Neck Fractures Research Articles

Odontoid Fractures: A Review of the Current State of the Art.

Odontoid fractures (OFs) represent up to 15% of all cervical fractures encountered and present most commonly amongst elderly patients, typically in the setting of low energy trauma such as falls. The Anderson and D'Alonzo classification and Roy-Camille subtype description are the most clinically noteworthy descriptions of OFs used. Even though most patients will not present with neurological injury, mechanical instability can occur with type II and type III (Anderson and D'Alonzo) fractures, particularly if the transverse ligament of the atlas is ruptured; however, this is very rare. Conservative treatment is usually employed for type I and type III injuries, and to a varying degree for non-displaced type II injuries. Surgical treatment is typically reserved for type II fractures, patients with neurological injury, and in the setting of other associated fractures or ligamentous injury. Anterior screw fixation is a viable option in the setting of a favorable fracture line orientation in type II fractures, whereas posterior C1-C2 screw fixation is an option for any type II or type III fracture presentation. There is evidence that surgery for type II fractures has higher rates of union and lower mortality than nonoperative treatments. While surgical options have increased over the decades and the management of OF has been optimized by considering fracture subtypes and patient factors, there remains a significant morbidity and mortality associated with OFs. The aging population and changing demographics suggest that there will be an ongoing rise in the incidence of OFs. Therefore, the appropriate management of these cases will be essential for ensuring optimization of health care resources and the quality of life of affected patients.

Time to surgery for subaxial cervical fractures: a multicenter study

ObjectiveTo identify delays for surgery to stabilize subaxial cervical fractures and the main reasons for them across Latin America. MethodsThis is a retrospective multicenter cohort study of patients surgically treated for subaxial cervical fractures from 13 spine centers across Latin America from January 1th 2014 to January 1th 2023. Causes of delay to surgery beyond 24 hours were documented. ResultsWe included 529 patients from 13 institutions in Latin American countries; 408 (77,1%) males and 121 (22,9%) females with a mean age of 43,4 (SD=±16,2). Predominantly caused by traffic accident (n=256; 48,4%), followed by fall from height (n=233; 44%). Mostly, suffered type C fractures (n=348; 65.8%) and/or neurological injury (n=384; 72,6%). The time from admission to surgery was >72 hours in 70% of the patients included (n=375; 70,9%). More than 45% waited longer than a week (n=257; 48,6%) for spine surgery. Only 12,5% (n=66) of the patients received surgery in the first 24 hours from admission. The primary reasons for the surgical delay were the necessity for other surgical procedures (n=161; 34,8%), the unavailability of surgical implants (n=60; 13,0%), patient clinical instability (n=55;11,9%), and delays in referral (n=38; 8,2%). ConclusionsWe documented significant and concerning delays in providing spinal decompression and stabilization surgery to patients with cervical spine fractures. Only 17% of patients have surgery in the recommended time <24 hrs., more than half of the patients must wait for more than 72 hours, and nearly half of patients wait for longer than a week.

Relationship of Mechanism of Injury to Asymptomatic Cervical Spine Fractures in the Elderly.

The Canadian Cervical Spine Rule, a clinical decision-making tool for patients post-trauma is often interpreted as recommending cervical spine computed tomography in patients ≥ 65 years old, who sustain a dangerous mechanism of injury, and/or have extremity paresthesias. We retrospectively reviewed 6 years' of emergency department cervical spine computed tomography reports to determine fracture rates in patients ≥ 65, symptomatic or not, who did and did not have a dangerous mechanism. Of those ≥ 65 years old, 240/13925 (1.72%) patients had cervical spine fractures. The fracture rate in asymptomatic patients ≥ 65 was 0.27%. The fracture rate in asymptomatic patients ≥ 65, who did not have a dangerous mechanism of injury was 0.15%. The rate of unstable fractures requiring surgery was 0.007%. The findings suggest that the algorithm to scan asymptomatic patients ≥ 65, and/or those ≥ 65 without a dangerous injury mechanism, should be revisited for appropriateness and overall value.ABBREVIATIONS: CCR = The Canadian Cervical Spine Rule; CSCT = cervical spine computed tomography; ED = emergency department; EMR = electronic medical record; MVC = motor vehicle collision.

Traumatic Cervical Facet Fractures and Dislocations.

Cervical facet injuries, though less common than other spinal injuries, represent a subset of subaxial cervical spine injuries and can present significant challenges in terms of diagnosis, management, and outcomes. A major concern with cervical facet fracture is identifying instability patterns that may necessitate surgical stabilization. Particularly in cases of cervical facet fracture dislocations, there remains controversy regarding requirements for closed reduction, timing, surgical approach, need for preoperative MRI, and method of fixation. This review article aims to provide a thorough understanding of the etiology, clinical presentation, diagnostic techniques, treatment options, and prognostic factors associated with cervical facet fractures.

Differences in Cervical Spine Fractures in Patients Younger or Older Than 65 Years of Age: Implications for the Canadian C-Spine Rule.

There has been a distinction made in the 2001 Canadian C-Spine Rule regarding patients 65 and older and younger than 65 years of age as far as indications for cervical spine CT scanning. We sought to determine if there are differences in the symptoms, mechanisms of injury, fracture locations, and types that are still relevant in 2024. The institutional review board approved this retrospective study of cervical spine CT emergency department results from 2 hospitals in our health system after reviewing 5 years of data in patients experiencing trauma. In addition to the primary variable of age (younger than 65 years and 65 years and older), we looked at injury mechanism, fracture types, sites, symptoms, and operative or medical treatments. Because the demographics of our home site is different from most towns in the United States, we provide race/ethnicity data. Of 21,986 cervical spine CTs, 190/9455 (2.0%) participants 65 years of age and older and 199/12,531 (1.6%) participants younger than 65 years of age had fractures (total, 389/21,986, 1.8%). There were more cases of falls from standing (106, 55.8%) and falls from a height (46, 4.2%) in those 65 years and older and this mechanism was associated with a higher risk of C1 and C2 fractures (52, 27.4%; and 78, 41.1%, respectively). Among the C1 fractures, anterior and posterior arch fractures predominated (37, 19.5%). For C2 fractures, types 2 and 3 odontoid fractures (39, 20.5%; and 12, 6.3%) were more common in the older cohort. Motor vehicle collisions were more common in the younger cohort (89, 44.7%), and they were associated with more C5-C7 fractures (47, 23.6%; 60, 30.2%; and 66, 33.2%, respectively) including the facets (49, 24.6%), spinous processes (31, 15.6%), and transverse processes (52, 26.1%). Overall, the rates of instability, surgical intervention, and asymptomatic fractures were similar in the 2 age groups. Cervical spine fractures appear in about 1.8% of the CT scans performed in a busy emergency department environment. Fractures in the elderly occur more commonly due to falls, are located at C1 and C2, and may involve ligamentous injuries. Younger patients incur trauma more commonly due to motor vehicle collisions, and they are more likely to affect the posterior elements, especially C5-C7. The differences in trends for fractures in the 65 years of age and older and younger than 65 years of age groups have persisted since the Canadian C-Spine Rule 1996-1998 data were collected.

Artificial Intelligence Detection of Cervical Spine Fractures Using Convolutional Neural Network Models.

To develop and evaluate a technique using convolutional neural networks (CNNs) for the computer-assisted diagnosis of cervical spine fractures from radiographic x-ray images. By leveraging deep learning techniques, the study might potentially lead to improved patient outcomes and clinical decision-making. This study obtained 500 lateral radiographic cervical spine x-ray images from standard open-source dataset repositories to develop a classification model using CNNs. All the images contained diagnostic information, including normal cervical radiographic images (n=250) and fracture images of the cervical spine fracture (n=250). The model would classify whether the patient had a cervical spine fracture or not. Seventy percent of the images were training data sets used for model training, and 30% were for testing. Konstanz Information Miner (KNIME)'s graphic user interface-based programming enabled class label annotation, data preprocessing, CNNs model training, and performance evaluation. The performance evaluation of a model for detecting cervical spine fractures presents compelling results across various metrics. This model exhibits high sensitivity (recall) values of 0.886 for fractures and 0.957 for normal cases, indicating its proficiency in identifying true positives. Precision values of 0.954 for fractures and 0.893 for normal cases highlight the model's ability to minimize false positives. With specificity values of 0.957 for fractures and 0.886 for normal cases, the model effectively identifies true negatives. The overall accuracy of 92.14% highlights its reliability in correctly classifying cases by the area under the receiver operating characteristic curve. We successfully used deep learning models for computer-assisted diagnosis of cervical spine fractures from radiographic x-ray images. This approach can assist the radiologist in screening, detecting, and diagnosing cervical spine fractures.

Risk factors for postoperative DVT exacerbation or new DVT in patients with spinal cord injury complicated with cervical fracture.

To investigate the dynamic changes of perioperative deep venous thrombosis (DVT) in patients with spinal cord injury complicated with cervical fracture and analyze the risk factors of postoperative DVT exacerbation or new DVT. From January 2018 to December 2023, a total of 232 patients with spinal cord injury complicated with cervical fracture in our hospital were retrospectively analyzed. Ultrasonography of both lower limbs was performed before and after surgery. According to whether there was aggravation of DVT or new thrombosis, the group was divided into DVT exacerbation or new DVT group and non-DVT exacerbation group. Clinical data were used to study the dynamic changes of perioperative DVT. Logistic regression analysis and receiver operating characteristic (ROC) curve were used to explore the risk factors. The DVT was found in 47 patients before surgery, including 26 cases of distal thrombus, 14 cases of mixed thrombus and 7 cases of proximal thrombus. Postoperative DVT increased to 81, including 31 distal thrombus, 35 mixed thrombus and 15 proximal thrombus. A total of 53 patients (22.8%, 53/232) experienced postoperative DVT exacerbation or new DVT. Logistic regression analysis revealed that age, American Spinal Injury Association (ASIA) score, time from injury to surgery, surgery time and blood loss were risk factors for postoperative DVT exacerbation. In patients with spinal cord injury complicated with cervical fracture, the risk of postoperative DVT exacerbation is very high. Age, ASIA score A-B, time from injury to surgery, surgery time and blood loss were risk factors for postoperative DVT exacerbation or new DVT.

Minimally Invasive Combined Medial and Lateral Approach for Treating Displaced Scapular Body and Neck Fractures.

BACKGROUND Traditional open surgery for displaced scapular body and neck fractures often results in significant trauma and complications. This study aimed to assess the efficacy of a combined medial and lateral minimally invasive approach compared with the traditional Judet approach. MATERIAL AND METHODS A retrospective analysis was conducted on 36 patients (22 men, 14 women; mean age 45.6 years) with displaced scapular body and neck fractures treated between May 2016 and May 2022. Nineteen patients underwent the minimally invasive approach, while 17 received the traditional Judet approach. Primary outcomes included surgical incision length, intraoperative blood loss, complication rate, time to postoperative pain relief (VAS score ≤3), and Constant-Murley shoulder score at 12 months. Statistical analysis was done using the t test and chi-square test. RESULTS The minimally invasive group had shorter incision lengths (mean difference: 10.0 cm; 95% CI: 8.1-11.9; P<0.001) and lower blood loss (mean difference: 129.4 mL; 95% CI: 119.0-139.8; P<0.001). They also experienced faster pain relief (mean difference: 3.0 days; 95% CI: 2.5-3.5; P<0.001) and higher Constant-Murley scores (mean difference: 7.4 points; 95% CI: 4.9-9.9; P<0.001). There were no significant differences in operative duration or fracture healing time. CONCLUSIONS The combined medial and lateral minimally invasive approach offers superior outcomes in reducing incision length, blood loss, complications, and pain, with enhanced shoulder function, making it a safe and effective alternative to the traditional Judet approach.

Numerical and Experimental Study of the Mechanical Reshaping Process for Laser Shock Clinching

This study investigates the viability of employing a mechanical reshaping method to reduce the protrusion height of laser shock‐clinched joints while improving their strength. The method involves utilizing a pair of flat reshaping dies to compress the protrusion on laser shock‐clinched joints made of copper foils and stainless steel sheets. Through numerical simulations and experiments, the study delves into the processes of laser shock clinching, mechanical reshaping, and failure modes of joints. Examination of the cross‐sectional profiles of both clinched and reshaped joints provides insights into the influence of process parameters during mechanical reshaping. Furthermore, tensile‐shear and cross‐tension tests are conducted to ascertain the mechanical properties of joints. The results show that the mechanical reshaping process not only effectively reduces the protrusion height of laser shock‐clinched joints but also significantly enhances their strength due to augmented interlock. Specifically, compressing the joint with an initial protrusion height of 0.20 mm down to 0.08 mm results in an increase in interlock from 27.65 to 62.00 μm, along with a 35.11% increase in tensile‐shear strength and a 122.17% increase in cross‐tension strength. The primary failure modes observed are neck fracture and pulling out.

Commentary on "Artificial Intelligence Detection of Cervical Spine Fractures Using Convolutional Neural Network Models".

Commentary on "Artificial Intelligence Detection of Cervical Spine Fractures Using Convolutional Neural Network Models".

Assessing the Performance of Models from the 2022 RSNA Cervical Spine Fracture Detection Competition at a Level I Trauma Center

Assessing the Performance of Models from the 2022 RSNA Cervical Spine Fracture Detection Competition at a Level I Trauma Center

Surgery do save life in cervical spinal injury: 5 years study of a tertiary care in East Java, Indonesia

Cervical spine has the most movement in spine therefore it has high risk of injury which may involve vertebrae, soft tissue and spinal cord. Trauma to cervical has highest risk of neurologic deficits due to spinal cord injury (SCI) causing high number of morbidity and mortality. Retrospective study was conducted with descriptive-analytic design by total sampling of cervical spinal injury patients in Dr. Soetomo General Academic Hospital from January 2018 to June 2023. Patient demographic and survival analysis of patients was described using Kaplan-Meier chart and logistic regression test to find factors contributing to patients’ survival. Gender, age, mechanism of injury, surgical approach, duration, intra-operative bleeding, lesion level, time to surgery, and initial blood laboratory had no significant impact while neurological status and operative treatment have significant survival probability. Patients with American Spinal Injury Association Impairment Scale (AIS) A score have lower survival rate which associated with respiratory muscle weakness, cardiovascular and autonomic nervous system dysfunction. Any unstable cervical fracture is advised for surgery while decompression surgery is recommended for improving outcome and ease of rehabilitation. Clinical implication of this study recommends surgery for cervical spinal injury with 5.6 times more chance of survival than non-operative patients. Initial AIS neurological status and surgery performed contributes to survival. Level of cervical lesion, age, gender, mechanism of injury, surgical approach, duration, blood laboratory tests do not have a significant impact on survival while fastest time admission to surgery does not reflect higher chance of survival probability.

EP241 - Managing Cervical Spine fracture in a district general hospital

Abstract Introduction Cervical spinal injury affects 2–3% of trauma patients and accounts for 8.2% of all trauma-related deaths. Respiratory complications are cited as the primary cause of mortality with a 14 - &amp;gt;27 % rate in patients aged more than 65 years old. Aim Produce a clear set of guidelines in an aim to reduce mortality in patients &amp;gt; 65 years presenting with cervical spine fracture. Method Data was retrospectively collected for patients aged &amp;gt;65 between September 2021 and August 2022 in a district general hospital. Patients with confirmed cervical spine injury were included in the study. Data was collated and analysed using Excel. Results 36 patients presented to ED with acute cervical spine fracture. 22 (61%) were female and 14 (39%) male with an age range of 66-98 years old. 31 (84%) patients were discussed with a tertiary centre. Complications ranged from constipation, delirium, DVT/PE, chest infections (n=5, 36%) to spinal shock (n= 3, 27%). 11 (30.6%) patients presenting with a c-spine fracture died within 30 days of admission.9 (25%) patients had an outpatient appointment booked in a tertiary centre and 13 (36%) were seen locally in the fracture clinic. 14 (39%) patients did not have any follow ups planned. Conclusions To mitigate in-hospital complications and improve outcomes, shared care with orthopaedics, geriatrics, and physiotherapy is being proposed for this group of patients. It would be beneficial to compare the data from the local network and aim at publishing an up-to-date set of robust guidelines.

A combination of osteosynthesis in proximal femur fracture and contralateral femoral neck local osteo-enhancement procedure (LOEP) in severe osteoporotic bone loss

Proximal femur fractures are among the main causes of mortality and morbidity worldwide in the elderly female population. Research efforts are currently focused on the development of a procedure that has immediate and long-term effectiveness, although pharmacological therapies are already capable of improving bone density and reducing the risk of fracture. A local bone enhancement procedure (LOEP) has been developed to facilitate bone augmentation. The procedure requires the preparation of an area of osteoporotic bone into which a triphasic, resorbable, calcium-based material is injected. Following the procedure, both the bone mineral density of the proximal femur and the bone resistance to compression and distraction forces acting on the femoral neck, which can cause fracture, are significantly improved. Ten women suffering from severe osteoporosis and intertrochanteric fracture underwent preliminary investigations after application of a local bone-strengthening procedure involving the use of AGN1 and nailing of the contralateral proximal femur. KEY WORDS: Proximal femur fracture, osteoporosis, local osteo-enhancement procedure (LOEP), proximal femoral nail (PFN).

The epidemiology of recreation-related cervical and thoracic fractures

CONTEXTRecreational activities are frequently associated with spinal fracture, yet contemporary characterization of sports-related cervical and thoracic fracture is lacking. PURPOSETo characterize cervical and thoracic fractures associated with recreational activities. STUDY DESIGN/SETTINGRetrospective cohort study. PATIENT SAMPLEThe National Electronic Injury Surveillance System (NEISS) database OUTCOME MEASURE AND COMPARISONSRecreation-related cervical and thoracic fracture incidence rates per year, stratified by age and sex. Common causative activities were established by demographics. METHODSThe NEISS database was queried to identify patients with recreation-related cervical fractures between 2003 and 2022 and recreation-related thoracic fractures between 2003 and 2022 in patients aged >2 years-old. United States Census data was utilized to generate incidence rates per year. Data was stratified by demographic variables to assess the impact of age and sex on incidence and causative activity. RESULTSBetween 2003 and 2022, an estimated 13,823 recreation-related cervical fractures occurred with an average annual incidence of 2.20±0.35 per 1 million person-years, while 24,236 estimated recreation-related thoracic fractures occurred from 2003 to 2022 with an average incidence of 3.85±1.26. Males experienced a 3.51 times higher (95% CI 3.38–3.66) rate of cervical fracture, but thoracic fracture rates were similar between sexes. Individuals under 18 experienced a 2.15 times higher rate of thoracic fractures than those aged 18–64 (95% CI 1.85–2.50) and 1.93 times higher rate than those over 65 (95% CI 1.68–2.22). Recreation-related cervical fracture rates in individuals 18–64 was 1.186 (95% CI 1.14–1.23) times higher than those under 18 and rates in those under 18 were 1.15 (95% CI 1.09–1.22) times higher than those over 65. Football (26.6%), horseback riding (19.7%), and skiing (8.35%) were the primary causes of cervical fractures, and horseback riding (46.8%), football (11.2%), and skiing (10.3%) primarily caused thoracic fractures. Cervical fractures resulted primarily from football in males (24.7%) and horseback riding in females (44.0%). Horseback riding primarily caused thoracic fractures in both sexes (males=21.5%, females=74.7%). Football led causative activities for individuals under 18 (Cervical=42.4%, Thoracic=40.7%), while horseback riding dominated among those aged 18–64 (26.7%, 56.7%) and over 65 (52.8%, 67.9%). CONCLUSIONSThis investigation revealed epidemiological trends in cervical and thoracic spinal fractures and underscore the need for targeted preventive measures and safety interventions to mitigate the burden of these fractures particularly in horseback riding and American football. LEVEL OF EVIDENCELevel III.

Mortality risk factors for adult trauma patients treated with halo brace for cervical spine fracture

Introduction and objectivesHalo braces treat upper cervical spine fractures and serve as the most rigid form of external immobilization. Recently, halo braces have lost favor due to known complications and advances in surgical stabilization. This study aims to determine the contemporary incidence for use of halo braces and identify risk factors associated with mortality in trauma patients undergoing halo brace for cervical spine fractures. Materials and methodsThe 2017–2019 Trauma Quality Improvement Program Database was queried for patients ≥18 years-old with a cervical spine fracture undergoing halo brace. Patients sustaining penetrating trauma and severe torso injuries (abbreviated injury scale >3 for the abdomen or thorax) were excluded. Bivariate and multivariable logistic regression analyses were performed. ResultsFrom 144,434 patients with a cervical spine fracture, 272 (0.2%) underwent halo brace and 14 (5%) of these died. Those who died were older (73.5 vs. 53 years-old, p = 0.011) and had higher rates of hypertension (78.6% vs 33.1%, p < 0.001) and chronic kidney disease (14.3% vs. 1.2%, p < 0.001). Glasgow Coma Scale ≤8 (46.2% vs. 8.2%, p < 0.001) and cervical spinal cord injury (71.4% vs. 21.3%, p < 0.001) were more common in patients who died. In addition, those who died more often sustained respiratory complications (7.1% vs. 0.4%, p = 0.004) and sepsis (7.1% vs. 0.4%, p = 0.004). On multivariable logistic regression analysis, only Glasgow Coma Scale ≤8 (OR 19.77, 3.04–128.45, p = 0.002) was associated with increased mortality. ConclusionsOnly 5% of cervical spine fracture patients undergoing halo brace died. Respiratory complications and sepsis were more common in those who died. On multivariable analysis only Glasgow Coma Scale ≤8 remained an independent associated risk factor for mortality.

Observational Study of the Clinical Impact of E-scooter Injuries at a Major Trauma Centre.

Background Due to the increased use of e-scooters in the UK, associated injuries have increased, and its cost has increased as well. Worldwide data on injuries related to e-scooter use are relatively limited, owing to the short duration since their first introduction to the public. Aim There has been an increase in using e-scooters as a method of transport recently. It was noticed that the severity and frequency of its injuries are increasing as well. This study focuses on the frequency of e-scooter-associated injuries, especially open fractures, and to evaluate its burden on the health system. Methods Data on e-scooter injuries were extracted from our trauma database from November 2017 to July 2022. Patients' notes and images were reviewed. Outcome measures were the type of injuries: site of bony fractures, closed vs. open fracture (using Anderson and Gustilo classification), number of operations, complications, and length of hospital stay. Results The number of patients enrolled was 104. The mean age was 34.3 years, and 78.8% (n = 82) were male. The main mechanism of injury was riding (91%, n = 95) vs. hitting by an e-scooter (9%, n = 9). Injured patients were more likely not to wear helmets (82% of total injured patients). Patients with bony injuries were 65.4% (n = 68), with 22.1% (n = 15) of them being open fractures. The most common bony injuries were lower limb-only fractures at 45.6% (n = 31), then upper limb-only injuries at 39.7% (n = 27). Combined upper and lower limb cases were 8.8% (n = 6), and pelvic injuries were 5.9% (n = 4). Head and neck injuries composed 23.1% (n = 24) of the reported injuries, including intracranial haemorrhages (9.6%, n = 10), extensive traumatic brain injury (3.8%, n = 4), haematoma/lacerations (3.8%, n = 4), cervical spine fractures (1.9%, n = 2), and skull fractures (1.9%, n = 2). The mean duration of hospital stay was 8.6 days, and 9.6% (n = 10) of patients needed intensive therapy unit(ITU) admission. The number of patients presented as trauma calls was 55.8% (n = 58). Patients who needed surgical intervention either under orthopaedics or other specialties were 52.9% (n = 55) and 21.2% (n = 22) of total patients had complications either due to surgical intervention or a long hospital stay. Conclusion E-scooter riding can lead to serious injuries that can end with limb- or life-threatening conditions. The most common demographic characteristics were adults in their early 30s. There should be more emphasis on wearing protective gear like wrist and elbow guards in addition to helmets. Future prospective studies with larger cohorts across multiple regions and hospitals are necessary to truly characterize the nature and cost of e-scooter injuries.

A Comparative Study in the Treatment of Fracture Neck of Femur with Cemented and Non Cemented Bipolar Prosthetic Replacement in Rural Hospitals of Bangladesh

Background: The treatment of fracture neck of femur with bipolar prosthetic replacement is commonly performed using cemented and non-cemented implants. This study compares the clinical outcomes, complications, and patient satisfaction between these two methods in rural hospitals of Bangladesh. Methods: This comparative study was conducted in rural hospitals of the Kishorganj district, Bangladesh, from January 2023 to December 2023, to evaluate the outcomes of cemented versus non-cemented bipolar prosthetic replacement in patients with femoral neck fractures. Results: The age range of participants was 48 to 68 years. Regarding gender distribution, 44.4% of patients in the Cemented group were male, compared to 37.0% in the Non-Cemented group. The cemented group had a mean hospital stay of 8.3 ± 2.1 days, while the non-cemented group had a slightly longer stay of 9.0 ± 2.3 days. Postoperative infection rates were higher in the cemented group (11.1%) compared to the non-cemented group (3.7%), with diabetic patients showing a higher infection risk in both groups. Patient satisfaction was 78% in the cemented group and 74% in the non-cemented group, with no significant difference between the two groups (p &gt; 0.05). Conclusion: Cemented bipolar prosthetic replacement offers the advantage of shorter hospital stays and slightly higher patient satisfaction, but at the cost of a higher infection rate, particularly among diabetic patients. Non-cemented prostheses provide comparable long-term outcomes with a lower infection risk, making them a viable option for patients with comorbid conditions

A comparative study of self pierceing riveting and mechanical clinch of DP590-Al5754 high-strength steel and aluminum alloys

This paper presents a comparative study of two joining processes, self piercing riveting (SPR) and mechanical clinch, used to join DP590 high-strength steel and Al5754 aluminum alloy. A comparative study of microhardness, tensile shear properties, fatigue properties, and economics of joints from both processes was conducted. The findings indicate that the highest hardness levels are observed in the rivet leg region for SPR joints and in the neck region for mechanical clinch joints. The maximum failure load and energy absorption values of SPR joints were found to be 1.46 and 9.07 times higher, respectively, than those of mechanical clinch joints. The static tensile test results demonstrate that the strength and hardness of SPR joints in aluminum sheets subjected to cold work hardening are significantly lower than those of steel sheets. Therefore, the failure of SPR joints is primarily attributed to the deformation and fracture of the lower aluminum sheet. Mechanical clinch joints fail by neck fracture because the steel sheet neck becomes brittle by cold work hardening and the neck thickness is small. The fatigue behavior of SPR joints was observed to be superior to that of mechanical clinch joints. The findings of the scanning electron microscopy and energy spectrum analysis suggest that fretting wear between the upper and lower sheets results in fatigue fracture of the lower sheet in the joints. When joining the same material on a large scale, the selection of mechanical clinch over SPR can prove an effective method of reducing costs. Furthermore, the selection of a set of dies with an extended life can contribute to the reduction of joining costs.

CNS and Thorax Injury and Associated Risks Factors in Equestrian Sports.

Equestrian sports continue to gain popularity in the United States and are associated with a high injury rate, especially involving the central nervous system and thorax. Due to this high rate of injury and the potential for long-term consequences associated with participation, an understanding of the unique risks of this sport is needed. To describe severe injury in equestrian sports and review the role that protective gear plays in injury mitigation. The PubMed Database was searched using the search terms "equestrian" and "horse" combined with "spinal cord injury," "head injury," "traumatic brain injury," "experience levels," and "demographics." A total of 53 papers were selected based on their relevance of epidemiology, risk factors, and management of injuries sustained during equestrian activities. Case studies, randomized controlled trials, prospective studies, and retrospective studies were all included for further review. Systematic review. Level 4. None. Injuries to the thorax, including fractures, pneumothoraces, internal organ contusions, and crush injuries, have been cited in multiple national and international trauma registries as the most prevalent injury location in equestrians; however, head and neck injuries, high cervical spine fractures, and closed head injuries are reported to be associated with the highest rates of mortality. Helmets provide protection against skull fracture and traumatic brain injury. Vests were not associated with diminished rates of spinal cord injuries; however, they may provide protection to the thorax. Riding experience also plays a role in reducing the prevalence of injury. Equestrian-related activities are associated with a high risk of injury despite protective measures. Protective gear can mitigate some injury risk but does not protect against spinal injury. Continued investigation into improving protective equipment, rider education, and preventative strategies to mitigate this risk is needed.