Common Fracture Type Research Articles

A biocultural study of nasal fracture, violence, and gender using 19th–20th century skeletal remains from Portugal

AbstractNasal fracture is usually described as the most common type of fracture of the facial bones, either alone or associated with other fractures. This work aims to study the nasal fracture among Portuguese individuals from the 19th and 20th centuries. The focus is on patterning in trauma in relation to gender and in the attempt to distinguish violent from accidental injury. The sample comprises 2023 (52.6% males, 47.4% females) individuals from three Portuguese identified skeletal collections who were born between 1804 and 1951 and died between 1895 and 1969. Age at death ranges between 1 and 109 years old. Nasal and other facial fractures were studied, and violent versus accidental trauma were distinguished following Magalhães et al. (2020). Nasal fracture was more frequent in males (10.4%, 101/969) than in females (5.9%, 47/800). This was true both for fracture inferred due to violence (laterally deviated fracture) and due to accident. Sixty‐one point five percent (91/148) of the individuals show a lateral impact force deviation. Comminutions correspond to 18.4% (26/141) of the total, and 12.8% (19/148) have other facial fractures. There is no association between nasal fracture and risk of death for both sexes, but the males seem to show a higher tendency for nasal fracture earlier in life than the females. The differences of nasal fracture between sexes are in accordance with the historical data showing that men had more social and cultural opportunities to engage in violent encounters. Although the percentage in women is lower, the majority of laterally deviated noses and isolated, non‐comminuted nasal fractures in both sexes show that interpersonal violence may have played an important role in the results.

MRI Evaluation in Acute Spinal Trauma in Tertiary Center of Nepal

IntroductionSpine injury is one of the leading caused for disability in Nepal. Patients with trauma relatedspine injury leads to neurological dysfunction, focal deficits and even fatal life threating events.The timely intervention in acute spinal trauma injury could save the patients from disability andmortality risk. Imaging modalities like Xray, CT Scan and MRI helps in diagnosis and managementof spinal trauma. MRI plays crucial role in detection of spinal cord and soft tissue injuries. It issuperior than CT scan in evaluation of spinal cord injuries, ligament, soft issue structures, disc,and occult osseous injuries. The objective of this research is to evaluate MRI in acute spinal traumain tertiary center of Nepal. MethodsThis is descriptive hospital based observational study in those patients who were admitted andreferred in hospital for MRI with acute spinal trauma injury. Data were analysed by SPSS 2022. ResultsAcute spinal trauma is most common in male with ratio of 1.7 with the mean±SD of age was foundto be 50.98±19.26 years. Most common mode of injury were fall injury (76%). Most common spinalregion involved were lumbar (42%) followed by thoracic (36%), dorso-lumbar (14%) and cervical(8%) region respectively. Spinal cord contusion with edema, disc rupture, paravertebral collectionand ligament injury were seen. Most common type of fractures were simple compression fracture(72%), followed by burst fracture (16%), both (6%) and listhesis and sub/dislocations (6%). Spinalcord injury were seen in 22%, followed by disc rupture, paravertebral collection and ligamentinjury. ConclusionsMRI helps in evaluating vertebrae, spinal cord, ligament and disc injuries. We can assess the cordcontusion, edema and canal compression. It provides involvement, extension and severity of cordinjury. It endowed about outcome of surgery as well as conservative management in patient ofspinal injury.

THE OUTCOME OF THREE LATERAL DIVERGENT PINNING VS PARALLEL PIN FIXATIONS FOR THE TREATMENT OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN.

Supracondylar humerus fracture is the most common type of elbow fracture in children younger than 15 years. This hospital based prospective study evaluated different pinning xations which is used in the treatment of Gartland Type II and Gartland Type III supracondylar humeral fractures in children with closed fractures ≤7 days old, extension type, for comparing clinical, radiological and functional outcome of lateral parallel and divergent pinning for displaced supracondylar fractures in children.The study was conducted from May 2021 to May 2022. The mean age was 8.2 years for Divergent pinning group and for Parallel pinning group, the mean age was 9.2 years. Functional outcome were measured using Flynn's criteria & radiological outcome measured using Baumanns angle & carrying angle. Divergent pinning group had 12 males and 7 females while Parallel pinning group had 15 males and 5 females. The time interval between injury and surgery was less than 12 hours in 84.21% of Divergent pinning group & 95% in Parallel pinning group. In our study the duration of surgery was less than 35 minutes in 68.5% in Divergent pinning group and 85% in Parallel pinning group. Patients were followed up clinicoradiologically at 3 weeks, 6 weeks, 3 months & 6 months post operatively & assessed for elbow function, carrying angle, rate of union etc., during each follow up. In our study divergent pinning gave better results than parallel pinning as the latter encountered slower rate of union and varus deformities (loss of carrying angle and baumanns angle).

Automatic classification of distal radius fracture using a two-stage ensemble deep learning framework

Distal radius fractures (DRFs) are one of the most common types of wrist fracture and can be subdivided into intra- and extra-articular fractures. Compared with extra-articular DRFs which spare the joint surface, intra-articular DRFs extend to the articular surface and can be more difficult to treat. Identification of articular involvement can provide valuable information about the characteristics of fracture patterns. In this study, a two-stage ensemble deep learning framework was proposed to differentiate intra- and extra-articular DRFs automatically on posteroanterior (PA) view wrist X-rays. The framework firstly detects the distal radius region of interest (ROI) using an ensemble model of YOLOv5 networks, which imitates the clinicians’ search pattern of zooming in on relevant regions to assess abnormalities. Secondly, an ensemble model of EfficientNet-B3 networks classifies the fractures in the detected ROIs into intra- and extra-articular. The framework achieved an area under the receiver operating characteristic curve of 0.82, an accuracy of 0.81, a true positive rate of 0.83 and a false positive rate of 0.27 (specificity of 0.73) for differentiating intra- from extra-articular DRFs. This study has demonstrated the potential in automatic DRF characterization using deep learning on clinically acquired wrist radiographs and can serve as a baseline for further research in incorporating multi-view information for fracture classification.

IMPLEMENTATION OF AN ANKLE FRACTURE FIXATION PATHWAY TO REDUCE HOSPITAL BED OCCUPANCY

Ankle fractures are among the most common types of fractures. If surgery is not performed within 12 to 24 hours, ankle swelling is likely to develop and delay the operative fixation. This leads to patients staying longer in the ward waiting and increased hospital occupancy. This prolonged stay has significant financial implication as well as it is frustrating for both patients and health care professionals.The aim was to formulate a pathway for the ankle fracture patients coming to the emergency department, outpatients and planned for operative intervention. To identify whether pre-operative hospital admissions of stable ankle fracture patients are reduced with the implementation of the pathway. We formulated an ankle fracture fixation pathway, which was approved for use in December 2020. A retrospective analysis of 6 months hospital admissions of ankle fracture patients in the period between January to June 2020. The duration from admission to the actual surgery was collected to review if some admissions could have been avoided and patients brought directly on the surgery day.A total of 23 patients were included. Mean age was 60.5 years and SD was 17years. 94% of patients were females. 10 patients were appropriately discharged.7 Patients were appropriately admitted. 6 Patients were unnecessarily admitted. These 6 patients were admitted on presentation to ED. Retrospective analysis of this audit showed that this cohort of patients met the safe discharge criteria and could have been discharged. Duration of unnecessary stay ranged from 1 to 11 days (21 days in total). Total saving could have been £6300.Standards were met in 74% of cases. Preoperative hospital admission could be reduced with the proposed pathway. It is a valuable tool to be used and should be implemented to reduce unnecessary hospital admissions.

Postoperative Outcomes in Malleolar Fractures Fixed With a 3.5-mm Locking Compression Plate Hook Plate.

Ankle fractures are among the most common types of fractures seen in the United States. Few studies have analyzed the use of a locking compression plate (LCP) hook plate in the fixation of malleolar fractures. The goal of this study was to analyze postoperative outcomes in malleolar fractures fixed with a 3.5-mm LCP hook plate. A cohort of 74 patients with ankle fractures treated operatively with hook plates between 2011 and 2021 by a single orthopedic surgeon was retrospectively reviewed. Time to union, duration of non-weight bearing, final range of motion, postoperative complications, demographics, and comorbidities were recorded. A total of 66 patients fulfilled our inclusion criteria. There were 5 isolated medial malleolar, 34 bimalleolar, and 27 trimalleolar fractures. There were 46 women and 20 men with a mean age of 60.9±18.9 years. Fourteen patients had diabetes, 27 had osteoporosis, and 4 were current or former tobacco users. All patients achieved union, with a mean time to union of 10.9±5.3 weeks. The mean time to weight bearing was 50.2±18.4 days. The mean length of follow-up was 8.1±5.6 months. At final follow-up, mean dorsiflexion was 9.9°±4.3° and mean plantarflexion was 14.1°±5.1°. Six patients experienced postoperative complications such as surgical site infections and posttraumatic osteoarthritis. This study demonstrates that the use of a 3.5-mm LCP hook plate in the operative fixation of malleolar fractures has a high rate of union while maintaining low rates of postoperative complications. [Orthopedics. 2023;46(6):340-344.].

Maxillofacial Fracture Types and Their Management in 3-to 18-year-old Individuals Referred to Shariati Hospital, Tehran, Iran.

Objectives: This study was performed to find the most common types of maxillofacial fractures and their management in 3 to 18-year-old individuals referred to the Department of Oral and Maxillofacial Surgery at Shariati Hospital in Tehran, during a 9-year period. Materials and Methods: This retrospective study evaluated the records of 319 patients with maxillofacial fractures between 2012-2020, ranging in age from 3 to 18 years. Data regarding the etiology and location of the fracture, age, gender, and treatment approach were retrieved from the archival records and analyzed. Results: A total of 319 patients were included in the study, out of which, 255 (79.9%) were males and 64 (20.1%) were females. Motor-vehicle accidents were the most common cause of trauma (N=124, 38.9%). We recorded 605 fractures and among them, the parasymphysis (N=131, 21.6%) was the most common site of isolated fractures. Type of treatment varied depending on the fracture type and degree of displacement of the broken segments. It consisted of open reduction and internal fixation, and closed reduction procedures, which included the use of arch bars, ivy loops, lingual splints, and circummandibular wirings. Conclusion: Analysis of the results revealed that the severity of injury increased with age. Older individuals had higher a number of fracture sites and experienced greater displacement of the broken segments.

BIOMECHANICAL INVESTIGATION OF FRACTURE LOADS AND PATTERNS OF THE ODONTOID PROCESS

Odontoid fracture of the second cervical vertebra (C2) is the most common spinal fracture type in elderly patients. However, very little is known about the biomechanical fracture mechanisms, but could play a role in fracture prevention and treatment. This study aimed to investigate the biomechanical competence and fracture characteristics of the odontoid process.A total of 42 human C2 specimens (14 female and 28 male, 71.5 ± 6.5 years) were scanned via quantitative computed tomography, divided in 6 groups (n = 7) and subjected to combined quasi-static loading at a rate of 0.1 mm/s until fracturing at inclinations of −15°, 0° and 15° in sagittal plane, and −50° and 0° in transverse plane. Bone mineral density (BMD), specimen height, fusion state of the ossification centers, stiffness, yield load, ultimate load, and fracture type according to Anderson and d'Alonzo were assessed.While the lowest values for stiffness, yield, and ultimate load were observed at load inclination of 15° in sagittal plane, no statistically significant differences could be observed among the six groups (p = 0.235, p = 0.646, and p = 0.505, respectively). Evaluating specimens with only clearly distinguishable fusion of the ossification centers (n = 26) reveled even less differences among the groups for all mechanical parameters. BMD was positively correlated with yield load (R² = 0.350, p < 0.001), and ultimate load (R² = 0.955, p < 0.001), but not with stiffness (p = 0.070). Type III was the most common fracture type (23.5%).These biomechanical outcomes indicate that load direction plays a subordinate role in traumatic fractures of the odontoid process in contrast to BMD which is a strong determinant of stiffness and strength. Thus, odontoid fractures appear to result from an interaction between load magnitude and bone quality.

Analysis of the clinical characteristics of adult patients with hangman's fractures: A retrospective study based on multicenter clinical data.

There are few reports on the clinical characteristics of adult patients with hangman's fractures. The clinical data of adult patients were collected from the hangman's fracture database of 7 medical centers. Data on patients who met the inclusion and exclusion criteria were retrospectively analyzed. Data, including gender, age, mechanism of injury, fracture classification, and treatment, were statistically analyzed. A total of 216 eligible patients (160 males and 56 females, with a mean age of 49.7 years) were selected. There was no statistically significant difference in gender distribution of different age groups. The male-to-female ratio was similar in the young group (18-44 years) and the middle-aged group (45-64 years) (both about 3:1) but decreased in the elderly group (65 years and above) (about 2:1). Overall, high-energy injury was the main mechanism of injury. There was a statistically significant difference in the percentage of patients with high-energy injury in various age groups (the highest in the young group, and the lowest in the elderly group). Overall, unstable fracture was the main fracture type, with a higher proportion in the young and elderly groups than that in the middle-aged group, but there was no statistically significant difference. From the perspective of treatment options, the percentage of patients receiving surgery was higher in the young and elderly groups than that in the middle-aged group. Hangman's fracture is predominant in males of all age groups, with high-energy injury as the main mechanism of injury. Unstable fracture is common fracture type. The percentage of patients receiving surgery in the young and elderly groups is higher than that in the middle-aged group, which may be correlated with the high incidence of unstable fracture and the life characteristics of the patients in the young and elderly age groups.

Management of Post-Traumatic Sternal Fractures in a West African Country: the Case of Niger

Introduction: Traumatic fractures of the sternum are relatively rare injuries and occur against the backdrop of high-energy chest trauma. The severity of these lesions is mainly related to their association with life-threatening cardiovascular lesions. Their treatment is mostly conservative. The aim of this work is to report the results of the management of post-traumatic fractures of the sternum in Niger. Patients and methods: a 27-month retrospective study involving 9 patients with a post-traumatic fracture of the sternum treated at the thoracic surgery department of the General Reference Hospital of Niamey. 8 of these patients were treated with conservative methods and 1 benefited from osteosynthesis by a screwed ankle plate adapted to the sternum. Results: The mean age of patients was 41.78 years (14 to 60 years). The male sex was predominant with 7 cases or 77.77%. Public road traffic is the most common occurrence circumstance found in 88.9% of cases. Symptomatology was dominated by presternal chest pain. The site of the fracture was at the level of the manubrium in 66.6% of cases and the most common type of fracture was the simple fracture in 55,56 of cases. Pulmonary contusion and hemothorax were the most associated lesions with respectively 44.4% each. There was 1 case of death in the context of polytrauma. Conclusion: Post-traumatic fractures of the sternum are rare and potentially serious, requiring multidisciplinary management.

Outcome of treatment of Unstable Intertrochanteric Fracture by Proximal Femoral Nail (PFN)

Background: Proximal Femoral Nail (PFN) is a surgical technique used to treat unstable intertrochanteric fractures, which are fractures that occur in the upper portion of the thigh bone (femur). The procedure involves using a nail-like device that is inserted into the femur and secured in place with screws to stabilize the fracture and promote healing. It is a commonly used treatment option for this type of fracture and can lead to good outcomes in most cases. The aim of the study was to observe the outcome of Unstable Intertrochanteric fracture by Proximal Femoral Nail (PFN). Material Methods: This prospective observational study was conducted at the Department of Orthopedics, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh. The study duration was 2 years, from July 2017 to June 2019. A total of 34 cases were included in the study sing purposive sampling (non-randomized) according to availability of the patients and considering inclusion and exclusion criteria. Results: The participants’ age range was 16-90, with a mean of 56.91 ± 17.76. Most (35.29%) were 61-75 years old. 61.76% were female and 38.24% were male. 50% were housewives, 14.71% ex-service holders, 14.71% service holders, 11.76% businessmen, 5.88% students, and 2.94% farmers. The leading cause of injury was falls on slippery ground (55.88%), followed by motor vehicle injuries (44.12%). 70.59% of injuries occurred on the right side and 29.41% on the left. 76% had Kyle Type III fractures, 24% had type IV. 85.29% had open reduction, 14.71% had closed reduction. The mean duration of injury to operation was 15.59 days and the mean hospital stay was 19.15 days. 70.59% had no complications and 55.88% reported no pain at last follow-up. 58.82% had a good Harris hip score and 58.82% had excellent outcomes by final follow-up. Conclusion: The majority of patients in this study were in the 61-75 age range and female, with the most common cause of injury being falls on slippery ground. The most common fracture type was Kyle type IV, with a major portion of cases requiring open reduction. The rate of complications was relatively low, and the functional outcomes were acceptable and comparable to other studies. The duration of injury to operation and hospital stay were slightly longer than other studies, likely due to the busy nature of the study location. Overall, the Proximal Femoral Nail is a safe and effective treatment option for unstable proximal femoral fractures.

The surgical treatment of proximal humerus fractures 2010-2019: United States national case volume and incidence trends

Proximal humerus fractures are the third most common fracture type for patients between the ages of 65 and 89 and occur more frequently in women than men. Given the variety of surgical treatments for proximal humerus fractures, the aim of this study was to (1) report United States national volume and incidence estimates for surgical management of proximal humerus fractures to better understand the changing practice over the past decade and (2) to analyze differences in volume and incidence among age groups, sex, and geographic region. Using IBM Marketscan national database, all patients that underwent open reduction internal fixation (ORIF), hemiarthroplasty, or reverse total shoulder arthroplasty (RTSA) between 2010 and 2019 were identified with Current Procedural Terminology codes. The dataset was further stratified to identify patients treated for proximal humerus fractures. IBM Marketscan provided discharge weights that were used to determine estimated national annual volumes of each procedure in IBM SPSS Statistics software (IBM Corp., Armonk, NY, USA). Volume and incidence were adjusted per 1,000,000 persons and calculated for subgroups according to age group, sex, and geographical region. The United States Census Bureau annual population data was used for all incidence calculations. Over the past decade, the total volume and incidence of surgically treated proximal humerus fractures increased by 13% and 5%, respectively. Although overall incidence decreased, ORIF remained the most common surgical treatment. The greatest decrease in volume and incidence of ORIF occurred in patients ≥75. The incidence of ORIF treatment increased in the South and West while it decreased in the Northeast and Midwest. Total volume and incidence of HA decreased between 2010 and 2019 and this trend remained among all subgroups. Total volume and incidence of RTSA increased by over 300%. The incidence of males and females receiving RTSA increased by 266% and 320%, respectively. Volume and incidence of RTSA increased across all age groups. Volume and incidence of RTSA increased in the Midwest, South, and Western regions while it remained unchanged in the Northeast. Surgical management trends of proximal humerus fractures have changed greatly over the past decade. ORIF remains the most common surgical treatment for proximal humerus fractures. HA has fallen out of favor while RTSA has seen significant increases in usage across sex, age groups, and geographic regions. These trends represent a change in practice for treating proximal humerus fractures by considering all patient and fracture characteristics when opting for surgical management.

Association of Hip Fracture With the Use of Walking Assistance Devices Post-surgery: A Retrospective Study Comparing Intertrochanteric and Subtrochanteric Hip Fractures.

Background Hip fractures, including intertrochanteric and subtrochanteric fractures, are among the most common types of fractures. The dynamic hip screw (DHS) and the cephalomedullary hip nail (CHN) are the two main techniques used for the fixation of these types of fractures. This study aims to explore the association of the fracture type with the use of walking assistance devices post-surgery, regardless of the fixation technique. Methodology This study is a retrospective study based on the review of de-identified patient data from the American College of Surgeons National Surgical Quality Improvement Program database. Patients aged 65 years old or above who underwent fixation procedures for intertrochanteric or subtrochanteric fractures using CHN or DHS techniques were included in this study. Results A total of 8,881 patients were included and divided into the following two groups: 876 (9.9%) patients treated for subtrochanteric fracture, and 8,005 (90.1%) patients treated for intertrochanteric fracture. No statistical significance was detected in the use of mobility aid postoperatively between the two groups. When compared to CHN, DHS was noted to be the most employed fixation technique among patients with intertrochanteric fractures. One main finding was that patients who underwent surgery using DHS for intertrochanteric fractures were more likely to use walking assistance devices postoperatively compared to those with subtrochanteric fractures treated with the same fixation technique. Conclusions Findings suggest that the use of walking assistance devices post-surgery is independent of the type of fracture and potentially dependent on the fixation technique employed. Future studies focused on the difference in the use of walking assistance devices based on fixation techniques for patients with distinctive sub-types of trochanteric fractures are highly encouraged.

Patterns and Characteristics of Midface Fractures in North-Eastern Romania

Midface fractures are common injuries that are the result of interpersonal violence, traffic accidents, falls, work-related accidents, sports-related accidents, or animal aggression. In the northeastern part of Romania, these injuries are a significant health concern that, if left untreated, may lead to functional and esthetic sequelae. Background and Objectives: This study aims to update the statistical data available to help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence. Materials and Methods: This research was conducted over five years and included 651 patients of both sexes, with ages between 3 and 95 years, that addressed our center for midface fracture treatment. Results: The authors of this study found that men are more predisposed to fractures of the middle third of the face, with anterior laterofacial fractures being the most common type of fracture. Interpersonal violence was the most incriminated etiology for all midface fractures. Conclusions: The present study regarding midfacial fractures shows similar results compared to the medical literature. These findings could help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence.

Two-Dimensional Post-Traumatic Measurements of Orbital Floor Blowout Fractures Underestimate Defect Sizes Compared to Three-Dimensional Approaches

Orbital floor fractures represent a common fracture type of the midface and are standardly diagnosed clinically as well as radiologically using linear measurement methods. The aim of this study was to evaluate the accuracy of diagnostic measurements of isolated orbital floor fractures based on two-dimensional (2D) and three-dimensional (3D) measurement techniques. A cohort of 177 patients was retrospectively and multi-centrically evaluated after surgical treatment of an orbital floor fracture between 2010 and 2020. In addition to 2D and 3D measurements of the fracture area, further fracture-related parameters were investigated. Calculated fracture areas using the 2D measurement technique revealed an average area of 287.59 mm2, whereas the 3D measurement showed fracture areas with a significantly larger average value of 374.16 mm2 (p < 0.001). On average, the 3D measurements were 1.53-fold larger compared to the 2D measurements. This was observed in 145 patients, whereas only 32 patients showed smaller values in the 3D-based approach. However, the process duration of the 3D measurement took approximately twice as long as the 2D-based procedure. Nonetheless, 3D-based measurement of orbital floor defects provides a more accurate estimation of the fracture area than the 2D-based procedure and can be helpful in determining the indication and planning the surgical procedure.

A Prospective Study on Functional Outcome of Surgical Management of Bimalleolar Fractures of the Ankle

Background: Ankle joint is hinged synovial joint. Ankle is a close fitting hinge-like joint of which two parts interlock like mortise (the box formed by the distal end of Tibia and Fibula) and the tenon (upward projecting Talus). Ankle fractures are very common. The various surgical modalities include fixation with cancellous lag screws, malleolar screw, tension band wiring, semi-tubular plating, fixation with rush pin. These operative methods restore the anatomy and contact loading characteristic of the ankle including easier rehabilitation, early mobilization and earlier weight bearing. Aims: To evaluate the functional outcome of surgical management of the bimalleolar fractures of ankle. Material and Methods: Present study was prospective study, carried out among patients with bimalleolar fractutes of the ankle coming to Orthopaedic department of Tertiary health care centre for duration of November 2020-22. Data analysis: Following the above procedure, the findings were recorded in the proforma. These findings were entered in Microsoft Excel 2010. The results were compiled by using suitable tables and graphs wherever necessary. The variations were analysed as a percentage of the total and reported. Data analysis was done with the help of openepi software version 2.3.1. Results: The mean age of the patients was 39.86 ± 10.67 years. Majority of the patients 24 (80%) included in the study were male. Almost 15 (50 %) patients had pain score of 1 and 9(30%) patients had zero score. On range of movement 93.3% had zero score and 6.7% had score 2. On final objective scoring majority 73.3% had good, 20% had fair and 6.7%had poor outcome. Conclusion: Supination-external rotation injury is the most common type of bimalleolar ankle fracture and also common type associated with dislocations and complications. Good functional outcome was achieved by restoring sufficient stability and providing good mobility at the ankle joint. Anatomical reduction of the fracture is associated

Intraoperative Periprosthetic Fractures during primary Total knee arthroplasty: Experience from an Asian high-volume arthroplasty centre

BackgroundIntraoperative periprosthetic fracture (IF) is an under-reported complication in primary total knee arthroplasty (TKA). This study aimed to audit the outcomes and complication rates in patients encountering IF during primary TKA and propose a new classification for its management. MethodsA nested case–control study was performed at a tertiary referral hospital where 50 patients encountering IF during primary TKA operated by a single surgeon team between January 2016 to May 2021, were compared with 150 (3:1) age-, gender- and implant-matched patients not encountering IF. Demographic data, risk factors, outcomes and complications of both groups were compared at a minimum follow up of 1 year. ResultsThe incidence of IF was 0.45%, with 44 fractures in the femur (88%), six (12%) in the tibia and none in the patella. Medial collateral ligament avulsion fracture (54.54%) in the femur and medial plateau fracture (66.66%) in the tibia were the most common fracture types. At final follow up, the fracture group had higher rates of 90-day re-admissions (8% vs. 2.66%, P = 0.095), deep infection (4% vs. 0.66%, P = 0.15) and revisions (6% vs. 1.33%, P = 0.06). The mean Knee Society Score was not significantly different between the two groups (152.22 ± 9.25 vs. 161.68 ± 11.22, P = 0.642) with union being achieved in all but one patient at a mean duration of 9.6 weeks. ConclusionsPatients with severe and fixed deformities have a higher risk for IF. The occurrence of fracture and the complexity of surgery equally contribute to the higher complication rates. Appropriately managed fractures have comparable functional outcomes.

Blood-Transfusion Risk Factors after Intramedullary Nailing for Extracapsular Femoral Neck Fracture in Elderly Patients

Extracapsular femoral neck fractures (eFNF) are the third most common type of fracture in traumatology. Intramedullary nailing (IMN) is one of the most frequently used ortho-pedic treatments for eFNF. Blood loss is one of the main complications of this treatment. This study aimed to identify and evaluate the perioperative risk factors that lead to blood transfusion in frail patients with eFNF who undergo IMN. From July 2020 to December 2020, 170 eFNF-affected patients who were treated with IMN were enrolled and divided into two groups according to blood transfusion: NBT (71 patients who did not need a blood transfusion), and BT (72 patients who needed blood transfusion). Gender, age, BMI, pre-operative hemoglobin levels, in-ternational normalized ratio (INR) level, number of blood units transfused, length of hospital stay, surgery duration, type of anesthesia, pre-operative ASA score, Charlson Comorbidity Index, and mortality rate were assessed. Cohorts differed only for pre-operatively Hb and surgery time (p < 0.05). Patients who have a lower preoperative Hb level and longer surgery time have a high blood-transfusion risk and should be closely followed peri-operatively.

Evaluation of cannulated compression headless screws as an alternative implant for superior pubic ramus fracture fixation: a biomechanical study

Background/purposePubic ramus fractures account for the most common types of pelvic fractures. The standard surgical approach for superior pubic ramus fractures (SPRF) is a minimally invasive percutaneous screw fixation. However, percutaneous closed reduction and internal fixation of anterior pelvic ring injuries have high failure rates of up to 15%. The aim of this biomechanical study was to evaluate the stability of SPRF following stabilization with retrograde placed cannulated compression headless screw (CCHS) versus conventional fully and partially threaded screws in an artificial pelvic bone model.MethodsSPRF type II as described by Nakatani et al. was created by means of osteotomies in eighteen anatomical composite hemi-pelvises. Specimens were stratified into three groups of six specimens each (n = 6) for fixation with either a 7.3 mm partially threaded cannulated screw (group RST), a 7.3 mm fully threaded cannulated screw (group RSV), or a 7.5 mm partially threaded cannulated CCHS (group CCS). Each hemi-pelvic specimen was tested in an inverted upright standing position under progressively increasing cyclic axial loading. The peak load, starting at 200 N, was monotonically increased at a rate of 0.1 N/cycle until 10 mm actuator displacement.ResultsTotal and torsional displacement were associated with higher values for RST versus CCS and RSV, with significant differences between RST and CCS for both these parameters (p ≤ 0.033). The differences between RST and RSV were significant for total displacement (p = 0.020), and a trend toward significance for torsional displacement (p = 0.061) was observed. For both failure criteria 2 mm total displacement and 5° torsional displacement, CCS was associated with significantly higher number of cycles compared to RST (p ≤ 0.040).ConclusionCCHS fixation presented predominantly superior stability to the standard surgical treatment and could therefore be a possible alternative implant for retrograde SPRF screw fixation, whereas partially threaded screws in group RST were associated with inferior biomechanical stability.

DISTAL RADIUS FRACTURE CLASSIFICATION USING DEEP LEARNING ALGORITHMS

Distal radius fractures (DRFs) are one of the most common types of fracture and one which is often treated surgically. Standard X-rays are obtained for DRFs, and in most cases that have an intra-articular component, a routine CT is also performed. However, it is estimated that CT is only required in 20% of cases and therefore routine CT's results in the overutilisation of resources burdening radiology and emergency departments. In this study, we explore the feasibility of using deep learning to differentiate intra- and extra-articular DRFs automatically and help streamline which fractures require a CT.Retrospectively x-ray images were retrieved from 615 DRF patients who were treated with an ORIF at the Royal Brisbane and Women's Hospital. The images were classified into AO Type A, B or C fractures by three training registrars supervised by a consultant. Deep learning was utilised in a two-stage process: 1) localise and focus the region of interest around the wrist using the YOLOv5 object detection network and 2) classify the fracture using a EfficientNet-B3 network to differentiate intra- and extra-articular fractures.The distal radius region of interest (ROI) detection stage using the ensemble model of YOLO networks detected all ROIs on the test set with no false positives. The average intersection over union between the YOLO detections and the ROI ground truth was Error! Digit expected.. The DRF classification stage using the EfficientNet-B3 ensemble achieved an area under the receiver operating characteristic curve of 0.82 for differentiating intra-articular fractures.The proposed DRF classification framework using ensemble models of YOLO and EfficientNet achieved satisfactory performance in intra- and extra-articular fracture classification. This work demonstrates the potential in automatic fracture characterization using deep learning and can serve to streamline decision making for axial imaging helping to reduce unnecessary CT scans.