Cut-out Rate Research Articles

Predictive value of tip-apex distance and calcar-referenced tip-apex distance for cut-out in 398 femoral intertrochanteric fractures treated in a private practice with dynamic intramedullary nailing.

Cut-out, a biomechanical complication, is one of the most common causes of internal fixation failure of trochanteric hip fractures. The tip-apex distance (TAD) and the calcar-referenced tip-apex distance (CalTAD) have been suggested as the radiographic parameters that most predict the risk of cut-out. The purpose of this study was to check whether these two factors could predict implant cut-out in a series 398 of intertrochanteric hip fractures, treated by dynamic intramedullary nailing with the Trigen Intertan short nail. We reviewed 398 consecutive intertrochanteric fractures included in a prospective study and treated in a single private hospital by the same surgeon. The radiographic parameters were obtained from anteroposterior (AP) and axial hip plain radiographs before surgery, immediately postoperatively, and every 3 weeks after surgery until 3 months postoperatively, and every month until the 6-month follow-up. The concept of medial cortex support (MCS) was also analyzed as a criterion for evaluating the quality of fracture reduction. The overall cut-out rate was 2.3% (9/398). The significant parameters in the univariate analysis were AO fracture type, quality of fracture reduction (p = 0.02), TAD (p < 0.001), CalTAD (p = 0.001), and quality of reduction. No statistically significant relationships were observed between the occurrence of cut-out and sex, age, fracture side, and American Society of Anesthesiologists type. Varus collapse and cut-out were only found in cases of negative MCS (22.2% and 77.8%, respectively). Multivariate analysis showed that only TAD showed an independent significant relationship to cut-out (p < 0.001). In this study, CalTAD has no predictive value in the multivariable analysis. Our findings differed from those in previous reported studies suggesting that CalTAD is the best predictor of cut-out. According to our data, careful optimal reduction ensuring stable fixation with TAD >25 mm reduced the occurrence of cut-out after dynamic intramedullary nailing of intertrochanteric fractures.

Management of the cut-out of various forms of osteosynthesis for proximal femoral fractures

Proximal femoral fractures are acommon type of injury in older people. Acut-out of the femoral neck screw after initial osteosynthetic surgery of proximal femoral fractures is afrequent and feared complication. There could be different causes for cut-outs. Osteoporosis and necrosis of the femoral head could be biological reasons for cut-outs; however, mechanical factors, such as reduction, implant position and morphological characteristics of fractures also have amajor influence on the cut-out rate. The treatment of the cut-out is often complex and depends on the destruction of the femoral head and the acetabulum. If the bone quality is still good and the head is not completely destroyed, areosteosynthesis can be performed. Conversion to an endoprosthetic replacement is often the only possibility. Endoprosthetic treatment is often complex and associated with ahigh morbidity.

ВЛИЯНИЕ КОНСТРУКЦИИ СЕГМЕНТНЫХ ПЕРЕГОРОДОК НА ПРОЦЕСС ТЕПЛООБМЕНА В ГАЗОМАСЛЯНОМ ТЕПЛООБМЕННОМ АППАРАТЕ

Shell-and-tube oil coolers are widely used for heat transfer in power systems. However, due to the high viscosity of lubricants, their heat transfer coefficients from the oil side are an order of magnitude lower than those of their analogues, where water is used in the inter-tube space. Therefore, it is important to select internal devices that would contribute to turbolization of the flow in the inter-tube space, but at the same time the hydraulic resistance value would be within acceptable limits in order to introduce a gas-oil heat exchanger (GOHE) into the existing lubrication system of the gas pumping unit (GPU). In this paper, the influence of three types of standard segment partitions (single-segment, two-segment, three-segment) with varying degrees of cutout on the thermal and hydraulic characteristics of the GMT was considered. Numerical simulation was performed using the Aspen EDR V12 software package. The results of the study showed that the highest heat transfer coefficient in a number of single-segment partitions is achieved at a cutout rate of 25% and reaches a value of 309.8 W*m2/K. In a series of two-segment partitions, the maximum value of the heat transfer coefficient is 284.3 W*m2/K with a cutout degree of a two-segment partition of 15%-20%. In a series of three-segment partitions, the maximum value of the heat transfer coefficient is 246.4 W*m2/K with a cutout degree of 5%_10%_15%, the study showed that with an increase in the cutout degree of a single-segment partition, the hydraulic resistance decreases by 1.9 times. In a row of two-segment partitions, the hydraulic resistance is reduced by 2 times. The hydraulic resistance decreases by 1.51 times with an increase in the degree of cutout of the three-segment partition. It was also found out that the highest value of the bypass flow E is achieved for single-segment partitions, and the lowest value for three-segment ones. The main flow in single-segment partitions is 35.81% less than in three-segment partitions.

Development of early complications after treatment of trochanteric fractures with an intramedullary sliding hip screw in a geriatric population.

Although trochanteric fractures (TF) are a frequent event in the geriatric population, studies reporting on complication rates associated with surgical treatment are sparse. Thus, this study investigated the relevance of fracture-, implant-, and surgery-associated complications in TF. Furthermore, the role of possible risk factors for the before mentioned complications was investigated. A consecutive series of patients with TF treated by intramedullary nailing with a sliding screw device was evaluated. Data were sampled retrospectively from the hospital patient information system and anonymized at the source. Demographic data and information regarding fracture pattern, the treatment performed, hospital stay, and evaluation of operative and follow-up radiographs were analyzed. Intraoperative problems (i.e., technical problems with the implant, intraoperative fracture) and postoperative complications were investigated. Postoperative surgical complications were noted in 11.7%. The most frequent surgical problem was a difficult fracture reduction (13%) and intraoperative fracture dislocation (3.6%). The most frequent postoperative complication was intra-hospital mortality (3.6%), delayed/non-union (2.7%), and a cut-out of the lag screw in the femoral head (2.3%). Implant failure (1,4%) was significantly associated with morbid obesity while cut-out (2,3%) correlated with a higher tip-apex distance (TAD). A complex fracture type and a suboptimal screw position significantly increased the cut-out rate to 5% (p = 0.018). Complications after TF treatment occur frequently. While patient-associated variables such as morbid obesity cannot be influenced by the surgeon, correct fracture reduction and implant positioning remain to be of highest importance.

Complication rates after proximal femoral nailing: does level of training matter?

BackgroundSurgical treatment of pertrochanteric fractures is one of the most performed surgeries in orthogeriatrics. Proximal femoral nailing, the most performed procedure, is often used as a training surgery for young residents. The objective of this study was to evaluate the relevance of the resident’s training level to complication rates.Material and methodsThis study was a retrospective cohort study. Surgeons were divided into four groups according to their training level. Complications included infection, cut-out, and revision surgery. The study was performed at a level 1 trauma center. All patients who were treated with proximal femoral nailing surgery with a radiological follow-up of at least 3 months were included.ResultsOf the 955 patients extracted, a total of 564 patients met the inclusion criteria. Second-year residents had significantly higher cut-out rates (p = 0.012). Further analysis indicated a correlation between level of training and surgery duration (p < 0.001) as well as a correlation between surgery duration and infection rate (p < 0.001). The overall complication rate was 11.2%. Analyzing overall complications, no significant difference was found when comparing surgeon groups (p = 0.3). No statistically significant difference was found concerning infection (p = 0.6), cut-out (p = 0.7), and revision surgery (p = 0.3) either.ConclusionComplication rates after proximal femoral nailing are not higher in patients who are treated by residents. Therefore, proximal femoral nailing is an excellent procedure for general orthopedic training. However, we must keep in mind that accurate positioning of the femoral neck screw is essential to keep cut-out rates as low as possible.Level of Evidence III.

A new scoring system for predicting cut-out risk in patients with intertrochanteric femur fractures treated with proximal femoral nail anti-rotation.

The objectives of this study were to: (1) determine all the potential risk factors defined in the literature for cut-out after proximal femoral nail anti-rotation in managing intertrochanteric fractures and (2) make a reliable prediction about the likelihood of cut-out by developing a quantitative scoring system. Four hundred eighty patients who were operated on for an intertrochanteric femur fracture were included in the study. The patients were evaluated retrospectively. Radiological parameters known to affect cut-out, including tip apex distance (TAD), calcarreferenced TAD (CalTAD), and reduction quality, were also used to evaluate the patients. Additionally, the classification of the fracture according to the cortical thickness index for osteoporosis, the Charlson comorbidity index for additional comorbidities, and the Arbeitsgemeinschaft Für Osteosynthesefragen classification were evaluated. The cut-out rate among all patients was 7.2%. Cut-out risk could be predicted by gender, TAD, CalTAD, and reduction quality. Female gender, TAD > 29.45, CalTAD > 31.75, and acceptable or poor reduction quality significantly increased the cut-out risk. Based on the chi-square analysis, it was determined that there was a significant relationship between the cut-out risk and the variables of TAD, CalTAD, reduction quality, gender, and fracture type (P=.000, P=.000, P=.000, P=.008, P=.016, respectively). Logistic regression analysis showed a strong correlation between the newly developed scoring system and the risk of cut-out. The risk of cut-out increased 8.1 times in individuals with a score of more than 2 (P < .001). Female gender, TAD > 29.45, CalTAD > 31.75, and acceptable or poor reduction quality are the parameters found to be significant in determining the cut-out risk. With the newly developed scoring system, risks can be calculated for all situations that may occur according to the scores obtained by the patients. The cut-out risk increases significantly in patients with a score above 2 points. Level III, Diagnostic Study.

Predictors of screw cutout in the surgical fixation of peritrochanteric hip fractures: A retrospective cohort study

Objectives: This study aimed to evaluate the impact of the tip-apex distance (TAD) and other reported risk factors on the screw cutout rate. Methods: This study retrospectively reviewed electronic medical records from January 2016 to December 2018 to analyze the relationship between TAD and implant cutout failure rate in patients with peritrochanteric (PT) fractures who underwent cephalomedullary nail (CMN) or dynamic hip screw (DHS) fixation. Secondary factors analyzed included age, body mass index (BMI), fracture stability, posterolateral fragment presence, post-operative radiographic reduction, implant type, and screw position. Results: A total of 68 patients (40 DHS, 28 CMN cases) were included in the study, with a mean age of 64 ± 20 years and a BMI of 25.5. Most of the included patients (65%; 44) were males. An overall cohort screw cutout rate of 7.3% (5 cases) was observed. The patient’s age, BMI, fracture classification (stability), implant type, and the level of the operating surgeon did not influence the screw cutout rate (P = NS). However, a TAD ≥25 mm (P = 0.02), lag screw position (P = 0.03), and fracture reduction in anteroposterior (P = 0.02) and lateral views (P = 0.024) showed statistically significant results. Conclusion: This study demonstrated that a TAD of ≥25 mm, lag screws malposition, and inappropriately reduced fracture in post-operative radiographs are significant risk factors for screw cutout in DHS and CMN fixation of PT fractures.

Comparison of Supine Position and Traction Table in the Surgical Treatment of Unstable Intertrochanteric Fractures with PFNA

Aim: Intertrochanteric femur fractures (IFF) are a major cause of morbidity and mortality in the elderly population. Proximal femoral nail-anti-rotation (PFNA) is one of the most preferred surgical treatment methods. This study aimed to compare the clinical and radiologic results of two different patient positions used during PFNA and to reveal the intraoperative advantages and disadvantages.&#x0D; Material and Method: Cases operated due to IFF between January 2020 and December 2022 were retrospectively analyzed. The study was conducted with 123 patients meeting the inclusion criteria. The minimum follow-up period was determined as one year. Two groups were formed: those operated on the traction table (opereted-TT) and those operated in supine lithotomy without traction table (operated-SP). The groups were compared regarding operative time, reduction quality, type-apex distance (calTAD), and radiologic and clinical results.&#x0D; Results: There were 76 patients in the operated-TT group and 47 in the operated-SP group. The mean age of the operated-TT group was 81.00±8.52 years, and the mean age of the operated-SP group was 79.30±8.12 years. (p=0.213) Gender, follow-up time, time from trauma to surgery, and fracture classification were similar for the groups. The mean operative time was 95.18±8.54 minutes in the operated-TT group and 88.23±7.12 minutes in the operated-SP group, and the operation was completed in a shorter time in the operated-SP group. (p=0.001) There were no differences between the groups in terms of reduction quality, calTAD, Harris Hip Score, VAS score, infection rates, and cut-out rates.&#x0D; Conclusion: Based on this study, the radiologic and clinical results of the cases operated with manual traction in the supine position and those operated using a traction table in treating IFF with PFNA are similar. In addition, it was concluded that shorter operation time was an advantage of the operated-SP group.

Predictive value of the deltoid tuberosity index for assessing the risk of screw cut-out

Abstract Background Reconstruction of the proximal humerus with a locking plate is often the first surgical approach for proximal humerus fractures. Screw cut-out is a common complication and is relevant in osteoporotic bone of older adults. The Deltoid Tuberosity Index (DTI) is an indirect measure for assessing local bone quality and failure rate before surgery, providing important information for surgical planning. This was the first independent, large-sample retrospective analysis of the correlation between local bone density, indirectly measured through the DTI, and screw cut-out. Methods In total, 306 cases of proximal humerus fractures treated with the PHILOS plate (DePuy Synthes, Oberdorf, Switzerland) were retrospectively analyzed. The DTI was measured on anteroposterior x‑rays. The primary endpoint was screw cut-out defined as the intra-articular position of at least one screw associated with a reduction loss after surgery. Results The mean clinical follow-up was 935 days. The DTI varied from 1.10 to 2.28 (average: 1.45). Screw cut-out occurred on average in 8% of the cases and was positively correlated with a DTI of ≤ 1.44 (p = 0.003). However, the rate of cut-out and correlation with DTI varied widely according to age group: for ages 65–80 years, a DTI of ≤ 1.44 increased the cut-out rate from 0% to 17% (p = 0.02); in younger ages (&lt; 65 years) the DTI did not correlate with cut-out and in the oldest group (&gt; 80 years) cut-out rates were high (17–20%) independently of the DTI. Conclusion We confirm the correlation between a DTI of ≤ 1.44 and screw cut-out. High-risk groups for screw cut-out are patients over 65 years with a DTI of ≤ 1.44 or any patient older than 80 years. Applying the DTI in the age group of 65–80 years offers relevant information for surgical planning in the trauma setting via a fast, cheap, and easy-to-use tool. Level of Evidence: Level 3, Retrospective Cohort Study.

Compressive Strength of Corrugated Paperboard Packages with Low and High Cutout Rates: Numerical Modelling and Experimental Validation

The finite element method is a widely used numerical method to analyze structures in virtual space. This method can be used in the packaging industry to determine the mechanical properties of corrugated boxes. This study aims to create and validate a numerical model to predict the compression force of corrugated cardboard boxes by considering the influence of different cutout configurations of sidewalls. The types of investigated boxes are the following: the width and height of the boxes are 300 mm in each case and the length dimension of the boxes varied from 200 mm to 600 mm with a 100 mm increment. The cutout rates were 0%, 4%, 16%, 36%, and 64% with respect to the total surface area of sidewalls of the boxes. For the finite element analysis, a homogenized linear elastic orthotropic material model with Hill plasticity was used. The results of linear regressions show very good estimations to the numerical and experimental box compression test (BCT) values in each tested box group. Therefore, the numerical model can give a good prediction for the BCT force values from 0% cutout to 64% cutout rates. The accuracy of the numerical model decreases a little when the cutout rates are high. Based on the results, this paper presents a numerical model that can be used in the packaging design to estimate the compression strength of corrugated cardboard boxes.

Standardized Tip-Apex Distance (STAD): a modified individualized measurement of cephalic fixator position based on its own femoral head diameter in geriatric intertrochanteric fractures with internal fixation

ObjectiveTo design a standardized Tip-Apex Distance (STAD) and analyze the clinical significance of STAD in predicting cut-out in geriatric intertrochanteric fractures with internal fixation.MethodsFirstly, we designed STAD according to the rule of TAD. We measured the STAD individually based on its own femoral head diameter (iFHD) instead of the known diameter of the lag screw in calculating TAD, resulting in that the STAD is simply the relative quantitation relationship of iFHD (the times of iFHD). In this study, we assumed that all the iFHD was 6D (1iFHD = 6D, or 1D = 1/6 of iFHD) in order for complete match of the Cleveland zone system, easy comparison of the STAD, and convenient identification for artificial intelligence. Secondly, we calculated and recorded all the STAD of cephalic fixator in 123 eligible ITF patients. Thirdly, we grouped all the ITF patients into the Failure and Non-failure groups according to whether cut-out or not, and analyzed the correlation between the cut-out and the STAD.ResultsCleveland zone, Parker’s ratio (AP), TAD, and STAD were associated with the cut-out in univariate analysis. However, only STAD was the independent predictor of the cut-out by multivariate analysis. No cut-out was observed when STAD ≤ 2D (1/3 of iFHD). The Receiver Operating Characteristic (ROC) curve indicated that STAD was a reliable predictor of cut-out, and the best cut-off value of STAD was 2.92D. Cut-out rate increased dramatically when STAD increased, especially when STAD > 3D (1/2 of iFHD).ConclusionEssentially, the STAD is a relative quantitation relationship of iFHD. The STAD is a reliable measurement of cephalic fixator position in predicting cut-out in geriatric ITF patients with single-screw cephalomedullary nail fixations. For avoiding cut-out, the STAD should be no more than a half of iFHD.Level of evidenceLevel III, Prognostic Study

Blade Augmentation in Nailing Proximal Femur Fractures-An Advantage despite Higher Costs?

Proximal femoral fractures occur with increasing incidence, especially in the elderly. Commonly used implants for surgical treatment are cephalomedullary nails. To increase stability, a perforated femoral neck blade can be augmented with cement. The study investigated whether this results in a relevant clinical advantage and justifies the higher cost. This is a single-center retrospective study of 620 patients with proximal femur fractures treated with cephalomedullary nailing. Between January 2016 and December 2020, 207 male and 413 female patients were surgically treated with a proximal femur nail (DePuy Synthes) using a perforated blade and cement augmentation in cases with severe osteoporosis. Primary outcome measures were the rate of cut-out, tip apex distance and the positioning of the blade in the femoral head. Secondary outcome measures were the implant costs and operating times. Of the 620 femoral neck blades, 299 were augmented with cement. A total of six cut-outs were seen in the first 3 months after the operation. There were three in the cement-augmented group (CAB = cement-augmented blade) and three in the conventional group (NCAB = non-cement-augmented blade). There was a significant positive correlation between age and augmentation, with a mean difference of 11 years between the two groups (CAB 85.7 ± 7.9 vs. NCAB 75.3 ± 15.1; p < 0.05). There was no difference in the tip-apex distance (CAB 15.97 vs. 15.69; p = 0.64) or rate of optimal blade positions between the groups (CAB 81.6% vs. NCAB 83.2%; p = 0.341). Operation times were significantly longer in the cemented group (CAB 62.6 21.2 min vs. NCAB 54.1 7.7 min; p < 0.05), and the implant cost nearly doubled due to augmentation. When the principles of anatomic fracture reduction, optimal tip-apex distance and optimal blade position are combined with cement augmentation in cases of severe osteoporosis, a cut-out rate of less than 1% can be achieved. Nevertheless, it should be noted that augmentation remains expensive and prolongs surgery time without definite proof of mechanical superiority.

Outcomes of TFN-Advanced™ Proximal Nail System (TFNA) for AO Type 31-A1/A2/A3 Intertrochanteric Fractures: A Retrospective Review of 100 Cases with Minimum 2-Year Follow-Up

Purpose: Hip fractures are a growing concern for healthy systems worldwide. Several fixation modalities have been developed for the fixation of AO type 31-A1/A2/A3 fractures. The TFN-AdvancedTM Proximal Nail System (TFNA) is a novel fixation device that aims to build on success of previous generation nails. Currently, there is a paucity of literature regarding the outcomes of this implant. The aim of this study was to present our experience using the TFNA implant over a 2-year minimum follow-up. Methods: We retrospectively reviewed patients above the age of 65 who underwent closed reduction and internal fixation (CRIF) for AO type 31-A1/A2/A3 intertrochanteric fractures, with the TFNA nail between January 2017 and June 2018. The minimum follow-up time in our study was 2 years. Radiological evaluation was performed during follow up visits to evaluate for post-operative complications. Results: Following exclusions, the final study population consisted of 100 patients. The mean follow-up was 30.8 months (range 24–44, SD 5.1). During the follow-up period, 6% of the patients (n=6) experienced orthopedic complications. The rate of peri-prosthetic fracture in our study was 2% (n=2), the rate of peri-prosthetic infection was 2% (n=2) and the cut-out rate was 1% (n=1). No cases of mal-union or non-union were observed. Revisions were required in 4% of patients (n=4). Conclusion: The low rates of complications reported in our study support the implementation of TFN-A as a fixation device for AO type 31-A1/A2/A3 intertrochanteric fractures undergoing CRIF. Additional follow-up is required in the long-term.

U-blade gamma 3 vs. gamma 3 nails for intertrochanteric hip fracture: Meta-analysis.

Intertrochanteric fracture is a growing problem in the traumatology department. The use of intramedullary devices has increased, representing the first treatment option in intertrochanteric fractures. U-Blade devices appeared to avoid rotation of the femoral head over the femoral neck. The aim of this study was to conduct a meta-analysis of the surgical treatment of intertrochanteric fractures comparing in terms of safety and efficacy the U-Blade Gamma 3 nail vs. the conventional Gamma 3 nail. A literature search for intertrochanteric fracture 31A1-31A3 according to the AO foundation/orthopaedic trauma association (AO/OTA) classification was performed. Baseline characteristics of each article were obtained; radiological outcomes were tip apex distance (TAD), sliding distance (mm), cut-out rate, and lateralization rate. Surgery time (min) was also recorded. A meta-analysis was performed with ReviewManager 5.4. Five retrospective studies (n = 993 patients) were included. With respect to TAD and sliding distance, there were no differences between two groups [mean difference (MD) 0.47, 95% confidence interval (CI), -0.46 to 1.40] and (MD 0.39, 95% CI, 0.13-0.66). The cut-out rate and lateralization rate did not show differences between two groups (p > 0.05). Finally, surgery time was significantly higher in the U-Blade Gamma 3 group (MD -4.84, 95% CI, -7.22 to -2.46). The use of U-Blade Gamma 3 did not show significant differences in the radiological results compared with the conventional Gamma 3 nail.

Eccentric distance zone analysis system: New regional evaluation of cephalic fixator tip location for predicting cut-out in geriatric intertrochanteric fractures with internal fixation.

The aim of this study was to investigate an eccentric distance (ED) zone analysis system for regional evaluation of the cephalic fixator tip based on the ED of the cephalic fixator tip referenced to the radius of its own femoral head to predict cut-out in intertrochanteric fractures (ITF) with internal fixation. First, we assumed all the femoral heads were regular spheres with the radius (R FD) of "3" for a complete match of the Cleveland zone system and calculated the ED of the cephalic fixator tip by measuring the distances from the cephalic fixator tip to the geometric central axis in the femoral neck and head on both anteroposterior (AP) view and lateral view radiographs. Second, we defined the maximum transverse section of the femoral head into three zones named ED Zone A with ED less than "1," Zone B with ED ranging in "1-2," and Zone C with ED ranging in "2-3" in turns by concentric circles (circles A, B, and C) with the radius of 1/3, 2/3, and 3/3 times of R FD, respectively. Third, we evaluated the ED zones according to the ED and location of the cephalic fixator tip in the eligible 123 ITF patients with single-screw cephalomedullary nail (SCMN) fixation and then analyzed the correlation between the cut-out rate and the ED zones. The cut-out rates in ED Zones A, B, and C were 4.17%, 38.46%, and 100%, respectively. Multivariate logistic regression indicated that ED Zone A had at least a 14 times lower rate of cut-out compared with ED Zone B. The cephalic fixator tip located in ED Zone A has a lower cut-out rate than that in Cleveland Zone 5. The cut-out rate in ED Zone A is significantly lower than that in the region inside Cleveland Zone 5 but outside ED Zone A. ED zone analysis system is a reliable regional evaluation of the cephalic fixator tip position for predicting cut-out in geriatric ITF patients with SCMN fixations and potentially an artificial intelligence measurement during surgery. For decreasing the cut-out rate, the cephalic fixator tip should be located in ED Zone A.

Clinical evaluation of suture materials for transtibial pullout repair of medial meniscus posterior root tear

BackgroundThere are no recommendations for specific suture materials in transtibial pullout repair of medial meniscus posterior root tears. This study aimed to evaluate the clinical outcomes of transtibial pullout repair of medial meniscus posterior root tears using ultrahigh-molecular-weight polyethylene sutures and suture tape.MethodsWe retrospectively reviewed the data of 36 patients (27 women and 9 men, mean age 64.1 years) who had undergone transtibial pullout repair of medial meniscus posterior root tears between November 2018 and December 2019. Two groups of 18 patients each received either two different cord-like sutures or suture tape. Clinical parameters were assessed preoperatively and on second-look arthroscopy (mean postoperative period 12 months). The meniscal healing status was assessed using a previously published scoring system (ranging from 0 to 10), and the incidence rate of suture cut-out was assessed on second-look arthroscopy.ResultsAll clinical scores significantly improved in both groups, with no significant between-group differences on second-look arthroscopy. The arthroscopic meniscal healing scores significantly differed between sutures (mean 6.7 points) and suture tape (mean 7.4 points; p = 0.044). No significant between-group difference in the suture cut-out rate was observed.ConclusionsThis study found no significant differences in the clinical outcomes between ultrahigh-molecular-weight polyethylene sutures and suture tape. Favorable clinical outcomes were obtained using both types of suture; however, the usefulness of suture tape appears to be limited.

Risk Factor of Proximal Lag Screw Cut-Out After Cephalomedullary Nail Fixation in Trochanteric Femoral Fractures: A Retrospective Analytic Study

Objective: A cephalomedullary nail is the treatment of choice for trochanteric fractures; however, a lag screw cutout is one of the most devastating complications. The lag screw cut-out rate was reported to be around 2.5%–8.3%. This study aimed to evaluate the prevalence of lag screw cut-outs and identify the associated risk factors.Materials and Methods: A retrospective review of 267 trochanteric fracture patients treated with cephalomedullary nail fixation from January 2007 to December 2017 was conducted. The demographic variables were documented, comprising age, gender, fracture pattern, and AO/OTA classification. Immediate postoperative radiographs were assessed for quality of reduction and implant position. Lag screw cut-outs or radiographic union were determined using the final follow-up radiograph. Prognostic factors associated with lag screw cut-out were determined using univariate and multivariate logistic regression analyses.Results: Of the 175 patients, 154 were successfully treated, and 21 had a lag screw cut-out. There were no significant differences in mean ages or genders of the union and cut-out groups. No lag screw cut-outs were observed in patients with AO/OTA 31-A1. Patients with AO/OTA 31-B2.1 had a higher rate of screw cut-out (OR 10.5, [3.22, 34.25] p &lt; .001). The disintegration of basicervical fragments was significantly associated with lag screw cut-out (OR 5.51, [2.01, 15.12] p = .001). The highest cut-out rate was found in the superoanterior and superoposterior positions of the lag screw. However, the screw position did not reach the significance level in a multivariate analysis (p = .094).Conclusion: The prevalence of lag screw cut-out after cephalomedullary nail fixation for trochanteric fractures was 12%. A simple, two-part, basicervical trochanteric fracture hads a significantly higher risk of lag screw cut-out.

A control algorithm to increase the efficient operation of wind energy conversion systems under extreme wind conditions

This paper aims to increase the power production of gearless permanent magnet synchronous generator (PMSG) based wind energy conversion systems (WECS) in strong (greater than 25 m/s) wind speed regions. In general, most wind turbines cut off when wind speed is over the cut-out rate; as a result, the power generation of the wind farm decreases. This study introduces the look-up table pitch angle and rotational speed control to generate extra power in a strong wind region. Consequently, WECS can produce electric power at a reduced level until the wind speed reaches 35 m/s and the possibility of shutting down the wind turbines decreases. The proposed algorithm decreases the mechanical stress of wind turbine by decelerating rotational speed rather than turbine torque in strong wind regions. Furthermore, the model predictive control (MPC) is proposed to replace the PI controller in the inner current loop of the rotor speed control loop, thereby improving the performance of the stator current track. The proposed control method is validated in Matlab/SimPowerSystem software. The simulation result confirms that the proposed control method reduces the possibility of shutdown and guarantees temporally power production in strong wind conditions.

What's New in Orthopaedic Trauma.

What's New in Orthopaedic Trauma.

The correlation between cutout and eccentric distance (ED) of the cephalic fixator tip in geriatric intertrochanteric fractures with internal fixation

BackgroundThe location of cephalic fixator tip with different eccentric distance (ED) should have different risks of cutout. This study aims to evaluate the cephalic fixator tip position by measuring ED of the cephalic fixator tip in geriatric ITF patients with single-screw cephalomedullary nail (SCMN) fixation and analyze the correlation between the cutout and the ED.MethodsFirstly, we assumed all the femoral head was a regular sphere and standardized the radius of the femoral head (RFD) as “3” no matter how big the RFD was for complete match of the Cleveland zone system and convenient identification of artificial intelligence. Secondly, we measured the ED of the cephalic fixator tip by calculating the distances from the cephalic fixator tip to the geometric central axis of the femoral neck and head on both AP view and lateral view radiographs. Thirdly, we evaluated all the ED of the cephalic fixator tip in the eligible 123 geriatric ITF patients and analyzed the correlation between the cutout and the ED.ResultsThe ED in cutout group (1.25 ± 0.43) is much bigger than that in non-cutout group (0.64 ± 0.34) with significant difference (OR = 50.01, 95% CI 8.42–297.19, p < 0.001). The probability of cutout increased with ED increasing, especially when “ED ≥ 1.” The best cutoff value of ED for predicting cutout was “1.022” (“1.022” was just a little bit more than 1/3 times of RFD because “RFD = 3,” sensitivity = 73.3%, specificity = 86.1%, and AUC = 0.867, p < 0.001).ConclusionED is suitable for evaluation of the cephalic fixator tip position for predicting cutout in geriatric ITF patients with SCMN fixation, and ED can potentially be used as artificial intelligence application during surgery. The smaller the ED, the lower the cutout rate. For avoiding cutout, the ED of the cephalic fixator tip should be less than one-third times of the radius of the femoral head.