Fair Results Research Articles

Functional Outcomes of a Dynamic Condylar Screw for Unstable Femoral Intertrochanteric Fractures in Patients Above 50.

Hip fractures areamong the most common fractures encountered in the emergency departments by orthopedic trauma teams. The optimal treatment method and implant choice for unstable intertrochanteric fractures are subject to debate, with various options available, including intramedullary and extramedullary implants. In this descriptive cross-sectional study, the researchers examined patients with unstable intertrochanteric fractures (classified as 31A2 according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification) who had undergone open reduction and internal fixation with a 95° dynamic condylar screw (DCS). The study was conducted at the Gezira Centre for Orthopedic Surgery and Traumatology (GCOST) during the latter half of 2022. Functional outcomes were assessed using the modified Harris Hip Score (mHHS). A total of 30 patients were enrolled in this study, with a mean age of 73 ± 12.27 years. Of these, 11 (36.7%) were male, and 19 (63.3%) were female. The mHHS was 73.6 ± 14.654. Among the surveyed patients, seven (23.3%) reported poor outcomes, 13 (43.3%) reported fair outcomes, six (20%) reported good outcomes, and four (13.3%) reported excellent outcomes. The Kruskal-Wallis test revealed statistically differences in mean mHHS scores between gender groups (p = 0.024) and between age groups (p = 0.04). However, no significant differences were found across different modes of trauma groups (p = 0.73), affected hip groups (p = 0.35), comorbidity groups (p = 0.84), or postoperative complication groups (p = 0.06). Our study found that DCS treatment for unstable intertrochanteric fractures yielded acceptable functional outcomes, making it a viable and effective treatment option.

AFTEA Framework for Supporting Dynamic Autonomous Driving Situation

The accelerated development of AI technology has brought about revolutionary changes in various fields of society. Recently, it has been emphasized that fairness, accountability, transparency, and explainability (FATE) should be considered to support the reliability and validity of AI-based decision-making. However, in the case of autonomous driving technology, which is directly related to human life and requires real-time adaptation and response to various changes and risks in the real world, environmental adaptability must be considered in a more comprehensive and converged manner. In order to derive definitive evidence for each object in a convergent autonomous driving environment, it is necessary to transparently collect and provide various types of road environment information for driving objects and driving assistance and to construct driving technology that is adaptable to various situations by considering all uncertainties in the real-time changing driving environment. This allows for unbiased and fair results based on flexible contextual understanding, even in situations that do not conform to rules and patterns, by considering the convergent interactions and dynamic situations of various objects that are possible in a real-time road environment. The transparent, environmentally adaptive, and fairness-based outcomes provide the basis for the decision-making process and support clear interpretation and explainability of decisions. All of these processes enable autonomous vehicles to draw reliable conclusions and take responsibility for their decisions in autonomous driving situations. Therefore, this paper proposes an adaptability, fairness, transparency, explainability, and accountability (AFTEA) framework to build a stable and reliable autonomous driving environment in dynamic situations. This paper explains the definition, role, and necessity of AFTEA in artificial intelligence technology and highlights its value when applied and integrated into autonomous driving technology. The AFTEA framework with environmental adaptability will support the establishment of a sustainable autonomous driving environment in dynamic environments and aims to provide a direction for establishing a stable and reliable AI system that adapts to various real-world scenarios.

Clinical and radiological outcome of proximal third tibia fractures treated with intramedullary nailing

Introduction. Extra articular proximal tibia fractures represent about 5-11% of all tibia fractures, and usually exhibit complex fracture patterns with moderate to severe soft tissue damage and deforming forces. No fracture arose more controversy regarding the best method of treatment, common methods of fixation of proximal tibia fractures with intramedullary nailing and minimally invasive plating widely in these fractures. The open reduction or minimally invasive plating of these fractures is widely used plates do not provide axial and varus stability and nail being load sharing device can provide both axial and varus stability, while the nail being a load sharing device can provide both axial and varus stability with minimal soft tissue handling. However, the nailing of extraarticular proximal tibia fractures is associated with malunion. This current study aims to analyse the outcome of proximal third fractures treated with nailing. Material and methods. Thirty consecutive patients with fracture of the proximal third of the tibia shaft underwent nailing and were followed for up to 2 years. The clinical and radiological outcome of these cases and the complications encountered were analysed according to modified Klemm and Borner scoring system. Results. Our study comprised of patients in the age group 19-80 years, average being 40.5 years. Average time of partial weight bearing in the present study was 7.9 weeks (range 6-18 weeks). The average time for full weight bearing was 13 weeks (range 10-24 weeks). The mean time for radiological union was 24.6 weeks (range 20-32 weeks). Fourteen had excellent result, 10 patients had good, 4 patients had fair results and 2 patients had poor results according to Klemm and Borner functional criteria. Conclusions. Intramedullary nailing of proximal third tibia fractures when used with proper reduction technique using reduction clamps, k-wires, poller screws or unicortical plating in semi extended position for nailing is an effective, stable and successful method of treatment for proximal third fractures of tibia.

Chronic shoulder instability using the Latarjet technique: About 20 cases

This retrospective study included 20 patients operated on in the Traumatology and Orthopedics Surgery Department (A) of the HASSAN II University Hospital in Fez, treated with a LATARJET · between January 2016 and December 2023, a 5-year period · In our series, the mean age at surgery was 27 years. · Male predominance was evident, with a traumatic context found in 90% of cases. · The apprehension test was positive in 65% of cases. · Our patients underwent a systematic standard preoperative radiological work-up. · We opted for the LATARJET technique · Elbow-to-body immobilization for 21 days post-operatively. · They were followed up in consultation with a 5-year follow-up. The results of our series are very satisfactory according to the ROWE score: · -85% of patients complained of no pain. Stability was perfect in 18 cases (90%). · -Unrestricted mobility was restored in 80% of cases. · -Only one case of recurrence (5%) · One patient with postoperative osteoarthritis, corresponding to 5%. In all, we had 85% good and excellent results, versus 15% fair and poor results. The results of this study are similar to those found in the literature, confirming that the LATARJET technique is the most reliable in the treatment of anterior shoulder instability, with good functional results and the fewest complications.

Modified Calcanization of Tibia for Hindfoot Defect Reconstruction: Method and Preliminary Results.

To introduce our modified technique for calcanization of the tibia in managing massive bony loss of hindfoot and preliminary outcomes. From January 2015 to December 2021, modified calcanization of the tibia were performed in 10 patients with unilateral loss of the calcaneus. Clinical outcomes were assessed based on the American Orthopaedic Foot & Ankle Society score and Symptom Checklist-90-Revised questionnaire. Paired two-group t-test was applied to compare the parameters. The mean lengthened length of the tibia was 77.3 ± 3.0 mm (range, 74-83 mm). The mean external fixation time was 123.7 ± 52.1 days (range, 117-134 days) and the mean external fixation index was 1.601 ± 0.046 days/mm. All patients stuck to the postoperative follow-up plan with an average follow-up time of 29.7 ± 3.4 months (range, 24-35 months). Deformities of the injured limbs were well corrected. Based on American Orthopaedic Foot & Ankle Society score, eight good and two fair results were achieved. The mental status of all patients was within the normal range, and several indices of the Symptom Checklist-90-Revised questionnaire of each patient were improved after the whole procedure. We demonstrate that the modified calcanization of the tibia is qualified for total loss of calcaneus with limited complications. Early rehabilitation is attainable since external fixation time is shortened due to a simplified procedure.

Exploring the Impact of Age and Pre-Stroke Modified Rankin Scale in Elderly Thrombectomy: A 15-Year Single-Center Experience

Introduction: The selection of endovascular thrombectomy (EVT) for acute ischemic stroke in the elderly remains challenging due to the underrepresentation of these patients in landmark randomized trials. The aim of this study was to assess the association between age and the pre-stroke modified Rankin scale score with functional outcomes after EVT in elderly patients aged ≥80 years. Methods: We prospectively collected data from consecutive elderly patients who underwent EVT of the anterior or posterior circulation at our institution between 2007 and 2022. Clinical and radiological parameters were analyzed using a fair outcome (mRS ≤3 or retained pre-stroke mRS score of 4) as the primary outcome. Results: In total, 307 elderly patients were included in the analysis. Fair functional outcomes were achieved in 162 (53%) patients. Eighty-four (27.4%) patients were deceased at 3-month follow-up and the mortality rate increased to 37.1% (114 deceased) at 1-year follow-up. The likelihood of achieving a fair functional outcome decreased by 8% for every 1-year age increase (OR 0.81, 95% CI 0.73–0.90). Lower National Institutes of Health Stroke Scale (OR 0.89, 95% CI 0.85–0.93, p < 0.001) and pre-stroke mRS (OR 0.67, 95% CI 0.53–0.84, p < 0.001) were associated with fair outcomes. Conclusions: EVT in elderly patients with stroke is beneficial in selected cases. Increasing age was associated with an increased risk of an mRS change to 4 or worse and death within 1 year. The pre-stroke mRS may aid clinicians in the selection of elderly patients for EVT.

Knee Instability Following Fractures Around the Knee Joint: Diagnostic Dilemma and Management Challenges.

Knee instability following fractures around the knee joint is not uncommon but is often missed. They present challenges in identifying them during index injury or at follow-up. We share our experience of knee instability following fractures around the knee joint. (1) To identify the pattern of clinically significant knee instability following fractures around the knee joint. (2) To discern the association of fracture morphology with ligamentous disruption. (3) To identify the risk factors for knee ligament injury following fractures around the knee. (4) To recognise the signs of instability in fracture scenarios and their diagnostic pitfalls/management challenges. After appropriate Ethical committee clearance and patient consent, a retrospective analysis of 595 fractures around the knee joint was performed at our institute from 2018 to 2021. After employing the exclusion criteria, a total of 92 cases of ligament injuries were included in the analysis. Seventy-six of them were identified and addressed during the index procedure, and 16 of them presented with delayed instability during fracture healing, treated by appropriate arthroscopic ligament reconstruction. Demographic data, mode of injury, fracture morphology, ligament injury pattern and associated injuries were documented and analysed. Functional outcome was assessed using Lysholm scoring and the International Knee Documentation Committee questionnaire at the final follow-up. The overall incidence of clinically significant knee ligament injury was 15.46%. Among the 76 acute cases, 8 were ACL avulsions, 47 were PCL avulsions, 9 were MCL injuries, 2 were LCL injuries, and 10 had MLKI treated by arthroscopic/open techniques. Out of the 16 cases that presented late, 6 had ACL injuries, 2 had LCL injuries, and 8 of them had a multi-ligamentous knee injury. With respect to the fracture pattern, 56 (60.9%) had tibia fractures, 24 (26.1%) had femur fractures, 3 (3.3%) of them had patella fractures, and 9 (9.8%) had floating knee injuries. The mean Lysholm score was 85.7±9.8. 19.6% (n = 18) had excellent outcome, 46.7% (n = 43) had good outcome, 23.9% (n = 22) had fair outcome and 9.8% (n = 9) had poor outcome. Knee instability following fractures around the knee is not uncommon, one out of six fractures may have significant instability. Identifying and addressing is key for a satisfactory outcome and to avoid its sequalae.

Refining Environmental Sustainability Governance Reports through Fuzzy Systems Evaluation and Scoring

Environmental, Social, and Governance (ESG) reports have become essential tools for enterprises to showcase their commitment to sustainable development and social responsibility. However, discrepancies persist regarding the criteria, assessments, and ratings disclosed in these reports. Moreover, there is a need for more objective methods to determine the weight distribution of indicator items. This study introduces a novel approach utilizing semantic variables in fuzzy theory and a multiple logic fuzzy inference system to develop an ESG environmental management performance assessment model. Therefore, this paper aims to develop a novel approach utilizing semantic variables and a multiple logic fuzzy inference system to quantitatively evaluate the sustainable performance of an environmental management plan. This research also aims to ensure fair and objective assessment outcomes, providing valuable guidance for enterprises in implementing performance management strategies. Key aspects investigated include the impact of membership functions, the extended utilization of semantic variables and logical rules, a comparative analysis of traditional weight assessments, and the limitations of applying fuzzy theory. Through comprehensive discussions and calculations, it is evident that fuzzy theory offers considerable flexibility in application. By tailoring fuzzy rules and selecting appropriate membership functions, diverse application scenarios can be accommodated. The Fuzzy systems evaluation and scoring EMP model generates EMP evaluation scores ranging from 1.76 to 8.29 for Gaussian membership, 1.80 to 8.19 for Triangular membership-A, 1.92 to 8.00 for Triangular membership-B, and 1.81 to 8.19 for Quadrilateral trapezoidal membership, based on simulated rating scenarios using the semantic variables of completeness and feasibility. This approach successfully incorporates distribution logic from subjective membership degrees to evaluate EMP scores. The findings demonstrate that fuzzy theory enables the consideration of multiple factors and facilitates the provision of objective-level membership, underscoring its potential in addressing complex evaluation challenges. This study illuminates the versatility of the fuzzy system theory, with its applications poised to extend across various domains.

Local Ancestry Inference Based on Population-Specific Single-Nucleotide Polymorphisms-A Study of Admixed Populations in the 1000 Genomes Project.

Human populations have interacted throughout history, and a considerable portion of modern human populations show evidence of admixture. Local ancestry inference (LAI) is focused on detecting the genetic ancestry of chromosomal segments in admixed individuals and has wide applications. In this work, we proposed a new LAI method based on population-specific single-nucleotide polymorphisms (SNPs) and applied it in the analysis of admixed populations in the 1000 Genomes Project (1KGP). Based on population-specific SNPs in a sliding window, we computed local ancestry information vectors, which are moment estimators of local ancestral proportions, for two haplotypes of an admixed individual and inferred the local ancestral origins. Then we used African (AFR), East Asian (EAS), European (EUR) and South Asian (SAS) populations from the 1KGP and indigenous American (AMR) populations from the Human Genome Diversity Project (HGDP) as reference populations and conducted the proposed LAI analysis on African American populations and American populations in the 1KGP. The results were compared with those obtained by RFMix, G-Nomix and FLARE. We demonstrated that the existence of alleles in a chromosomal region that are specific to a particular reference population and the absence of alleles specific to the other reference populations provide reasonable evidence for determining the ancestral origin of the region. Contemporary AFR, AMR and EUR populations approximate ancestral populations of the admixed populations well, and the results from RFMix, G-Nomix and FLARE largely agree with those from the Ancestral Spectrum Analyzer (ASA), in which the proposed method was implemented. When admixtures are ancient and contemporary reference populations do not satisfactorily approximate ancestral populations, the performances of RFMix, G-Nomix and FLARE deteriorate with increased error rates and fragmented chromosomal segments. In contrast, our method provides fair results.

Pornography, sexual privacy and copyright

This article proposes a new paradigm in the consideration of privacy in pornographic works in copyright enforcement actions. It focuses particularly on attempts to threaten individuals with copyright infringement action based on a speculative invoicing model. We approach this issue from the perspective of the right to sexual privacy of alleged infringers, which, as we argue, is particularly pertinent for pornographic works. The courts in England and Wales have broadly recognised the role of individual privacy and embarrassment caused to alleged infringers in the leading cases of Golden Eye and subsequently in Mircom, but the law remains unclear with no real recognition of, or meaningful mechanisms in place to address, the underlying issues. The article points out that this is due to a fundamental lack of appreciation of sexual privacy at a conceptual level in the context of consumption of pornography in the internet age, and consequent failure to consider this in copyright enforcement proceedings. We argue that the law should achieve a balance between the right holder's interest and the sexual privacy of alleged infringers, and copyright enforcement actions need to be approached with this in mind. This calls for a fundamental reconceptualisation of the right to privacy, and we call upon the courts to recognise and balance the sexual privacy rights of the alleged infringers of copyright in pornographic works with the interests of the right holders in certain copyright enforcement actions to achieve fair and equitable outcomes.

The impact of the COVID-19 pandemic on higher education: Assessment of student performance in computer science.

The COVID-19 pandemic had radically changed higher education. The sudden transition to online teaching and learning exposed, however, some benefits by enhancing educational flexibility and digitization. The long-term effects of these changes are currently unknown, but a key question concerns their effect on student learning outcomes. This study aims to analyze the impact of the emergence of new models and teaching approaches on the academic performance of Computer Science students in the years 2019-2023. The COVID-19 pandemic created a natural experiment for comparisons in performance during in-person versus synchronous online and hybrid learning mode. We tracked changes in student achievements across the first two years of their engineering studies, using both basic (descriptive statistics, t-Student tests, Mann-Whitney test) and advanced statistical methods (Analysis of variance). The inquiry was conducted on 787 students of the Lublin University of Technology (Poland). Our findings indicated that first semester student scores were significantly higher when taught through online (13.77±2.77) and hybrid (13.7±2.86) approaches than through traditional in-person means as practiced before the pandemic (11.37±3.9, p-value < 0.05). Conversely, third semester student scores were significantly lower when taught through online (12.01±3.14) and hybrid (12.04±3.19) approaches than through traditional in-person means, after the pandemic (13.23±3.01, p-value < 0.05). However, the difference did not exceed 10% of a total score of 20 points. With regard to the statistical data, most of the questions were assessed as being difficult or appropriate, with adequate discrimination index, regardless of the learning mode. Based on the results, we conclude that we did not find clear evidence that pandemic disruption and online learning caused knowledge deficiencies. This critical situation increased students' academic motivation. Moreover, we conclude that we have developed an effective digital platform for teaching and learning, as well as for a secure and fair student learning outcomes assessment.

The Role of Early Mobilization in Outcome of Proximal Tibia Fractures Treated with Dual Plating

The management of bicondylar fracture of the proximal tibia is a challenging task and the aim of management is to achieve stable, painless and mobile joint and also to prevent the secondary degeneration of the joint. Open reduction and internal fixation with dual plating in such fractures is beneficial to address fracture fragments in different planes and also to achieve anatomical reduction under direct vision. It also allows stabilizing the fracture which helps in early mobilization of the patient. Early post-op rehabilitation is one the most important factor that play a vital role in outcome of the operated knees by preventing the post- operative stiffness and achieving good range of motion. This is a retrospective study conducted in Department of Orthopedic Surgery, Kurmitola General Hospital, Dhaka, Bangladesh from July to December 2022. Total 100 patients were included in the study. The functional outcome was evaluated according to Rasmussen scoring system. Mal-reduction of the articular surface was defined as an intra- articular step-off of at least 2 mm measured on scaled radiographs. Oldest patient was 71 years and youngest patient was 20 years old. Male were 79% and female were 21%. All the patients with bicondylar fracture treated with dual plating. Data was obtained from the Medical record department, indoor ward records, OPD registers and Operation theatre records. This study analyses the outcome of bicondylar proximal tibia fracture treated with dual plating in 100 patients. In our series we found 63 % excellent results and 28 % good results, while 7 % and 2% fair and poor outcome respectively. Fractures of proximal tibia are increasing with the increase in mechanization and increased road traffic in current world today. These fractures are more in men and those who use automobiles frequently for their outdoor ventures. Better preoperative planning in selection of approach can minimize the soft tissue injury and unnecessary periosteal stripping. ......

Assessing Functional Outcome of PHILOS Plate Fixation in Proximal Humerus Fractures- A Prospective Study

Introduction: Despite the availability of numerous treatment options, managing unstable proximal humeral fractures remains a significant surgical challenge. Utilizing a PHILOS plate is an effective surgical technique for addressing these fractures. This approach provides stability and support to the fracture site, promoting proper healing and potentially improving patient outcomes. Aim of the study: The aim of this study was to assess the functional outcome of PHILOS plate fixation in proximal humerus fractures. Methods: This prospective study was conducted in the the Department of Orthopedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Sher-e-Bangla Nagar, Dhaka, Bangladesh during the period from January 2009 to December 2010. A total of 80 patients aged over 18 years were included in the study. Patients with open, pathological and ipsilateral distal fractures in the same limb were excluded from the study. Result: The youngest and the oldest one were 23 and 78 years respectively. Majority of the patients were male and business was their main occupation. Fifty patients (62.5%) presented with 3-part fractures, ten (12.5%) with four-part fractures and twenty (25%) with fracture dislocation. The interval between injury and plate fixation was 18 days and minimum and maximum interval was 2 and 78 days respectively. Majority (92.5%) of the injury was caused by high-velocity accident. Evaluation of the outcome at 6 months showed that 62.5 percent of patients had good outcome, 25 percent patients had fair outcome. Conclusion: PHILOS plate fixation for proximal humeral fractures provides stable fixation and good functional outcomes, particularly in elderly patients.

TO EVALUATE THE FUNCTIONAL OUTCOME IN PATIENTS WITH FLOATING KNEE WHO UNDERWENT MAGNETIC RESONANCE IMAGING

Objective: The incidence of floating knee injuries has traditionally been underestimated. However, with the increased use of magnetic resonance imaging (MRI) and arthroscopy, their frequency has risen. There is a crucial need to classify this complex injury pattern by also considering associated soft-tissue injuries. Soft-tissue injuries might be missed during clinical examination due to tenderness and swelling but can be detected through immediate MRI scans. This study aimed to evaluate the functional outcomes of patients with floating knee injuries who underwent MRI for soft tissue injuries. Methods: This study was conducted at a tertiary care center from February 2021 to January 2024. The study involved 100 patients with floating knee injuries who underwent MRI assessments for soft-tissue injuries. Follow-ups were scheduled at 1 month, 3 months, 6 months, and 1 year, with a maximum follow-up duration of 2½ years. The outcomes of floating knee injuries were assessed using the Karlstrom Olerud criteria. Results: Among 100 patients with floating knee injuries who underwent MRI, 72 had meniscus or ligament injuries, and nine had patellar fractures with extensor mechanism rupture. According to the Karlstrom Olerud criteria, seven patients had excellent outcomes, 46 had good outcomes, 33 had fair outcomes, and six had poor outcomes. Eight patients were lost to follow-up. Conclusion: Our aim is to ensure timely and accurate treatment by thoroughly addressing all associated injuries, including often-overlooked ligament damage around the knee. To improve clinical outcomes, we recommend a multidisciplinary approach involving various specialists in the care of these patients.

Electoral system: concept and elements

The article focuses on the approaches towards understanding the concept of the electoral system, which may be the subject of research outside the field of law. The author distinguishes different opinions of foreign and Ukrainian scholars on the term “electoral system”, in particular, narrow and broad interpretation. The author analyzes the elements which inherently fill and reveal the concept of the electoral system. The article provides an overview of scientific research and concepts that study electoral systems, including the works of prominent Ukrainian and foreign scholars, as well as documents of international organizations and institutions. The author analyzes different approaches to the interpretation of the concept of “electoral system”, its legal nature and key elements that have a significant impact on the formation of elected bodies and the organization of electoral processes, and further establishment of democratic principles. The author presents various positions on the elements through which the concept of the electoral system is revealed, such as the electoral formula, electoral district, method of expressing the will of voters, structure of the ballot and the process of filling it out, method of voting, etc. The author shows the importance of these elements and how they are reflected in the definition and modification of different types of electoral systems. The author emphasizes the need for further study of the concept of an electoral system and its system-forming elements, which allow constructing an appropriate type of electoral system, in the context of Ukraine’s experience in organizing and conducting elections. This will have a positive impact on the process of improving the electoral systems used in the formation of elected bodies at the legislative level, which will consequently contribute to ensuring greater transparency of a number of electoral procedures, obtaining fair results and minimizing the risks of their distortion. The author outlines the problem of periodic unsystematic changes in electoral systems in the formation of elected bodies in Ukraine, which in turn generates negative trends in the decline of citizens’ electoral culture, trust in the results of voters’ expression of will and unpredictable consequences in the socio-political context.

A novel approach for assessing fairness in deployed machine learning algorithms

Fairness in machine learning (ML) emerges as a critical concern as AI systems increasingly influence diverse aspects of society, from healthcare decisions to legal judgments. Many studies show evidence of unfair ML outcomes. However, the current body of literature lacks a statistically validated approach that can evaluate the fairness of a deployed ML algorithm against a dataset. A novel evaluation approach is introduced in this research based on k-fold cross-validation and statistical t-tests to assess the fairness of ML algorithms. This approach was exercised across five benchmark datasets using six classical ML algorithms. Considering four fair ML definitions guided by the current literature, our analysis showed that the same dataset generates a fair outcome for one ML algorithm but an unfair result for another. Such an observation reveals complex, context-dependent fairness issues in ML, complicated further by the varied operational mechanisms of the underlying ML models. Our proposed approach enables researchers to check whether deploying any ML algorithms against a protected attribute within datasets is fair. We also discuss the broader implications of the proposed approach, highlighting a notable variability in its fairness outcomes. Our discussion underscores the need for adaptable fairness definitions and the exploration of methods to enhance the fairness of ensemble approaches, aiming to advance fair ML practices and ensure equitable AI deployment across societal sectors.

A Study Evaluating the Functional Outcomes of Mason Type III and IV Radial Head Fractures Treated With a Radial Head Prosthesis.

Objective This research aimed to assess the functional result of type III and IV radial head fractures that were treated using a radial head prosthesis. Methods A retrospective investigation was conducted on 70 patients with type III and IV radial head and neck fractures, as classified by Mason. The patients were hospitalized and received treatment at the Orthopaedics Department, where they had radial head prosthesis surgery for three years. Results Among the total of 70 cases, 42 (60%) cases were below the age of 40, while 28 (47%) cases were over 40 years. The average age was 36.4 years. The maximum age recorded was 54 years, while the lowest age recorded was 30 years. The female population outnumbered the male population. The majority of instances (42, 60%) were attributed to falls, while the remaining cases were caused by road traffic accidents (RTAs). Out of the total 70 instances, 52 cases (74.28%) exhibited right-side dominance, whereas 18 cases (25.72%) exhibited left-side dominance. Within our case study group, 56 (80%) cases fell under modified Mason's classification type Ill, totaling 56 instances. The remaining 20% of the cases, amounting to 11 cases, were classified as modified Mason's classification type IV. Among the 70 patients, 55 cases (78.58%) did not have any ligamentous damage, whereas seven (10%) cases had lateral ulnar collateral ligament (LUCL) injury and eight (11%) cases had medial collateral ligament (MCL)injury. The P value for flexion, extension, pronation, and supination was shown to be very significant. Out of the total, 47 (67%) instances had an MEPI score (Mayo Elbow Performance Index) of more than 90, indicating exceptional performance. In addition, 16 cases (22.85%) had an MEPI score ranging from 75 to 89, which is considered a good result. Lastly, seven cases (10%) had an MEPI score ranging from 60 to 74, indicating a fair result. Conclusion The use of a radial head prosthesis is considered a viable option for managing severe and irreparable fractures of the radial head. Effective outcomes hinge on meticulous preoperative planning, skilled intraoperative techniques, and intensive postoperative rehabilitation. These elements collectively contribute to achieving consistent and favorable results in patients undergoing this surgical intervention.

The functional outcome of surgical management of distal femur fractures using a distal femoral locking compression plate.

Objective: To evaluate the functional outcomes following surgical intervention for distal femur fractures using femoral locking compression plates. Study Design: Descriptive study an Observational study. Setting: Department of Orthopedics, MTI Mardan Medical Complex in Mardan. Period: January 2023 to December 2023. Methods: Was conducted on 86 patients with distal femur fractures treated with femoral locking compression plates at the Orthopedic Ward. The sampling method employed was non-probability consecutive sampling. All surgeries were performed using a standardized technique by an experienced surgeon. Functional outcomes were assessed using the Oxford Society score six weeks post-procedure. Data analysis was conducted using SPSS 23, with significance set at p ≤ 0.05. Results: Of total 86 patients, n=57(66.3%) were male while n=29(33.7%) were female. Mean age was 35.43±10.49. Overall, 39 patients (45.3%) had excellent functional outcomes, 22 patients (25.6%) had good functional outcomes, 13 patients (15.1%) had fair functional outcomes, and 12 patients (14.0%) had poor functional outcomes. After cross tabulation with functional outcomes, gender and BMI were found insignificant with p value of 0.584 and 0.399 respectively. While diabetes, hypertension and age was found to be significantly associated with functional outcomes with p value of &lt;0.001,0.005 and &lt;0.001 respectively. Conclusion: The use of locking compression plates for distal femur fractures resulted in predominantly favorable functional outcomes with minority of patients experiencing poor outcomes. Additionally, diabetes, hypertension, and age emerged as significant predictors of functional outcome.

Functional Outcomes of Bipolar Hemiarthroplasty in Unstable Intertrochanteric Femur Fractures in the Elderly: A Prospective Study.

Background Intertrochanteric femur fractures are relatively common injuries among elderly individuals. Treatment options include fixation of intertrochanteric fractures using proximal femoral nails (PFNs), dynamic hip screws (DHSs), and unipolar and bipolar hemiarthroplasty. Unstable types of intertrochanteric fractures (Arbeitsgemeinschaft für Osteosynthesefragen (AO) types 31-A2 and A3) are more common in elderly osteoporotic people. Intertrochanteric femur fractures having a subtrochanteric extension, comminution at the posteromedial cortex, and reverse obliquity are considered to be unstable. The purpose of the study is to evaluate the functional outcomes of an unstable intertrochanteric femur fracture treated with bipolar hemiarthroplasty as the primary treatment option. Aims and objectives This study aims to assess the functional outcomes of bipolar hemiarthroplasty in unstable intertrochanteric fractures in the elderly using the Harris Hip Score (HHS) and the Merle d'Aubigné and Postel Criteria. The time point of assessment was from August 2016 to August 2018. Material and methods Fifteen elderly patients with unstable intertrochanteric fractures of the femur were treated with cemented bipolar hemiarthroplasty. Patients with unstable femur fractures or with osteoporosis and age above 65 years were included in the study. Harris Hip Score and the Merle d'Aubigné and Postel Criteria were used to measure functional outcomes. Patients were followed up at the first, third, and sixth months and subsequently at the end of one year. Results The mean age of the patients was 78.73 years. The majority (11) of the patients were female (73%). The average operative time was 119 minutes, the average blood loss was 380 ml, the mean postoperative hospital stay was 12 days, and the average time taken for mobilization was four days. An average of 15 elderly patients with unstable intertrochanteric fractures of the femur were treated with cemented bipolar hemiarthroplasty. The HHS on the first follow-up was 42.44 (SD of 6.52), followed by a score of 64.43 (SD of 8.11) on the second follow-up, 82.32 (SD of 2.81) on the third follow-up, and 84.23 (SD of 3.15) on the fourth follow-up. Eleven patients had good results, and two had fair results at the one-year follow-up, according to the HHS. According to the Merle d'Aubigné and Postel Criteria, 11 patients had very good results, and two had moderate results at the one-year follow-up. The average Merle d'Aubigné score was 14.6 on the final follow-up after one year. Conclusion Bipolar hemiarthroplasty in an unstable intertrochanteric femur fracture in the elderly results in better functional outcomes, as it helps in early full weight-bearing mobilization, which significantly decreases complications of prolonged immobilization and can be safely considered in the treatment of unstable intertrochanteric fractures in elderly patients.

Comparison of the functional outcome of Philos Plate Vs. external fixator in the management of proximal humerus fracture

Background: Proximal humerus fractures, are a major medical issue that are relatively prevalent. 4-5% of all fractures are proximal humeral fractures, most of which involve older and osteoporotic individuals. Objectives: To compare the functional outcome of philos plate vs. external fixator in the management of proximal humerus fracture. Material and Methods: A retrospective comparative study was conducted at the Department of Orthopaedic Surgery, Ghurki Trust Teaching Hospital, Lahore. From November 23, 2022, to May 23, 2023. After approval from the hospital's ethical board, 112(56 per group) patients were included in the study through an emergency. Informed consent was taken from parents. We stratified patients into two groups. Group A received the treatment of Philos, while Group B received the external fixator treatment. Functional outcome was assessed at the end of 3 months postoperatively using constant shoulder score. The collected data were entered and analyzed accordingly using SPSS version 27. Results: In the current study, a total of 112 patients included underwent two surgical interventions, among these, 56 patients underwent Philos plating while an equal number of patients underwent external fixation. In Group A and B, the majority were males (37:47) out of 112. The mean age of patients was equal in both groups (Group A=44.36±11.71), and the mean age of patients was (Group A=44.88±10.05), ranging from 20 to 80 years. In Group A, the average BMI was less than 24.29±4.23, ranging from 18-35 kg/m2, compared to Group B, 28.89±3.77, ranging from 22-35 kg/m2. 38(67.9%) were effected from right side as in Group A while 41(73.2%) were effected from right side in Group B. Majoruty 28(50.0%) had history of RTA in Group A while patients 24(42.9%) were observed with history of RTA in Group B25(44.6%) cases reported excellent outcome, 6(10.7%) reported very good outcome, 16(21.4%) good, 7(12.5%) fair and 2(3.6%) poor outcome in Group A. In Group B, 36(64.3%) excellent, 7(12.5%) very good, 12(21.4%) cases reported Good and 1(1%) reported fair outcome. So it is concluded that 25(44.6%) cases reported excellent outcome in Group A, comparatively low as compared to Group B 36(64.3%). Only age was significantly associated with excellent outcomes as p&lt;.05. Conclusion: It is concluded that External fixation demonstrated a better outcome as compared to Philos Plating, so in Orthopaedic practice, External fixation should be preferred for patients diagnosed with proximal humerus fracture to get better results and reduce the complications.