, the union can be achieved, albeit late, in cases with osteoarthritis due to neglected ankle malleolus fracture. Especially in the presence of infection, it should be kept in mind that union may be delayed compared to the regular arthrodesis recovery duration, requiring the team performing the surgery to be familiar with the Ilizarov technique.

Triglyceride glucose index is associated with vertebral fracture in older adults: a longitudinal study.

Diabetes is a risk factor for bone fractures. However, the association between insulin resistance and the risk of fracture has not been well studied. In the present study, we explored the association of the triglyceride glucose index as a measure of insulin resistance with the risk of vertebral fracture in older adults. A total of 1995 subjects aged 50 years or older who underwent computed tomography (CT) for lung cancer screening from 2016-2021 were included in this study. They were followed until July 2023. Demographic information and laboratory test data were collected from the electronic medical system. Vertebral fractures were evaluated on the basis of sagittal CT images of the spine. The triglyceride glucose (TYG) index was calculated via the following equation: Ln [fasting glucose (mg/dl)×fasting triglyceride (mg/dl)/2]. The association between the TYG index and vertebral fracture incidence was evaluated via a multivariable Cox proportional hazards model. Ninety-five cases of fracture were observed during the 60 months of follow-up. The incidence of fracture was lower for the fourth TYG index than for the first TYG index (3.26% vs. 6.00%, P = 0.04). The risk of vertebral fracture decreased with increasing TYG index (adjusted hazard ratio (aHR): 0.56, 95% confidence interval (CI): 0.35-0.90). Fracture risk was significantly lower in subjects with the highest TYG (the fourth quartile) than in those with the first quartile (aHR: 0.46, 95% CI: 0.22-0.96) according to the fully adjusted model. A similar association was observed in subjects without diabetes (aHR = 0.44, 95% CI: 0.21-0.95). Restricted cubic splines further revealed that the risk of vertebral fracture decreased with increasing TYG index. A greater TYG index was associated with a lower risk of vertebral fracture, independent of body mass index and bone mass.