Fracture Site Research Articles

Usefulness of non-surgical treatment without weight bearing restriction versus surgical treatment for maintaining activities of daily living in patients with peri-prosthetic femoral fractures.

Non-surgical treatment without weight-bearing restriction, even in the early post-injury phase, may have a favourable effect on the activities of daily living (ADLs) in elderly patients with peri-prosthetic femoral fractures (PFFs). This study aimed to assess the effectiveness of surgical and non-surgical treatments for PFFs in terms of ADL maintenance and clinical safety. This retrospective cohort study included 44 patients with PFFs proximal to the stem fixation site without stem loosening. Rehabilitation with weight bearing was initiated after internal fixation of the fracture site in the surgical group (n = 12) and immediately after the injury in the non-surgical group (n = 32). Clinical and radiological outcomes, including time until the first weight-bearing exercise, time until independent walking, ADL deterioration, and bone union rate, were compared between groups. Independent risk factors for ADL deterioration were also evaluated. The time until first weight-bearing exercise was shorter and the ADL deterioration rate was smaller in the non-surgical group than in the surgical group (8.8 ± 9.2 vs. 21 ± 13 days, P = 0.004; 6.2% vs. 12.5%, P = 0.04, respectively). Bone union rates were similar between groups (91% vs. 83%, P = 0.42), and aseptic loosening of the stem was not observed. Time until first weight-bearing exercise was identified as an independent risk factor for ADL deterioration (odds ratio, 1.13; 95% confidence interval, 1.01-1.26; P = 0.03). Non-surgical treatment of PFFs proximal to the stem fixation site without stem loosening, which does not restrict early weight-bearing exercise after injury, is an effective and safe treatment procedure that maintains ADL performance in elderly patients.

Utility of ultrasound imaging in monitoring fracture healing in rat femur: Comparison with other imaging modalities

ObjectiveFractures are common injuries and various imaging modalities are employed to diagnose and monitor bone union. However, the follow-up of fracture healing using ultrasound imaging (US) remains a topic of debate. In this study, we analyzed of fracture healing process and compared US and radiological analyses with histological analyses to clarify the characteristics and limitations of each modality. MethodsAn osteotomy model was created using the femur of Wistar rats, and US, radiological (radiography and micro-computed tomography (micro-CT)), and histological analyses were performed. Radiological assessments were conducted for the evaluation of calcified tissue. The gap between the bony callus and cartilaginous callus was measured. ResultsUS effectively captured changes on the fracture surface, potentially reflecting the early healing processes. Both US and radiographic findings showed strong correlation in terms of the decrease in the bony callus gap. US was unable to distinguish cartilaginous callus from the surrounding soft tissue. During the remodeling stage, micro-CT offered a detailed assessment of the internal fracture surface, whereas US was limited to evaluating the outer bone surface and lacked accuracy in visualizing the entire fracture site. Radiography provided a general overview of the fractures. The decrease in the bony callus gap measured using US correlated with the reduction in cartilaginous callus observed histologically. ConclusionThis study demonstrated that US could be a valuable tool for evaluating fracture healing. Combining fracture management with US and radiological examinations may provide a more accurate assessment of healing progress.

Design and field evaluation of hydraulic fracturing boreholes for terminal mining faces

The terminal mining is an essential part of fully mechanized mining, and the reasonable length of the flap roof during the terminal mining is an important basis for the smooth operation of the terminal mining. With the research background of the 213 working face of the Longde Coal Mine, the contribution of this study is the influence law of hydraulic fracturing on the terminal mining mechanical behavior of the working face. Four different numerical calculation models of terminal mining hydraulic fracturing are established, and the optimal hydraulic fracturing site plan is determined according to the length of the terminal mining flap top and the working resistance of hydraulic support. The effect of hydraulic fracturing construction and the law of mechanical behavior in the terminal mining stage in the field test are analyzed. The results show that through hydraulic fracturing technology, the control of the length of the flap roof of the working face during the terminal mining period has been realized.

Postmortem CT and autopsy findings in an elevator-related death: a case report

AbstractElevator-related fatalities and injuries are rarely discussed. Falls have been identified as the first cause of mortality in the majority of these accidents. Evidence suggests that many elevator accidents may be attributed to inadequate equipment maintenance or malfunctions of the devices. This study examines a case involving an elevator maintenance worker found within an elevator shaft, using postmortem computed tomography (PMCT) along with a full autopsy. The autopsy revealed that the cause of death was severe polytrauma resulting from dragging, compression, and crushing mechanisms, which resulted in a dislocated skull and multiple thoraco-abdominal injuries, including exposed organs and viscera. Detailed examination identified a cranio-encephalic crush, leading to a significant alteration in the physiognomy of the facial structures. Additionally, PMCT revealed complex spinal fractures, such as a Jefferson fracture and a complete Chance fracture at the D6 vertebra, accompanied by spinal deviation proximal to the fracture site. Autopsy findings corroborated these PMCT results. A multidisciplinary approach, including PMCT, is proposed as a strategic method for the comprehensive reconstruction of such accidents, facilitating the collection of extensive data.

A novel 4-point scleral fixation technique with a hydrophobic IOL: The LOTO technique.

to describe a new surgical technique that combines 4-point, flanged polypropylene scleral fixation with a hydrophobic IOL. Using the Envista MX60 and 6.0 polypropylene, scleral 4-point fixation was achieved using a flanged-suture technique 5 times in a model eye and in a case series of 8 patients, retrospectively reviewed. The polypropylene is passed through each eyelet in a novel configuration (LOTO: Loop to Optic and Trailing ends to Outside). Conjunctival peritomies, scleral flaps/pockets, glue, and suture knots are avoided. The load needed for haptic fracture and scanning electron microscopy (SEM) at fracture sites were studied. Haptic fracture occurred once following the first model eye implantation due to excessive suture tension. The fracture load was similar between the LOTO and the simple-pass technique (1.08 ± 0.52 N vs 1.09 ± 0.32 N), suggesting no safety compromise. SEM did not disclose cheese-wiring effect. Over a mean follow-up of 10.8 months (range: 3 to 19; median 11.5 months), all cases experienced visual improvement with best-achieved-postoperative uncorrected visual acuity (BAPUCVA) of 20/25-20/200, and the IOL was well-centered. Postoperative IOL tilt averaged 2.9 degrees (range: 0 to 9.6; median: 2.9 degrees). Two patients developed post-operative CME treated topically. The first case developed flange extrusion that was readily repaired in clinic. This novel technique adds 2 main advantages to previously described flanged-suture techniques: 1) 4-point fixation of a hydrophobic IOL and 2) immediate application at the time of initial complicated cataract surgery since it requires no additional supply, IOL, or instrumentation.

The Use of Nitinol Staples as Reduction Aids in Fixation of Forearm Diaphyseal Fractures: Surgical Technique and Case Series.

Forearm diaphyseal fractures are common orthopedic injuries that typically require surgical intervention using various implants and approaches. Maintaining reduction while simultaneously achieving compression in radial and/or ulnar shaft fractures during compression plate application can be challenging, particularly with unstable segmental and/or transverse fracture patterns. Nitinol compression staples have become increasingly used as a reduction aid because of their ability to provide continuous compression between the staple legs at the fracture site, low profile, and ease of application. These staples have the potential to be an effective means of maintaining reduction and applying compression before definitive plate fixation for radial and ulnar shaft fractures. We present our surgical technique and an associated patient series detailing our institution's experience, highlighting favorable outcomes and potential considerations when using nitinol compression staples for forearm fracture management.

Prevalence Characteristics of Osteoporosis Fractures in the Elderly in Two Regions of China and Analysis of the Lag Effect of Air Pollutants on them.

Air pollution is increasing and threatening human health. The objective of this study is to investigate the population distribution characteristics of elderly osteoporosis fractures in Hebei Province and Xinjiang Uygur Autonomous Region and to analyze the effects of air pollutants on the number of elderly osteoporosis fracture inpatients in the two regions. A retrospective collection of elderly osteoporosis fracture cases was conducted in selected hospitals in Hebei Province and Xinjiang Uygur Autonomous Region from January 1, 2018 to December 31, 2022. The chi-square test was used to compare the distributional characteristics of the population in the two regions. Additionally, we used a distributed lag nonlinear model (DLNM) in order to assess the effect of air pollutants on the number of daily hospital admissions of elderly osteoporosis fracture patients in different regions. A total of 19,203 elderly osteoporosis fracture patients were included in the study. The average age of these patients was 76.66 ± 7.55 years, and the majority of them were female (13,514 instances, 70.37%). The disparities in age distribution (χ2 = 133.9 p < 0.001), fracture site (χ2 = 62.0 p < 0.001), and hospitalization cost (Z = -15.635 p < 0.001) between the two regions were statistically significant. The lag effect curves of PM2.5, PM10, and NO2 on the number of elderly osteoporosis fracture hospitalizations in Xinjiang Uygur Autonomous Region exhibited a similar pattern resembling a "W"-shaped curve. All three pollutants reached their highest values after a lag time of 14 days (PM2.5: RR = 1.053, 95% CI: 1.031, 1.074; PM10: RR = 1.031, 95% CI: 1.018, 1.043; NO2: RR = 1.125, 95% CI: 1.070, 1.182). In Hebei Province, the largest impacts of PM2.5 and PM10 were observed after a lag of 14 days (PM2.5: RR = 1.022, 95% CI: 1.013, 1.028; PM10: RR = 1.013, 95% CI: 1.008, 1.018). Similarly, the maximum effect of NO2 was observed after a lag of 11 days (RR = 1.020, 95% CI: 1.010, 1.028). There were differences in the epidemiological characteristics of hospitalized patients with osteoporosis fractures between the two regions, PM2.5, PM10, and NO2 increased the number of hospitalizations for osteoporosis fractures. Exposure to air pollutants such as PM2.5 increases the risk of osteoporosis fractures in the elderly population.

Stimulation of fracture mineralization by salt-inducible kinase inhibitors.

Over 6.8 million fractures occur annually in the US, with 10% experiencing delayed- or non-union. Anabolic therapeutics like PTH analogs stimulate fracture repair, and small molecule salt inducible kinase (SIK) inhibitors mimic PTH action. This study tests whether the SIK inhibitor YKL-05-099 accelerates fracture callus osteogenesis. 126 female mice underwent femoral shaft pinning and midshaft fracture, receiving daily injections of PBS, YKL-05-099, or PTH. Callus tissues were analyzed via RT-qPCR, histology, single-cell RNA-seq, and μCT imaging. Biomechanical testing evaluated tissue rigidity. A hydrogel-based delivery system for PTH and siRNAs targeting SIK2/SIK3 was developed and tested. YKL-05-099 and PTH-treated mice showed higher mineralized callus volume fraction and improved structural rigidity. RNA-seq indicated YKL-05-099 increased osteoblast subsets and reduced chondrocyte precursors. Hydrogel-released siRNAs maintained target knockdown, accelerating callus mineralization. YKL-05-099 enhances fracture repair, supporting selective SIK inhibitors' development for clinical use. Hydrogel-based siRNA delivery offers targeted localized treatment at fracture sites.

The observation that older men suffer from hip fracture at DXA T-scores higher than older women and a proposal of a new low BMD category, osteofrailia, for predicting fracture risk in older men.

The clinical significance of osteoporosis lies in the occurrence of fragility fractures (FFx), and the most relevant fracture site is the hip. The T-score is defined as follows: (BMDpatient-BMDyoung adult mean)/SDyoung adult population, where BMD is bone mineral density and SD is the standard deviation. When the femoral neck (FN) is measured in adult Caucasian women, a cutpoint value of patient BMD of 2.5 SD below the young adult mean BMD results in a prevalence the same as the lifetime risk of hip FFx for Caucasian women. The FN T-score criterion for classifying osteoporosis in older Caucasian men has been provisionally recommended to be - 2.5, but debates remain. Based on a systematic literature review, we noted that older men suffer from hip FFx at aFN T-score approximately 0.5-0.6 higher than older women. While the mean hip FFx FN T-score of around - 2.9 for women lies below - 2.5, the mean hip FF FN T-score of around - 2.33 for men lies above - 2.5. This is likely associated with that older male populations have a higher mean T-score than older female populations. We propose a new category of low BMD status, osteofrailia, for older Caucasian men with T-score ≤ - 2 (T-score ≤ - 2.1 for older Chinese men) who are likely to suffer from hip FFx. The group withT-score ≤ - 2 for older Caucasian men is comparable in prevalence to the group withT-score ≤ - 2.5 for older Caucasian women. However, older men in such category on average have only half the FFx risk as that of older women with osteoporotic T-score.

Median nerve lesions in pediatric displaced supracondylar humerus fracture: A prospective neurological, electrodiagnostic and ultrasound characterization.

Supracondylar humerus fractures (SCHFs) are the most common elbow fractures in children. Traumatic median nerve injury and isolated lesions of its pure forearm motor branch, anterior interosseus nerve (AIN), have both been independently reported as complications of displaced SCHFs. Our main objectives were to characterize the neurological syndrome to distinguish median nerve from AIN lesions and to determine the prognosis of median nerve lesions after displaced SCHFs. Ten children were prospectively followed for an average of 11.6 months. Patients received a standardized clinical examination and high-resolution ultrasound of the median nerve every 1-3 months starting 1-2 months after trauma. Electrodiagnostic studies were performed within the first 4 months and after complete clinical recovery. All children shared a clinical syndrome with predominant but not exclusive affection of AIN innervated muscles. High-resolution ultrasound uniformly excluded persistent nerve entrapment and neurotmesis requiring revision surgery but visualized post-traumatic median nerve neuroma at the fracture site in all patients. Electrodiagnostic studies showed axonal motor and sensory median nerve neuropathy. All children achieved complete functional recovery under conservative management. Motor recovery required up to 11 months and differed between involved muscles. It was shown that neurological deficits of the median nerve in displaced SCHFs exceeded an isolated AIN lesion. Notably, detailed neurological follow-up examinations and sonographic exclusion of persistent nerve compression were able to guide conservative therapy in affected children. Under these conditions the prognosis of median nerve lesions was excellent despite severe initial deficits, development of neuroma and axonal injury.

Study on Laser Transmission Welding Technology of TC4 Titanium Alloy and High-Borosilicate Glass.

As the demand for high-performance dissimilar material joining continues to increase in fields such as aerospace, biomedical engineering, and electronics, the welding technology of dissimilar materials has become a focus of research. However, due to the differences in material properties, particularly in the welding between metals and non-metals, numerous challenges arise. The formation and quality of the weld seam are strongly influenced by laser process parameters. In this study, successful welding of high-borosilicate glass to a TC4 titanium alloy, which was treated with high-temperature oxidation, was achieved using a millisecond pulsed laser. A series of process parameter comparison experiments were designed, and the laser welding behavior of the titanium alloy and glass under different process parameters was investigated using scanning electron microscopy (SEM) and a universal testing machine as the primary analysis and testing equipment. The results revealed that changes in process parameters significantly affect the energy input and accumulation during the welding process. The maximum joint strength of 60.67 N was obtained at a laser power of 180 W, a welding speed of 3 mm/s, a defocus distance of 0 mm, and a frequency of 10 Hz. Under the action of the laser, the two materials mixed and penetrated into the molten pool, thus achieving a connection. A phase, Ti5Si3, was detected at the fracture site, indicating that both mechanical bonding and chemical bonding reactions occurred between the high-borosilicate glass and the TC4 titanium alloy during the laser welding process.

Ultrasound Diagnosis of Clavicle Fractures in Newborns: A Systematic Review.

Fractures of the clavicle are the most common birth injury among newborns. Aim of this systematic review was to provide a comprehensive analysis of the role of ultrasound (US) in diagnosing clavicular fractures in neonates. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed and Embase, including studies focusing on US in neonatal clavicle fracture. Age at US, number of cases examined by US and X-ray, US and X-ray diagnoses, US probe used, fracture site were systematically extracted. A total of 231 articles were found. We ultimately selected 7 publications that satisfied the inclusion criteria, involving 136 patients examined between 3 days and 3 weeks of age, with 135 confirmed fractures. US was performed on all patients and correctly diagnosed all fractures (135/135, 100%). X-ray was performed on 94/136 patients (69.1%) and correctly diagnosed 89/93 fractures (95.7%). Fracture site was: medial in 2/79, middle in 37/79, and lateral in 40/79. In the remaining 57 cases, site was not reported. This review indicates that ultrasound is extremely reliable in diagnosing clavicle fractures in newborns and should be considered as the gold standard in this context.

Atraumatic Release of Incarcerated Inferior Rectus Muscle in Trapdoor Fracture Can Lead to Better Functional Outcome.

Deciding the proper surgical approach for repairing blowout fractures with entrapped soft tissue are among one of the most challenging decisions for maxillofacial surgeons. This is due to multiple factors including the type and site of fracture, time elapsed from trauma. Tranconjunctival, subciliary, and/or transantral endoscopic has been described before. The authors report here a case of a young adult, presenting with diplopia, pain, and enophthalmos after being exposed to a blunt trauma on the left side. Computed tomography (CT) scan confirmed diagnosis of left orbital floor fracture with trapped inferior rectus in a trapdoor manner. Although presentation was later than 48 hours from trauma, yet incorporating, minimally traumatic dual, transconjunctival-transantral endoscopic approach the inferior rectus muscle was preserved and regained full range of movement, after <3 months postoperatively.

Related factors of severe osteoporotic vertebral compression fracture and clinical outcomes of percutaneous kyphoplasty: A retrospective study.

Osteoporosis is the most common disease in postmenopausal women and the elderly, which can lead to vertebral compression fracture. To investigate the related factors of severe osteoporotic vertebral compression fracture (SOVCF) and evaluate the long-term outcomes of percutaneous kyphoplasty (PKP) for treating SOVCF through comparison with mild OVCF (MOVCF). From September 2015 to March 2019, 294 osteoporotic vertebral compression fracture (OVCF) patients treated with PKP were analyzed. Compression of the anterior margin of the fractured vertebral body beyond 2/3 of the original height was defined as SOVCF. Baseline data, clinical and imaging findings before and after surgery and at the last follow-up were recorded. Numerical Rating Scale (NRS) was used to evaluate low back pain, the Oswestry Disability Index (ODI) was used to evaluate activity of daily life. Anterior vertebral height (AVH) and local kyphosis angle (LKA) was used to evaluate radiographic outcomes. During the follow-up, patients with recurrent back pain were examined by MRI to identify new fractures and the incidence of adjacent vertebral fracture (AVF) was recorded. Age, sex, body mass index (BMI), dual energy X-ray absorptiometry based T value, duration of symptom, history of trauma, steroid use, and fracture site were collected for univariate logistic regression analysis Variables with a P-value of less than 0.05 were then included in multivariate analysis to determine the related factors for SOVCF. Logistic regression analysis indicated that longer duration of symptom (OR = 1.109, 95%CI: 1.038-1.185, P= 0.002), lower T value (OR = 0.332, 95%CI: 0.139-0.763, P= 0.001), and steroid use (OR = 31.294, 95%CI: 1.020-960.449, P= 0.049) were related factors of SOVCF. Compared with the MOVCF group, the SOVCF group had longer operation time (57.3 ± 13.51 minutes vs 44.9 ± 8.13 minutes, P< 0.001), more radiation exposure (39.9 ± 7.98 times vs 25.5 ± 4.01 times, P< 0.001), and higher cement leakage rate (55.81% vs 18.73%, P< 0.001). At the last follow-up, the SOVCF group had higher NRS (2.28 ± 0.85 vs 1.30 ± 0.71, P< 0.001), and ODI (16.23 ± 4.43 vs 12.88 ± 3.34, P< 0.001). After operation and at the last follow-up, the SOVCF group had higher LKA and lower AVH (all P< 0.05). The AVF rate at the last follow-up was higher in the SOVCF group at the last follow-up (4.78% vs 18.60%, P< 0.001). Lower T value, longer duration of disease, and steroid use were related factors of SOVCF. Compared with MOVCF, PKP for SOVCF had longer operation time, more radiation exposure, and higher cement leakage rate, and the long-term outcomes were worsen.

Imaging findings in suspected penile fracture: alternative diagnoses and surgical correlation.

The primary objective is to compare the imaging and surgical findings in a cohort of patients with suspected penile fracture (PF). Retrospective cohort study of all patients with suspected PF over an 11-year period at a tertiary referral andrology centre. All dedicated presurgical imaging with ultrasound (US) and MRI was analysed and correlated with intraoperative findings; alternative diagnoses were recorded. One hundred and ninety-three patients were included. One hundred and four (54%) had alternative diagnoses to PF including dorsal vein rupture and haematoma. Ninety-nine (51%) underwent surgical exploration of which 89 (46%) had PF. US correctly confirmed the presence and marked the site of fracture in 92% of cases. MRI was primarily used as a problem-solving tool (13 cases) and demonstrated a more extensive injury than US (12 cases). The reported size of tunical defect on imaging was a median of 7 mm (IQR 4-10) significantly smaller than on exploration (median 20 mm, IQR 10-30; P < .0001). US has a high positive predictive value in the confirmation of PF. MRI improves the detection and characterizing the extent of injury. Imaging marking informs surgical incision but defect size is under appreciated on all imaging modalities. Penile imaging has a high positive predictive value to not only confirm the diagnosis of PF but to stage the extent of injury and mark the skin, which impacts the surgical technique. Alternative diagnoses to fracture are common and imaging could prevent unnecessary surgical exploration.

Management of isolated favourable compound mandibular fractures: A retrospective study of outpatient versus inpatient in a tertiary health institution

AbstractBackgroundHospital admission is often a prerequisite for those who endure mandibular fractures, but disagreement arises among patients whose fractures are isolated and favourable.ObjectivesTo determine the rate and types of complications between the two cohorts of patients categorized as outpatient and inpatient treatment groups, and also the effect of outpatient management after closed reduction and maxillomandibular fixation.Materials and MethodsClinical and demographic data were collected retrospectively about patients who were treated for isolated, favourable, compound mandibular fractures between 1998 and 2022 to explore whether outpatient management is an independent variable influencing post‐operative complications. Bivariate and descriptive statistics were computed.ResultsSix‐hundred and sixty‐four (664) patients were evaluated (n = 335 in the study group and n = 329 in the control). There was equitable distribution of subjects between the two groups investigated in relation to their sex, age, aetiology of fractures, sites of fracture and their combinations per subject including number of fractures and duration of injury before treatment. Unifocal fractures occurred in 40.7% of subjects while multifocal fractures were seen in 59.3% (p = 0.04). The overall complication rate was 11.7%, more prevalent in multifocal than unifocal fractures (p = 0.001). Conversely, the complication rates of outpatient and inpatient cases were 11.4% and 12.1%, respectively with no significant difference (p = 0.81).ConclusionsThere was no difference between outpatient and inpatient treatment groups. Outpatient management was not a risk factor affecting post‐operative isolated favourable mandible fracture complications, if demographic and clinical confounding variables affecting treatment outcomes were controlled.

Lag screw versus locking plate fixation for traumatic displaced medial malleolar fractures: a systematic review and meta-analysis

BackgroundLag screw fixation (LSF) or locking plate fixation (LPF) are both recommended for the treatment of medial malleolar fractures (MMFs). However, no standard has been established for attaining optimal surgical treatment or functional recovery. We hypothesized that LPF for MMFs would result in superior outcomes compared to LSF. To test this hypothesis, we conducted a systematic review and meta-analysis of the clinical outcomes of LSF and LPF in the treatment of MMF. Patients and methodsWe searched for studies published prior to November 2023 across the PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases. Standardization of individual effect sizes was conducted; subsequently, pooled effect sizes were derived by employing random-effects models. ResultsFive retrospective studies involving 394 patients were reviewed. American Orthopedic Foot and Ankle Society (AOFAS) scores were significantly higher among patients who received LPF (mean difference [MD]: 2.21; 95% confidence interval [CI]: 0.37–4.04; p = 0.02) than among those who received LSF. Pain scores were significantly lower among patients who received LPF (MD: −0.35; 95% CI: −0.64 to −0.05; p = 0.02) than among those who received LSF. No significant differences in delayed union was observed between the groups (Relative risk [RR]: 1.43; 95% CI, 0.37–4.04; p = 0.42). Fixation failure was slightly higher in patients who received LSF than in those who received LPF (RR: 3.11; 95% CI, 0.88–11.01; p = 0.08). DiscussionCompared with LSF, LPF yields superior functional outcomes, superior patient comfort, and comparative complication rates. LPF is also better able to prevent rotation and apply compressive forces across fracture sites, which can facilitate the management of different types of MMF. Additional randomized controlled trials with larger sample sizes are warranted. Level of evidenceIII.

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

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

Routine Prescription of Proton Pump Inhibitors in the Perioperative Period is Associated With Decreased Rates of 2-Year Revision Surgery After Total Hip and Knee Arthroplasty

BackgroundProton pump inhibitors (PPIs) are often prescribed in conjunction with nonsteroidal anti-inflammatory drugs after total hip arthroplasty (THA) and total knee arthroplasty (TKA) due to their gastroprotective effects. In animal studies, it has been suggested that PPIs have immunosuppressive effects and impair fracture healing; however, the association between PPI use and adverse events following THA and TKA has not been well-studied. MethodsAn administrative claims database was queried for patients who underwent elective THA from 2010 to 2019. The experimental group consisted of patients who did not have a prior history of gastrointestinal bleeding or gastroesophageal reflux disease and who received a PPI prescription in the perioperative period. A 1:1 propensity score matching was used to create control cohorts of patients who did not have any PPI prescription filled, also matching for age, sex, and the Charlson Comorbidity Index. This same cohort selection and matching procedure was then repeated for patients undergoing elective TKA. In total, 11,450 patients were studied (3,103 TKA + PPI, 2,622 THA + PPI, 3,103 TKA controls, and 2,622 THA controls). The mean age was 64 years (range, 38 to 94), and 57% were women. Significance was considered at P < 0.05. ResultsPerioperative PPI prescription in TKA patients was associated with significantly lower rates of all-cause revision (3.0 versus 4.1%, P < 0.01) and periprosthetic joint infection (1.0 versus 1.8%, P < 0.01). In THA patients, PPI prescription was associated with a lower all-cause revision rate (2.8 versus 4.0%, P = 0.02). No significant differences were found between PPI and non-PPI groups for aseptic loosening, periprosthetic fracture, gastrointestinal bleeding, or surgical site infection in either cohort. ConclusionsPatients receiving routine PPI prescriptions in the perioperative period surrounding TKA and THA have a lower risk of all-cause revision surgery, and perioperative PPI use is associated with a decreased risk of PJI in patients undergoing TKA. As these results conflict with the few previous studies performed on this topic, additional controlled studies are warranted to fully elucidate the relationship between PPI use and adverse events after THA and TKA.

Paley cross union protocol for congenital pseudoarthrosis of the tibia

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; Congenital pseudarthrosis of the tibia (CPT) is a rare, dysplastic condition causing significant disability in the lower limbs. A treatment aims to achieve long-lasting union, prevent limb length discrepancies, and prevent soft tissue lesions. Traditional surgery often yields satisfactory results, but amputation may be proposed in failed cases. This report presents a congenital pseudarthrosis of the tibia and fibula, treated with the Paley cross-union protocol.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods &amp;lt;/strong&amp;gt;A 15-month-old girl presented with a crook-ed right lower leg at the age of two months, history of a right lower leg fracture at the age of eight months, and pain when moving her leg. She had undergone an initial surgical procedure to maintain tibia alignment with K-Wire insertion and was cast at a private hospital.&amp;amp;nbsp;&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results &amp;lt;/strong&amp;gt;The patient&amp;#039;s physical examination showed a cast causing limited range of motion, but no tenderness or distal neurovascular issues. The Paley cross-union protocol was performed, involving anterior approach, curettage, and insertion of a titanium intramedullary elastic nail into the tibia. The fracture site area was covered with a meshed periosteum layer and filled with synthetic bone grafts. A long leg cast was performed after the procedure. An imaging examination post-cross-union protocol showed a good result.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion &amp;lt;/strong&amp;gt;Cross-union for CPT represents a paradigm shift in the treatment of this horrible child disease. Given the promising result, the cross-union approach has to be regarded as a fresh criterion for treating CPT.&amp;lt;/p&amp;gt;