Fracture Classification Research Articles

An AI-Driven Framework for Detecting Bone Fractures in Orthopedic Therapy.

This study presents an advanced artificial intelligence-driven framework designed to enhance the speed and accuracy of bone fracture detection, addressing key limitations in traditional diagnostic approaches that rely on manual image analysis. The proposed framework integrates the YOLOv8 object detection model with a ResNet backbone to combine robust feature extraction and precise fracture classification. This combination effectively identifies and categorizes bone fractures within X-ray images, supporting reliable diagnostic outcomes. Evaluated on an extensive data set, the model demonstrated a mean average precision of 0.9 and overall classification accuracy of 90.5%, indicating substantial improvements over conventional methods. These results underscore a potential framework to provide healthcare professionals with a powerful, automated tool for orthopedic diagnostics, enhancing diagnostic efficiency and accuracy in routine and emergency care settings. The study contributes to the field by offering an effective solution for automated fracture detection that aims to improve patient outcomes through timely and accurate intervention.

Outcomes of internal fixation with Femoral Neck System (FNS) for intracapsular femoral neck fractures

Abstract Background: Internal fixation of hip fractures is associated with high reoperation rates. This study investigated the reoperation rates after internal fixation with the femoral neck system (FNS). Materials and Methods: A single-institution cohort study was conducted on patients aged 18 years or older who sustained intracapsular femoral neck fractures and underwent internal fixation with a fixed-angle implant. Surgeons, patients, and investigators were not blinded. The primary outcome was any hip reoperation at the final follow-up. Secondary outcomes were to characterize a cohort of patients regarding demographics, fracture classification, intraoperative findings, postoperative fracture complications and union rates, and postoperative pain. Results: This study found that internal fixation with FNS for intracapsular femoral neck fractures was associated with a 23% rate of revision surgery. Of the initial 94 patients who received FNS internal fixation, 44 patients were included for analysis; of those, 10 patients underwent revision surgery. Patients had a 22% rate of in-hospital medical adverse events with a 30-day readmission rate of 9%. Increasing body mass index was associated with increased revision rates (P = 0.037). Patients who sustained displaced femoral neck fractures had a significant decrease in SF-12 Mental Health Composite, SF-12 Physical Health Composite, and quality-of-life subscale scores. Conclusions: The FNS is a viable alternative for internal fixation of intracapsular femoral neck fractures. The observed rate of revision after internal fixation was comparable with previously published outcomes following fixation with cannulated screws and sliding hip screws. Level of Evidence: Level IV, Therapeutic Study.

Development and validity evidence of an interactive 3D model for thoracic and lumbar spinal fractures pedagogy: a first step of validity study.

Thoracic and lumbar spinal fractures are common in trauma care, requiring accurate classification to guide appropriate treatment. While traditional teaching methods use static 2D images, there is a growing need for interactive tools to improve understanding. This study addresses the lack of interactive three-dimensional (3D) models for teaching the AO (Arbeitsgemeinschaft für Osteosynthesefragen) Spine classification for thoracic and lumbar fractures. A free and open-access interactive 3D model of thoracic and lumbar spinal fractures was developed. The study aimed to provide preliminary validity evidence. We hypothesized that this model would be a valid educational tool for teaching the AO Spine classification, receiving high scores from senior spine surgeons on a validation questionnaire regarding anatomical realism and pedagogical value. The primary endpoint was the percentage of surgeons rating the model ≥ 8/10 on the Likert scale for content validation. We hypothesized that the 3D model would be validated by at least 75% of participating senior spine surgeons (rating ≥ 8/10) for anatomical realism and pedagogical value. The 3D model was created using the Blender® software, incorporating CT-scan images of a lumbar spine. AO Spine classification was used to recreate spinal fractures animations. The model could be used on any computer or smartphone, directly online. A total of 24 senior spine surgeons (5 professors, 6 fellows, 8 hospital practitioners, and 5 private practitioners) evaluated the 3D model using a structured questionnaire with seven Likert-scale items, assessing anatomical realism, fracture representation, adherence to the AO Spine classification, pedagogical value, and ease of use. A score of ≥ 8/10 was considered a positive validation. Group comparisons were made based on hospital activity and age. The 3D model was positively validated by 92% of surgeons for anatomical realism, 88% for fracture representation, and 92% for adherence to the AO Spine classification. The model's educational value for junior residents was rated positively by 100% of participants. Six out of 24 surgeons (25%) rated the ease of navigation < 8/10. Group comparisons revealed that university-affiliated surgeons rated the model higher overall (mean score 9.25/10) compared to private practitioners, who gave the lowest ratings (mean score 8.6/10). No significant correlation was found between age and ease of navigation (p = 0.948). The developed 3D model of thoracic and lumbar spine fractures is the first of its kind. It provides an innovative, open-access and freely online accessible tool for teaching the AO Spine classification. The findings demonstrate that it is a valid pedagogical tool for teaching the AO Spine classification, with strong support for its anatomical accuracy and pedagogical effectiveness. This study sets the stage for a future validation study with surgical residents. III.

Abnormality-aware bone fracture detection and classification using the triple context attention model

&lt;span lang="EN-US"&gt;In this study, a novel approach is introduced for fracture detection in bone x-ray images, introducing the triple context attention model (TCAN) that combines concentrated extensive convolutional segments with an attention mechanism to enhance positional data. The TCAN model significantly improves fracture recognition accuracy while reducing model complexity. Leveraging a diverse dataset, consistently achieving high accuracy levels across various body parts. By addressing, mislabelling issues, and employing a visual attention network (VAN), to refine the model's performance. The TCAN model emerges as a robust, computationally efficient solution, offering a remarkable average accuracy of 97.86%. This study contributes valuable advancements to medical imaging and diagnostics, providing a highly effective tool for skeletal fracture detection.&lt;/span&gt;

Bone fracture classification using convolutional neural network architecture for high-accuracy image classification

Bone fracture classification using convolutional neural network architecture for high-accuracy image classification

Is the Orthopaedic Trauma Association-Open Fracture Classification (OTA-OFC) Better than the Gustilo-Anderson Classification at Predicting Fracture-Related Infections in the Tibia?

To investigate and compare the predictive ability of the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) and the Gustilo-Anderson classification systems for fracture-related infections (FRI) in patients with open tibia fractures. Design: Retrospective cohort study. Academic trauma center. Patients aged 16 years or older with an operatively treated open tibia fracture (OTA-OTA 41, 42, and 43) between 2010 and 2021. The primary outcome was FRI. The OTA-OFC and the Gustilo-Anderson classifications were compared in their ability to predict FRI. 890 patients (mean age, 43 years [range, 17 to 96]; 75% male) with 912 open tibia fractures were included. 142 (16%) had an infection. The OTA-OFC was not significantly better at predicting FRI than the Gustilo-Anderson classification (area under the curve, 0.66 vs. 0.66; P = 0.89). The Gustilo-Anderson classification was a stronger predictor of FRI than any single OTA-OFC domain, explaining 72% of FRI variance. Only the addition of the OTA-OFC wound contamination domain to Gustilo-Anderson significantly increased the variance explained (72% vs. 84%, P = 0.04). Embedded contamination increased the risk of FRI by approximately 10% as the risk of FRI with embedded contamination was 16% for Type I or IIs, 26% for Type IIIAs, 45% for Type IIIBs, and 46% for Type IIICs. The more complex OTA-OFC system was not better than the Gustilo-Anderson classification system in predicting FRIs in patients with open tibia fractures. Adding embedded wound contamination to the Gustilo-Anderson classification system significantly improved its prognostic ability. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Removing hardware from anterior approaches following acetabular fractures: a challenging yet indicated procedure.

To describe the indications, outcomes, and incidence of complications after hardware removal from anterior approaches following acetabular fractures. Over ten years, 13 patients were included, complaining of pain due to late infection in nine (69.2%) and secondary osteoarthritis in four (30.8%). Fractures classification were T-type fracture (46.2%), both columns (38.5%), one transverse (7.7%), and one (7.7%) T-type with a posterior wall. The approaches utilized for hardware removal were modified Stoppa in 11 (84.6%) patients, ilioinguinal lateral (iliac) window in nine (69.2%), Pararectus in one (7.7%), ilioinguinal in one (7.7%), and Kocher-Langenbeck approach in one (7.7%)). The patients' mean age was 37.1 ± 14.9 (21 to 65) years, and nine (69.2%) were males. Hardware removal was performed after the index surgery by a mean of 35.6 ± 20 months. The mean operative time was 143.8 ± 36min, and the mean blood loss was 1573 ± 842 CC. The mean hospital stay was 3.2 ± 2.3 days, and all patients required blood transfusion. Four (30.8%) intraoperative complications, two (15.4%) vascular injuries, One (7.7%) urinary bladder injury, and in two (15.4%) broken screws could not be retrieved. Postoperative complications in five (38.5%): three (23.1%) had superficial wound infection, one (7.7%) had DVT, and one (7.7%) had L5 nerve root injury. After a mean follow up of 11.3 ± 4.4 (6 to 20) months, the VAS score decreased from a preoperative median of 6 (2 to 8) to a median score of 1 (0 to 6) at the last follow up. 11 (84.6%) patients described the pain as none or occasional, and eight (61.5%) were very satisfied with the results. Hardware removal from the anterior approaches after acetabular fractures is demanding and carries a high complication risk. The surgeries should be performed when highly indicated, and the surgical team must be familiar with the anterior approaches.

Fracture Line Morphology and a Novel Classification ofPilon Fractures.

Currently, there is no research that includes a comprehensive three-dimensional fracture mapping encompassing all types of Pilon fractures. Moreover, the existing classification systems for Pilon fractures exhibit only moderate to fair consistency and reproducibility. Additionally, some of these classification systems fail to accurately depict the morphological characteristics of the fractures. This study aimed to create a fracture map encompassing all types of Pilon fractures by three-dimensional fracture mapping. In addition, this study conducted a finite element analysis of the normal ankle joint, and based on the distribution of fracture lines and the stress distribution at the distal tibia, proposed a new classification for Pilon fractures. A retrospective analysis of Pilon fractures in our hospital from January 2018 to January 2024 was performed. A total of two hundred forty-four Pilon fractures were included, and their fracture lines were transcribed onto the tibia and fibula templates, and fracture maps and heat maps were created. A nonhomogeneous model of the ankle joint was constructed and verified, and the stress distribution on the distal tibia articular surface was measured and analyzed in three models (neutral, dorsiflexed, and plantarflexed model). Based on the fracture map and stress distribution, a five-column classification system for Pilon fractures was proposed, and the intraobserver and interobserver reliability was calculated using Cohen and Fleiss k statistics. The fracture line on the distal tibia articular surface showed a V-shaped distribution. One branch extended from the junction of the medial malleolar articular surface and the inferior tibial articular surface toward the medial malleolus. The other branch extended from the middle of the fibular notch to the posterior part of the medial ankle, toward the tibial shaft. The fibula fracture line mainly extended from the anterior and lower part of the lateral malleolus to the posterior and upper part. As evidenced by the neutral, dorsiflexed, and plantar flexion models, the stress on the posterolateral articular surface (posterolateral column) was low, while the majority of the stress was concentrated in the center. Three-column fractures were the most common, followed by two-column fractures. Using the five-column classification, the K-weighted values of interobserver and intraobserver analysis were 0.653 (p < 0.001) and 0.708 (p < 0.001), respectively. In this study, the fracture line and morphological characteristics of Pilon fractures were analyzed in detail by three-dimensional mapping. In addition, this study conducted a finite element analysis of the stress distribution on the distal tibial joint surface of the normal ankle joint. Moreover, a novel classification system was proposed to reflect these findings. The new classification not only exhibits greater consistency, facilitating accurate communication of fracture characteristics among surgeons, but also aids in understanding the mechanisms of injury and formulating surgical strategies.

Machine Learning-Based Structural Health Monitoring Technique for Crack Detection and Localisation Using Bluetooth Strain Gauge Sensor Network

Within the domain of Structural Health Monitoring (SHM), conventional approaches generally are complicated, destructive, and time-consuming. It also necessitates an extensive array of sensors to effectively evaluate and monitor the structural integrity. In this research work, we present a novel, non-destructive SHM framework based on machine learning (ML) for the accurate detection and localisation of structural cracks. This approach leverages a minimal number of strain gauge sensors linked via Bluetooth Low Energy (BLE) communication. The framework is validated through empirical data collected from 3D carbon fibre-reinforced composites, including three distinct specimens, ranging from crack-free samples to specimens with up to ten cracks of varying lengths and depths. The methodology integrates an analytical examination of the Shewhart chart, Grubbs’ test (GT), and hierarchical clustering (HC) algorithm, tailored towards the metrics of fracture measurement and classification. Our novel ML framework allows one to replace exhausting laboratory procedures with a modern and quick mechanism for the material, with unprecedented properties that could provide potential applications in the composites industry.

Diffusive-length-scale adjustable phase field fracture model for large/small structures

In phase field fracture (PFF) method, the sharp crack is approximated by a phase field crack zone whose size is characterized by a diffusive length scale. Recently, the diffusive length scale is usually regarded as a constant material parameter determined by the fracture toughness, material strength, and young's modulus. As a result, the application of the PFF method poses challenges when dealing with structures whose sizes are much too large or small compared to the constant diffusive length scale. In details, for a large-scale structure, a significant computational burden is inevitable due to the limitation imposed by the constant diffusive crack length scale on the element size (i.e. the element size is generally at least smaller than half of the diffusive crack length scale to achieve the sufficient precision for the phase field process zone). For a small-scale structure, the crack patterns tend to be unclear and unrealistic due to the excessively large diffusive crack zone. To address these limitations, we propose a novel PFF method to make the relation between the diffusive length scale and the material parameters adjustable via modifying the energetic degradation functions. It is found that with the increase of the diffusive crack length scale, a transition from quasi-brittleness to brittleness is observed in the constitutive relationship curves, which coincides with the classical size effect on structural strength. Further, the Bažant's size effect in classical fracture mechanics can be reproduced by the present PFF method through scaling the size of a geometrically similar structure, i.e. a large-scale structure exhibits toughness-dominated fracture while a small-scale structure behavior strength-dominated fracture. The present PFF method efficiently addresses the mismatch of diffusive length scales for various material constituents by examining phase field crack growth in particle-reinforced composite plates. By adjusting the diffusive crack length scale based on structure size, it avoids high computational costs from large structures and unrealistic crack patterns from small ones. Moreover, it outperforms traditional PFF methods using a constant diffusive length scale in handling composite materials.

Accuracy and reliability of the AO/OTA classification for tibial shaft fractures

BackgroundAvailable literature lacks information regarding the accuracy and reliability of the AO/OTA classification for tibial shaft fractures. This study aimed to assess the inter- and intra-observer agreement and accuracy of the AO/OTA 42 classification (4-signs) for adult patients with tibial shaft fractures. Materials and methodsThe study design is an accuracy, inter- and intra-observer agreement study. Anterior posterior (AP) and lateral X-rays of the fracture were used in the examination. The raters comprised of two junior doctors and two orthopedic trauma consultants, who underwent patient scoring twice in a blinded and randomized set-up. A committee including two consultant orthopedic trauma surgeons, one consultant orthopedic radiologist, and one associate professor was established to represent the “gold standard.” The 3- and 4-signs AO/OTA 42 classification was used for classification. ResultsA total of 101 patients were included. X-rays were available for all 101 patients. Based on the gold standard classification, AO/OTA 42-A1 (56 %) was the most common fracture type, followed by AO/OTA 42-A3 (14 %). The agreement at 4-signs, when comparing the four raters and the gold standard classification was between 75 % and 86 % (Choen's kappa 0.53 to 0.79). Choen's kappa coefficient at 4-sgns for intra-and inter-observer agreement was between 0.47 and 0.74 and 0.31 and 0.60, respectively. ConclusionThis study showed substantial to moderate accuracy of the 4-signs AO/OTA 42- classification for tibial shaft fractures. Intra-observation agreements at 4-signs showed moderate to substantial agreement with and without available CT scans. Inter-observer agreements at 4-signs showed moderate to substantial agreement with only X-rays available. Inter-observer agreements for CT scan at 4-signs showed slight to moderate agreements.

Analysis of the efficacy of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicle fractures with coracoclavicular ligament injuries

ObjectiveTo investigate the efficacy of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicular fractures with coracoclavicular ligament injuries.MethodsA retrospective analysis was performed on 43 patients who sustained distal clavicular fractures along with injuries to the coracoclavicular ligament. These patients were treated between January 2017 and December 2023. The fractures were classified according to the fixation method: high-strength Nice knot suture fixation (experimental group, n = 23) and acromioclavicular Kirschner wire fixation (control group, n = 20). The basic information of the two groups of patients, including age, gender, cause of injury, fracture classification, hospitalization duration, fracture healing time and complications, was collected and analyzed. The increase rate of coracoclavicular space on the affected side was collected and analyzed. The pain level of the affected shoulder was assessed using the visual analog scale (VAS). The shoulder joint function was assessed using the American Shoulder and Elbow Surgeons (ASES) scores and Constant-Murley scores before and after surgery.ResultsNo significant differences were observed in the general demographic data, including age, gender, injury etiology, Craig classification, and hospitalization duration between the two groups (p > 0.05). Both groups were followed for a period ranging from 12 to 33 months, with an average follow-up of 20.53 ± 5.16 months. The bone healing time in the experimental group was significantly shorter than in the control group (12.82 ± 1.12 weeks vs. 17.25 ± 1.71 weeks, p < 0.05). At the final follow-up, The increase rate of coracoclavicular space was (9.25 ± 2.53) % in the experimental group and (8.10 ± 2.53) % in the control group, which was not significantly different (p > 0.05). Both groups demonstrated significant improvements in VAS scores, Constant-Murley scores, and ASES scores post-operatively compared to pre-operative values (p < 0.05). One month after surgery, the Constant-Murley and ASES scores were significantly superior in the experimental group compared to the control group (p < 0.05). However, no statistical difference was observed three months post-surgery or during the final follow-up (p > 0.05). The control group reported one case of infection related to the Kirschner wire and one case of Kirschner wire displacement postoperatively. Conversely, no significant complications were reported in the experimental group.ConclusionIn the management of distal clavicle fractures accompanied by coracoclavicular ligament injuries, particularly oblique fractures or those with butterfly-shaped fragments, the application of a high-strength Nice knot suture in conjunction with Endobutton plate fixation can effectively stabilize the fracture site. This approach not only mitigates complications associated with Kirschner wire fixation but also enhances fracture healing, leading to favorable postoperative outcomes.

Context-Aware Level-Wise Feature Fusion Network with Anomaly Focus for Precise Classification of Incomplete Atypical Femoral Fractures in X-Ray Images

Incomplete Atypical Femoral Fracture (IAFF) is a precursor to Atypical Femoral Fracture (AFF). If untreated, it progresses to a complete fracture, increasing mortality risk. However, due to their small and ambiguous features, IAFFs are often misdiagnosed even by specialists. In this paper, we propose a novel approach for accurately classifying IAFFs in X-ray images across various radiographic views. We design a Dual Context-aware Complementary Extractor (DCCE) to capture both the overall femur characteristics and IAFF details with the surrounding context, minimizing information loss. We also develop a Level-wise Perspective-preserving Fusion Network (LPFN) that preserves the perspective of features while integrating them at different levels to enhance model representation and sensitivity by learning complex correlations and features that are difficult to obtain independently. Additionally, we incorporate the Spatial Anomaly Focus Enhancer (SAFE) to emphasize anomalous regions, preventing the model bias toward normal regions, and reducing False Negatives and missed IAFFs. Experimental results show significant improvements across all evaluation metrics, demonstrating high reliability in terms of accuracy (0.931), F1-score (0.9456), and AUROC (0.9692), proving the model’s potential for application in real medical settings.

Diagnostics and classification of fractures of the thoracic and lumbar spine in adults : Approach depending on the bone structure

The epidemiology, treatment and prognosis of thoracolumbar vertebral fractures are fundamentally influenced by the bone quality of the patient. In individuals with healthy bone structure, ahigh-energy trauma is typically required to cause afracture. In contrast, osteoporosis can cause fractures and also be present as acomorbid pathology in traumatic fractures. Comprehensive diagnostics and a precise classification are essential for appropriate treatment. This narrative review outlines the diagnostic approach and classification of thoracolumbar vertebral fractures depending on the bone quality as the basis of treatment. In addition to aphysical examination, conventional radiographs with the patient in a standing position and computed tomography (CT) scans of the affected region serve as the foundation for fracture classification. Supplementary magnetic resonance imaging (MRI) primarily assesses discoligamentous and neurological structures of the spine as well as the age of the fracture. In suspected cases of osteoporotic fractures, ashort-tau inversion recovery (STIR) sequence of the entire thoracic and lumbar spine is recommended for reliable detection of bone marrow edema. For patients with healthy bone structure, the AOSpine classification is used, whereas the osteoporotic fracture (OF) classification and the OF score are applied in cases of osteoporosis.

Effectiveness of unilateral biportal endoscopy technique combined with percutaneous pedicle screw fixation in treatment of lumbar burst fractures

To compare the effectiveness of unilateral biportal endoscopy (UBE) technique assisted spinal canal decompression combined with percutaneous pedicle screw internal fixation versus traditional open decompression and internal fixation for treatment of lumbar burst fractures. A retrospective study was conducted on the clinical data of 61 patients with single-segment lumbar burst fractures who met the selection criteria and were admitted between October 2022 and December 2023. Of them, 25 patients received UBE technique assisted decompression combined with percutaneous pedicle screw fixation (UBE group), while 36 patients were treated with traditional posterior unilateral hemilaminectomy decompression and internal fixation (open group). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, body mass index, fracture segment, cause of injury, AO classification of lumbar fractures, and preoperative height ratio of the anterior margin of injured vertebra, segmental kyphosis angle, rate of spinal canal invasion, the classification of American Spinal Injury Association (ASIA) grading, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and postoperative complications were recorded and compared between the two groups. VAS score, ODI, and ASIA grading were used to evaluate the effectiveness before operation, at 1 week after operation, and at last follow-up. Lumbar anteroposterior and lateral X-ray films and CT were performed to measure the segmental kyphosis angle, height ratio of the anterior margin of injured vertebra, and the rate of spinal canal invasion. Surgery was successfully completed in both groups. No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. There was no significant difference in operation time between the two groups ( P>0.05), the UBE group revealed significant less intraoperative blood loss when compared with open group ( P<0.05). Patients in both groups were followed up 6-20 months, with an average of 13 months. There was no loosening, breakage, or failure of internal fixation in all patients. The ASIA grading, VAS score, ODI of the two groups significantly improved at 1 week after operation and further improved at last follow-up ( P<0.05). There was no significant difference in ASIA grading at 1 week after operation and last follow-up between the two groups ( P>0.05), but the VAS score and ODI in the UBE group were significantly superior to the open group ( P<0.05). At 1 week after operation, the height ratio of the anterior margin of injured vertebra, segmental kyphosis angle, rate of spinal canal invasion significantly improved when compared to preoperative ones ( P<0.05), the height ratio of the anterior margin of injured vertebra and segmental kyphosis angle significantly decreased at last follow-up when compared to the values at 1 week after operation ( P<0.05), but the rate of spinal canal invasion was further significantly improved, and there was no significant difference between the two groups at different time point postoperatively. UBE technique assisted spinal canal decompression combined with percutaneous pedicle screw fixation is a safe and effective treatment for lumbar burst fractures, which with little trauma and faster recovery when compared with traditional open decompression and internal fixation.

INVOLVEMENT OF REGION OF SPINE AND TYPE OF FRACTURES WITH RESPECTIVE MODE OF TRAUMA

Spinal injuries are complex and often result from traumatic events such as falls, road traffic accidents, and impacts from heavy objects. Proper assessment of the injured spinal region, classification of the injury type, and evaluation of neurological impairment are critical for determining prognosis and guiding management. Objective: This study aims to assess the correlation between spinal regions involved and the mode of trauma, while also comparing the severity and prognosis of spinal injuries using the AO Spine Trauma Classification, Subaxial Cervical Spine Injury Classification (SLICS), Thoracolumbar Injury Classification and Severity Score (TLICS), and American Spinal Injury Association (ASIA) grading systems. Methods: After the ethical approval from the institutional review board, this cross-sectional was conducted at Shaheed Mohtarma Benazir Bhutto Institute of Trauma (SMBBIT), Karachi from 1st June 2022 to 31st December 2023 . Through non-probability consecutive sampling 100 patients aged 15-60 years, both gender, who had a spinal injury due to any sort of trauma (RTA, fall, or impact by an object, etc) were included in the present study. Results: The most common cause of spinal trauma was falls from height, accounting for 59% of cases, followed by road traffic accidents (22%), falls from heavy objects (16%), and assaults (3%) (Table 1). Lumbar spine fractures were the most prevalent, occurring in 41% of participants, followed by thoracic fractures (34%) and cervical fractures (25%). In terms of fracture classification, the AO-spine system identified 51% of subaxial cervical spine fractures as Type A, while thoracolumbar spine fractures were predominantly Type B (58%).SLICS classification revealed that 70% of fractures were compressions, and 51% of patients had nerve root injurie. The ASIA scale revealed 12% of patients had complete motor and sensory loss (Grade A), while 30% retained normal function (Grade E). Conclusion: This study supports the earlier works where spinal injuries are complex trauma and require more elaborate assessment and classification systems for patient management.

HOW DOES VERTICAL LAMINAR FRACTURE IMPACT THE DECISION-MAKING IN THORACOLUMBAR FRACTURES?

Objective Although vertical laminar fracture (VLF) is generally considered a severity marker for thoracolumbar fractures (TLFs), its exact role in decision-making has never been established. This scoping review aims to synthesize the research on VLF’s role in TLF decision-making. Methods A systematic review was conducted following PRISMA guidelines. We searched PubMed, Scopus, and Web of Science from inception to 11 June 2023 for studies examining the association of VLF in thoracolumbar fractures with dural lacerations, neurological deficits, radiographic parameters, or treatment outcomes. Additionally, experimental studies that analyze the biomechanics of burst fractures with VLF were included. The studies extracted key findings, objectives, and patient population. A meta-analysis was performed for the association of VLF with dural laceration and neurological deficit, and ORs were pooled with a 95% confidence interval (CI). Results Twenty-eight studies were included in this systematic review, encompassing 2,021 patients, and twelve were included in the meta-analysis. According to the main subject of the study, the association of VLF with a dural laceration (n=14), neurological deficit (n=4), radiographic parameters (n=3), thoracolumbar fracture classification (n=2), treatment outcome (n=2). Seven studies with a total of 1010 patients reported a significant association between VLF and neurological deficit (OR= 7.35, 95% CI [3.97, 14.25]; P&lt; 0.001). The pooled OR estimates for VLF predicting dural lacerations was 7.75, 95% CI [2.41, 24.87]; P&lt; 0.001). Conclusion VLF may have several important diagnostic and therapeutic implications in managing TLFs. VLF may help to distinguish AO type A3 from A4 fractures. VLF may help to predict preoperatively the occurrence of dural laceration, thereby choosing the optimal surgical strategy. Clinical and biomechanical data suggest VLF may be a valuable modifier to guide the decision-making in burst fractures; however, more studies are needed to confirm its prognostic importance regarding treatment outcomes.

Case series study and finite element analysis of a new cervicothoracic fixation device

ObjectiveTo introduce a specialized device designed for the fixation of the cervical-thoracic spine and describe its surgical installation, finite element analysis, and clinical outcomes.MethodsA finite element model of the C6-T1 segment was developed and validated, and simulations of subtotal resection of anterior cervical vertebrae, artificial vertebrae placement, and titanium plate fixation were performed. The model was subjected to a 75 N load to simulate the weight of the head and a 1 N·m force to simulate flexion, lateral bending, and axial rotation. The analysis focused on range of motion, total stress, stress in the artificial vertebrae, and stress in the device. The clinical outcomes were evaluated in a retrospective case series of 140 patients with cervical spine fractures.ResultsUnder the same loading conditions, the maximum stresses on specialized anatomical and biomechanical devices for the fixation of the cervicothoracic segment of the spine during neutral, forwards flexion, backwards extension, left lateral bending, right lateral bending, left rotation, right rotation and other working conditions were 25.097 MPa, 149.480 MPa, 64.150 MPa, 67.804 MPa, 72.754 MPa, and 117.98 MPa, respectively. And, the maximum ROMs were 2.230 mm, 5.585 mm, 4.682 mm, 3.184 mm, 3.061 mm, 4.451 mm, and 4.645 mm. Compared with those in the preoperative period, the patients’ CL, OPCL, UCL, LCL, UROM, LROM, VAS score, NDI score, JOA score, intervertebral space height at the injured segment, cervical anterior kyphosis angle, Cobb angle, vertebral displacement, ASIA grade, fracture classification, and vertebral displacement improved (P < 0.05). Sixty-two patients had dysphagia, and 3 patients experienced leakage of cerebrospinal fluid.ConclusionThe design of the new cervicothoracic internal fixation device conforms to the anatomical structure of the cervicothoracic spine, which can provide immediate stability, better screw placement and adequate bone grafting, and reduce the risk of complications. Despite some disadvantages, it is a good device for segmental fixation of the cervical and thoracic spine.

Reliability of distal radius fracture classification systems: a CT based study.

To assess the reliability and reproducibility of AO/OTA, Frykman and Fernandez classification systems for distal radius fractures on CT. Four radiologists, including one radiology resident, two musculoskeletal radiology fellows and one radiology consultant independently evaluated CT scans of 115 patients with distal radius fractures and classified the fractures according to AO/OTA, Frykman and Fernandez classification system. To assess reproducibility, a second set of reading was done by two observers after an interval of six weeks. Interobserver reliability was calculated for each classification system using intraclass correlation coefficient (ICC) and using Light's modification of kappa. Intraobserver agreement was calculated using Cohen's kappa. Interobserver reliability using ICC showed fair agreement for AO/OTA (0.447) and Frykman (0.432) classification system and poor agreement for Fernandez (0.196) classification system. Interobserver agreement using kappa was moderate for AO/OTA fracture (0.447) classification into either of three types, while it was only slight for complete classification into type, group and subgroup (0.177). Interobserver agreement using kappa was slight for Fernandez (0.196) classification systems and moderate for Frykman classification system (0.406). Intraobserver agreement for AO/OTA classification system was moderate for observer 1 (0.449) and slight for observer 2 (0.162). Intraobserver agreement for Frykman classification system was substantial for observer 1(0.754) and moderate for observer 2 (0.496). Intraobserver agreement for Fernandez classification system was moderate for both the observers (0.333, 0.320). Currently there is no classification system that is fully reproducible. AO/OTA and Frykman classification systems performed better than Fernandez classification system in terms of interobserver reliability. However, Frykman classification system performed better than both AO/OTA and Fernandez classification system in terms of intraobserver reproducibility. Fernandez classification system had worst inter and intraobserver reliability in present study. Reliability and reproducibility of AO/OTA classification system decreased when fractures were divided into subgroups.

To Manipulate or Not? Management of Pediatric Knee Arthrofibrosis Following Operative Fixation of Tibial Spine Fractures

ObjectivesKnee arthrofibrosis is a common complication after surgical fixation of tibial spine fractures. However, there is no standardized treatment modality for resultant arthrofibrosis, with some surgeons electing for non-operative management, while others prefer manipulation under anesthesia with a possible arthroscopic lysis of adhesions, if indicated. To better understand indications and outcomes from these treatment modalities for arthrofibrosis, we examined patients treated by both approaches. MethodsWe performed a multicenter retrospective case series of patients with arthrofibrosis after tibial spine fracture surgery. Arthrofibrosis was defined as loss of knee extension ≥ 10.0° and/or knee flexion ≥ 25.0° compared to the contralateral, uninjured knee at three months following index surgery. Patients were organized into two cohorts: non-operative and operative treatment. Data was collected for demographics, fracture classification, concomitant injuries, treatment timeline, and knee range of motion. ResultsThere were 16 patients in the operative group and 10 patients in the non-operative group. At the time of diagnosis, the operative group had a mean 10° larger flexion deficit compared to the non-operative group. Both treatment modalities resulted in similar ranges of motion at terminal evaluation. Final flexion was recorded as 130° in the operative group and 127° in the non-operative group. Final extension deficits were 3° in both cohorts. ConclusionsOperative and non-operative treatment modalities can be effective in management of knee arthrofibrosis after fixation of tibial spine fractures. Non-operative treatment may be more suitable for milder range of motion deficits, but further research is necessary to guide clinical practice. Level of EvidenceLevel IV, Case Series;