Fracture Group Research Articles

Identification of the miRNA-mRNA regulatory network in a mouse model of early fracture.

Fracture healing is a complex process that involves multiple molecular events, and the regulation mechanism is not fully understood. We acquired miRNA and mRNA transcriptomes of mouse fractures from the Gene Expression Omnibus database (GSE76197 and GSE192542) and integrated the miRNAs and genes that were differentially expressed in the control and fracture groups to construct regulatory networks. There were 130 differentially expressed miRNAs and 4,819 differentially expressed genes, including 72 upregulated and 58 downregulated miRNAs, along with 2,855 upregulated and 1964 downregulated genes during early fracture healing. Gene ontology analysis revealed that most of the differentially expressed genes were enriched in the extracellular matrix (ECM) structure and the ECM organization. The Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment suggested cell cycle, DNA replication, and mismatch repair were involved in the progression of fracture healing. Furthermore, we constructed a molecular network of miRNAs and mRNAs with inverse expression patterns to elucidate the molecular basis of miRNA-mRNA regulation in fractures. The regulatory network highlighted the potential targets, which may help to provide a mechanistic basis for therapies to improve fracture patient outcomes.

Novel Use of Fractal Analysis for Quantifying Polymethylmethacrylate Distribution Patterns in Osteoporotic and Malignant Vertebral Compression Fractures Following Vertebroplasty.

Purpose: Fractal analysis is a mathematical tool which allows the evaluation of complex microstructural features within materials that cannot be expressed in traditional geometric terms. The purpose of this study is to quantify the differences in polymethylmethacrylate intravertebral cement spatial distribution patterns following vertebroplasty using fractal analysis through the examination of osteoporotic and malignant compression fractures. Methods: Frontal and lateral post-vertebroplasty radiographs were evaluated from 29 patients with osteoporotic and malignant compression fractures who underwent vertebroplasty. The individually treated vertebra were divided into osteoporotic (n = 35) and malignant groups (n = 41). Images underwent segmentation, thresholding, and binarization prior to fractal analysis. Fractal dimension and lacunarity values were derived from the region of interest in treated vertebrae using the "box-counting" and "gliding-box" techniques respectively using ImageJ. The mean values of both parameters were compared between the 2 groups. Results: The mean fractal dimension was significantly higher in the malignant vertebral compression fracture group (1.53 ± 0.08) compared to the osteoporotic group (1.34 ± 0.17; P < .001). Similarly, mean lacunarity values were significantly higher in the malignant fracture group (0.50 ± 0.09) compared to the osteoporotic group (0.37 ± 0.10; P < .001). Conclusions: Fractal dimension and lacunarity values of cement spatial distribution patterns obtained from the post-vertebroplasty radiographs can differentiate between benign osteoporotic and malignant vertebral compression fractures. This novel technique may be useful for evaluating cement spatial distribution patterns in spine augmentation procedures, although further research is warranted in this area.

Long non-coding RNA MIAT serves as a biomarker of fragility fracture and promotes fracture healing

BackgroundFragility fracture is common in the elderly. Osteoblast differentiation is essential for bone healing and regeneration. Expression pattern of long non-coding RNA MIAT during fracture healing was examined, and its role in osteoblast differentiation was investigated.Methods90 women with simple osteoporosis and 90 women with fragility fractures were included. Another 90 age-matched women were set as the control group. mRNA levels were tested using RT-qPCR. Cell viability was detected via CCK-8, and osteoblastic biomarkers, including ALP, OCN, Collagen I, and RUNX2 were tested via ELISA. The downstream miRNAs and genes targeted by MIAT were predicted by bioinformatics analysis, whose functions and pathways were annotated via GO and KEGG analysis.ResultsSerum MIAT was upregulated in osteoporosis women with high accuracy of diagnostic efficacy. Serum MIAT was even elevated in the fragility fracture group, but decreased in a time manner after operation. MIAT knockdown promoted osteogenic proliferation and differentiation of MC3T3-E1, but the influences were reversed by miR-181a-5p inhibitor. A total of 137 overlapping target genes of miR-181a-5p were predicted based on the miRDB, TargetScan and microT datasets, which were mainly enriched for terms related to signaling pathways regulating pluripotency of stem cells, cellular senescence, and osteoclast differentiation.ConclusionsLncRNA MIAT serves as a promising biomarker for osteoporosis, and promotes osteogenic differentiation via targeting miR-181a-5p.

Prediction of subsequent fragility fractures: application of machine learning

BackgroundMachine learning (ML) has shown exceptional promise in various domains of medical research. However, its application in predicting subsequent fragility fractures is still largely unknown. In this study, we aim to evaluate the predictive power of different ML algorithms in this area and identify key features associated with the risk of subsequent fragility fractures in osteoporotic patients.MethodsWe retrospectively analyzed data from patients presented with fragility fractures at our Fracture Liaison Service, categorizing them into index fragility fracture (n = 905) and subsequent fragility fracture groups (n = 195). We independently trained ML models using 27 features for both male and female cohorts. The algorithms tested include Random Forest, XGBoost, CatBoost, Logistic Regression, LightGBM, AdaBoost, Multi-Layer Perceptron, and Support Vector Machine. Model performance was evaluated through 10-fold cross-validation.ResultsThe CatBoost model outperformed other models, achieving 87% accuracy and an AUC of 0.951 for females, and 93.4% accuracy with an AUC of 0.990 for males. The most significant predictors for females included age, serum C-reactive protein (CRP), 25(OH)D, creatinine, blood urea nitrogen (BUN), parathyroid hormone (PTH), femoral neck Z-score, menopause age, number of pregnancies, phosphorus, calcium, and body mass index (BMI); for males, the predictors were serum CRP, femoral neck T-score, PTH, hip T-score, BMI, BUN, creatinine, alkaline phosphatase, and spinal Z-score.ConclusionML models, especially CatBoost, offer a valuable approach for predicting subsequent fragility fractures in osteoporotic patients. These models hold the potential to enhance clinical decision-making by supporting the development of personalized preventative strategies.

Intertrochanteric femoral fracture with lateral wall fracture at the lag screw insertion site may cause postoperative anterior wall fracture and lead to deterioration in activities of daily living

BackgroundIncomplete reduction and fixation of intertrochanteric femoral fractures significantly affect patients' daily activities. The lateral wall's integrity is pivotal in such fractures. This study examines instability, particularly lateral wall fractures at the lag screw insertion site and postoperative anterior wall fractures. MethodsOverall, 161 patients with femoral intertrochanteric fractures were included. Three-dimensional computed tomography was conducted preoperatively and 3 weeks postoperatively to determine the postoperative anterior wall fractures incidence. Patient background, operative time, intraoperative blood loss, postoperative telescoping, and daily living activities were compared. ResultsThe study recorded 51 cases of lateral wall fractures at the lag screw insertion site and 17 of postoperative fractures of the anterior wall. Postoperative fractures of the anterior wall were found in 3 of 110 and 14 of 51 patients in the group without and with the lag screw insertion site, respectively. The group of postoperative fractures of the anterior wall had significantly lower bone mineral density, longer operative time, and increased intraoperative blood loss. At 4 weeks postoperatively, the group of postoperative fractures of the anterior wall showed increased telescoping and decreased motor component of the functional independence measure (with postoperative fractures of the anterior wall: 28, without postoperative fractures of the anterior wall: 30), and significant reductions were observed in the transfer and locomotion items, indicating lower limb function (with postoperative fractures of the anterior wall group: 11, without postoperative fractures of the anterior wall group: 12). ConclusionsPostoperative anterior wall fractures occurred in 27.5% cases with lateral wall fractures at the lag screw insertion site. Three-dimensional computed tomography is useful for preoperative evaluation of lateral wall fractures at the lag screw insertion site to assess instability. Postoperative fractures of the anterior wall related reduction in daily living activities needs attention.

Opioid use in impending versus pathologic proximal femur fractures.

e24061 Background: Pathologic and impending fractures commonly occur in the proximal femur, and patients may be prescribed opioids prior to surgery and often require opioids for postoperative pain relief. This study compared postoperative opiate usage and ambulatory functional status in patients with impending versus pathologic fractures in the proximal femur. Methods: This was a retrospective review of patients using opioids postoperatively who underwent internal fixation for a pathologic or impending fracture between 2016 and 2022. Preoperative and postoperative opioid usage as well as ambulation status and risk factors at three and six months associated with postoperative opioid use were recorded. Results: Twenty-four pathologic fractures and twenty-three impending fractures were included. Preoperative opioid daily morphine milligram equivalent (MME) was significantly higher in the pathologic fracture group (p = 0.021), but there were no significant differences at three or six months. In the impending fracture group, daily MME at three months was significantly higher than preoperative daily MME (p = 0.018) but returned to preoperative levels at six months. There was statistically significant improvement in ambulation status in the combined cohort (p = 0.008) and impending fracture cohort (p = 0.016) at 6 months. Conclusions: Although patients did not experience a significant postoperative change in opioid use, patients with pathologic fractures notably required higher opioid dosages and there was overall improvement in function following fixation. Future studies should examine postoperative opioid use with careful consideration of concurrent pain management pain therapies and tumor characteristics.[Table: see text]

Four-screw compression plate fixation for diaphyseal humerus fractures.

While many humeral shaft fractures can be successfully treated with nonoperative management, compression plating techniques using at least three or four screws on either side of the fracture are the current gold standard. We hypothesized that a less rigid construct using compression with only two screws on either side of the fracture can provide adequate strength for uneventful fracture union. This is a retrospective review of all the patients who underwent open reduction and compression plate fixation for acute diaphyseal humerus fractures (ADHFs) at an academic Level-1 urban trauma center between 2018 and 2023. Patients treated with compression plating using only two screws and three or four plate-holes on either side of the fracture (Group 1) were matched one-to-one with patients treated using the conventional number of screws (three or more on either side of the fracture - Group 2). The incidence of nonunion/malunion, infection, and implant failure was compared among the two groups. There were eleven matched patients in both groups. The nonunion, infection complications, and hardware failure rates were 0% and 9.1% for the control group (Group 2) and four-screw group (Group 1) respectively. This difference was not statistically significant (p = 1.00). Although convention dictates the use of six or more bicortical screws (at least three bicortical screws on each side of the fracture), four-screw bicortical fixation may be a feasible option for ADHFs treated with large fragment compression plating techniques.

Hip fracture is associated with a reduced risk of type 2 diabetes: A retrospective cohort study

ObjectivesType 2 diabetes mellitus (T2DM) shares a complex relationship with bone metabolism and few studies investigated the effect of impaired bone health on the risk of T2DM. This study was conducted to investigate the association between hip fractures and the risk of incident T2DM. MethodsThis is a retrospective cohort study using data from the real-world hip fracture cohort. Hong Kong Chinese patients aged ≥ 65 years without T2DM who were admitted to public hospitals due to a fall between 2008 and 2015 were included in the study. Patients who sustained falls with and without hip fractures were matched by propensity score (PS) at a 1:1 ratio. Competing risk regression was used to evaluate the association between hip fracture and incident T2DM, with death being the competing event. ResultsA total of 23,314 hip fracture cases were matched to 23,314 controls. The median follow-up time was 5.09 years. The incidence rate of T2DM was 11.947 and 14.505 per 1000 person-years for the hip fracture and control group respectively. After accounting for the competing risk of death, the hip fracture group had a significantly lower risk of developing T2DM (HR: 0.771, 95% CI: 0.719–0.827). Similar results were observed in all subgroups after stratification by age and sex. ConclusionsHip fracture was found to be associated with a reduced risk of T2DM. These findings provide insight into the topic of bone and glucose metabolism and prompt further research in evaluating the role of bone health in the management of T2DM.

Biomechanical study of a biplanar double support screw (BDSF) technique based on Pauwels angle in femoral neck fractures: finite element analysis.

The objective of the present study is to conduct a comparative analysis of the biomechanical advantages and disadvantages associated with a biplanar double support screw (BDSF) internal fixation device. Two distinct femoral neck fracture models, one with a 30° angle and the other with a 70° angle, were created using a verified and effective finite element model. Accordingly, a total of eight groups of finite element models were utilized, each implanted with different configurations of fixation devices, including distal screw 150° BDSF, distal screw 165° BDSF, 3 CLS arranged in an inverted triangle configuration, and 4 CLS arranged in a "α" configuration. Subsequently, the displacement and distribution of Von Mises stress (VMS) in the femur and internal fixation device were assessed in each fracture group under an axial load of 2100N. At Pauwels 30° Angle, the femur with a 150°-BDSF orientation exhibited a maximum displacement of 3.17mm, while the femur with a 165°-BDSF orientation displayed a maximum displacement of 3.13mm. When compared with the femoral neck fracture model characterized by a Pauwels Angle of 70°, the shear force observed in the 70° model was significantly higher than that in the 30° model. Conversely, the stability of the 30° model was significantly superior to that of the 70° model. Furthermore, in the 70° model, the BDSF group exhibited a maximum femur displacement that was lower than both the 3CCS (3.46mm) and 4CCS (3.43mm) thresholds. The biomechanical properties of the BDSF internal fixation device are superior to the other two hollow screw internal fixation devices. Correspondingly, superior biomechanical outcomes can be achieved through the implementation of distal screw insertion at an angle of 165°. Thus, the BDSF internal fixation technique can be considered as a viable closed reduction internal fixation technique for managing femoral neck fractures at varying Pauwels angles.

Variations in the Anatomic Morphology of the Scapular Spine and Implications on Fracture After Reverse Shoulder Arthroplasty.

This study evaluates the role of anatomic scapular morphology in acromion and scapular spine fracture (SSAF) risk after reverse shoulder arthroplasty (RSA). Twelve scapular measurements were captured based on pilot study data, including scapular width measurements at the acromion (Z1), middle of the scapular spine (Z2), and medial to the first major angulation (Z3). Measurements were applied to 3D-CT scans from patients who sustained SSAF after RSA (SSAF group) and compared with those who did not (control group). Measurements were done by four investigators, and the intraclass correlation coefficient was calculated. Regression analysis determined trends in fracture incidence. One hundred forty-nine patients from two separate surgeons (J.L., A.M.) were matched by age and surgical indication of whom 51 sustained SSAF after reverse shoulder arthroplasty. Average ages for the SSAF and control cohorts were 78.6 and 72.1 years, respectively. Among the SSAF group, 15 were Levy type I, 26 Levy type II, and 10 Levy type 3 fractures. The intraclass correlation coefficient of Z1, Z2, and Z3 measurements was excellent (0.92, 0.92, and 0.94, respectively). Zone 1 and 3 measurements for the control group were 18.6 ± 3.7 mm and 3.2 ± 1.0 mm, respectively, compared with 22.5 ± 5.9 mm and 2.0 ± 0.70 mm in the SSAF group, respectively. The fracture group trended toward larger Z1 and smaller Z3 measurements. The average scapular spine proportion (SSP), Z1/Z3, was significantly greater in the control 6.20 ± 1.80 versus (12.60 ± 6.30; P < 0.05). Regression analysis showed a scapular spine proportion of ≤5 was associated with a fracture risk <5%, whereas an SSP of 9.2 correlated with a 50% fracture risk. Patients with a thicker acromions (Z1) and thinner medial scapular spines (Z3) have increased fracture risk. Understanding anatomic scapular morphology may allow for better identification of high-risk patients preoperatively.

Lumbar Lordosis is a Risk Factor for Lumbar Catheter Fracture of Lumboperitoneal Shunt

ObjectiveThis study aimed to investigate the causes of lumboperitoneal (LP) shunt failure and determine risk factors for lumbar catheter fracture. MethodsWe retrospectively investigated 149 patients who underwent LP shunting in our hospital between January 2012 and March 2023. Shunt reconstruction occurred in 22 patients (14.8%). Among these, cause of failure was lumbar catheter fracture in five (22.7%). Patient backgrounds, cause of LP shunt failure, surgical technique factors, and anatomical characteristics were extracted for comparative analysis and risk factors of lumbar catheter fracture were analyzed. ResultsCompared with the no reoperation group (n=127), patients in the lumbar catheter fracture tended to be younger (63 ± 20 vs. 72 ± 11 years) and favorable neurological status (modified Rankin scale score ≤2) after initial LP shunt; however the differences were not significant. Lumbar lordosis was significantly higher in the lumbar catheter fracture group (52.7° ± 14.8° vs. 37.1° ± 12.3°; P = 0.0067). ConclusionsExcessive lumbar lordosis is a risk factor for lumbar catheter fracture in patients undergoing LP shunting. Younger age and higher level of postoperative activities of daily living might also be associated with lumbar catheter fracture.

A COMPARATIVE STUDY ON NASAL BONE FRACTURE ASSOCIATED WITH SEPTAL DEVIATION CORRECTED WITH SEPTOPLASTY VERSUS CLOSED REDUCTION

Objective: The dorsum of the nose formed by nasal bones helps to maintain the airway and esthetic appearance of the nose. Faciomaxillary trauma is associated with a nasal bone fracture with or without nasal septal fractures. Nasal bone fractures can lead to deviation of the external nose and nasal obstruction. The management includes correction of nasal bone deformity with either septoplasty or reduction of nasal septal deviation by the non-surgical method. A study was conducted to compare the results of septal deviation corrected by septoplasty and non-surgical reduction of septal deviation combined with nasal bone fracture reduction.The aim of this study was to compare the results of septal deviation corrected by septoplasty and non-surgical reduction of septal deviation combined with nasal bone fracture reduction. Materials: Sixty-two patients with nasal bone fractures with varying degrees of external nose deformity and nasal septal deviation were divided into two groups. Group A consisted of patients treated with septoplasty and nasal bone fracture correction and Group B consisted of patients treated with non-surgical reduction of septal deviation and nasal bone fracture correction. Type I, II, and II nasal bone fractures were included with all types of septal deviations. The subjective improvement in nasal obstruction was assessed using the visual analog scale in both groups. Results: There were 26 males (81.25%) and 06 (18.75%) females in Group A and 25 (83.33%) males and 05 (16.67%) females in Group B. In Group A, 12 (37.5%) patients were aged between 18 and 27 years, 10 (31.25%) patients were aged between 28 and 27 years, 07 (21.87%) patients were aged between 38 and 47 years, and 03 (09.37%) patients were aged between 48 and 57 years. The mean age was 23.54±2.30 years. Conclusion: Nasal bone fractures cause not only esthetic facial deformity but also functional airway obstruction. A thorough clinical examination, computed tomography scan, and patient counseling are necessary. There is no statistically significant difference in the final outcome between the septoplasty and closed reduction of the septal deviation undertaken to relieve nasal obstruction in patients with associated nasal bone fractures.

Lower body bone fractures have high mortality rates and poor prognosis in the patients with hemodialysis.

The objective of the current study was to investigate the association between lower body bone fractures occurring during maintenance hemodialysis and prognosis. This study included 151 hemodialysis patients at the dialysis center of our hospital as of December 2017, and data were systematically gathered from medical records over a period of 5 years, concluding in December 2022. Fourteen patients, 3.0 per 100 person-years, in 151 hemodialysis patients suffered from lower body bone fractures. The ratio of males was significantly lower, and age was significantly higher in the lower body bone fracture group than in the no lower body bone fracture group. Duration of hemodialysis prior to entry into this study was significantly shorter in the lower body bone fracture group than in the no lower body bone fracture group. Serum albumin was significantly lower and alkaline phosphatase was significantly higher in the lower body bone fracture group than in the no lower body bone fracture group. Mortality rate was significantly higher in the lower body bone fracture group (85.7%) compared to no lower body bone fracture group (28.5%) (p = 0.01). Kaplan-Meier survival curves for mortality showed that lower body bone fracture group had poor prognosis compared to no lower body bone fracture group. Multivariable-adjusted odds ratio for mortality were significantly higher for cases with lower body bone fractures. Lower body bone fractures have high mortality rates and poor prognosis in the patients with hemodialysis.

Foot radiologic morphology as a predictor of pseudo-jones fractures: A retrospective case-control study

BackgroundFifth metatarsal basis fractures are common injuries. Zone 1 fractures are also known as pseudo-jones fractures. This study aimed to elucidate the impact of foot radiologic morphology on pseudo-Jones fractures. MethodsPatients with pseudo-Jones fractures formed the case group and individuals with ankle sprains but no fractures formed control group. Weight-bearing anteroposterior and lateral radiographs were evaluated for pre-determined measurements: metatarsus adductus angle (MAA), intermetatarsal angles (1−2, 4−5), calcaneal inclination (CI) angle, and fifth metatarsal base angle. All measurements were performed by a single investigator using digital PACS tools. Statistical analysis compared these radiographic parameters between the groups. ResultsThe fracture group demonstrated a significantly lower 4–5 intermetatarsal and calcaneal inclination angles than the control group (p < 0.05). Notably, no statistically significant difference was found in the metatarsus adductus angle. ConclusionThis study demonstrates a potential association between foot radiographic morphology and pseudo-Jones fractures. Patients with a lower 4–5 IMA and calcaneal inclination angle may be at a higher risk for developing pseudo-Jones fractures. However, these requires future prospective studies. Level of evidenceLevel III case control study

Is it safe and effective to leave Titanium Elastic Nail (TEN) tips outside the skin in pediatric femoral diaphyseal fractures?

Aim: In this study, we aimed to retrospectively evaluate the use of nail tips outside and under the skin in TEN (Titanium Elastic Nail) application in pediatric femur diaphyseal fractures. Patients and methods: Forty-six patients (47 fractures) who underwent TEN due to femoral diaphyseal fractures between January 2016 and July 2019 were examined retrospectively. While the patients whose TEN ends were left outside the skin were called Group 1, the patients whose TEN ends were left under the skin were called Group 2.. Age, gender, fracture side, and follow-up periods were evaluated. Clinical evaluation; hip and knee ROM (range of motion), rotational or angular deformities, pin bottoms, incision scars, infective findings; In radiological evaluation; angulation, deformity and length differences were examined on two-way radiography. Implant removal times and all complications were evaluated. Results: 21 fractures (Group 1) TEN ends were left outside the skin; In 26 fractures (Group 2), the TEN ends were left under the skin. Both groups had similar distributions in terms of age, gender and fracture sides. The follow-up period of Group 2 was significantly longer (p&amp;lt;0.05), but the minimum follow-up period in both groups was 9 months. There was a significant difference in the distribution of coronal and sagittal angulations in both groups (p&amp;lt;0.05), but all of the angulations were within acceptable limits in their age groups. Pin bottom discharge of both groups had similar distribution. (p&amp;gt;0.05) In terms of implant removal time, Group 1 achieved this in a shorter time compared to Group 2. (p&amp;lt;0.05) Union was achieved without any problems in all fractures in both groups. No notable angulation defects, rotation defects or shortness were observed in the patients. No patient developed infection in deep tissues. Conclusions: In pediatric femur diaphyseal fractures, in addition to removing the implants in a short time under outpatient clinic conditions and without the need for anesthesia by leaving the TEN ends outside the skin; leaving the implant tip outside seems to be quite advantageous, since union or angulation problems are similar to nail tips being left inside. However, nail root infection is still a serious concern; therefore, we believe that this problem can be solved with close monitoring and parental education.

Spinopelvic fixation failure in the adult spinal deformity population: systematic review and meta-analysis.

Despite modern fixation techniques, spinopelvic fixation failure (SPFF) after adult spinal deformity (ASD) surgery ranges from 4.5 to 38.0%, with approximately 50% requiring reoperation. Compared to other well-studied complications after ASD surgery, less is known about the incidence and predictors of SPFF. Given the high rates of SPFF and reoperation needed to treat it, the purpose of this systematic review and meta-analysis was to report the incidence and failure mechanisms of SPF after ASD surgery. The literature search was executed across four databases: Medline via PubMed and Ovid, SPORTDiscus via EBSCO, Cochrane Library via Wiley, and Scopus. Study inclusion criteria were patients undergoing ASD surgery with spinopelvic instrumentation, report rates of SPFF and type of failure mechanism, patients over 18years of age, minimum 1-year follow-up, and cohort or case-control studies. From each study, we collected general demographic information (age, gender, and body mass index), primary/revision, type of ASD, and mode of failure (screw loosening, rod breakage, pseudarthrosis, screw failure, SI joint pain, screw protrusion, set plug dislodgment, and sacral fracture) and recorded the overall rate of SPF as well as failure rate for each type. For the assessment of failure rate, we required a minimum of 12months follow-up with radiographic assessment. Of 206 studies queried, 14 met inclusion criteria comprising 3570 ASD patients who underwent ASD surgery with pelvic instrumentation (mean age 65.5 ± 3.6years). The mean SPFF rate was 22.1% (range 3-41%). Stratification for type of failure resulted in a mean SPFF rate of 23.3% for the pseudarthrosis group; 16.5% for the rod fracture group; 13.5% for the iliac screw loosening group; 7.3% for the SIJ pain group; 6.1% for the iliac screw group; 3.6% for the set plug dislodgement group; 1.1% for the sacral fracture group; and 1% for the iliac screw prominence group. The aggregate rate of SPFF after ASD surgery is 22.1%. The most common mechanisms of failure were pseudarthrosis, rod fracture, and iliac screw loosening. Studies of SPFF remain heterogeneous, and a consistent definition of what constitutes SPFF is needed. This study may enable surgeons to provide patient specific constructs with pelvic fixation constructs to minimize this risk of failure.

Role of Whey Protein in the Treatment Outcome of Maxillofacial Trauma Patients: An Interventional Study.

Maxillofacial fracture severely affects the diet of the patients leading to reduction of body weight. Facial trauma affects the muscles of mastication and the bones of face leading to reduction in bite force. The purpose of our study was to investigate the effect of whey protein supplement in the postoperative period of maxillofacial trauma patients with respect to body weight, bite force and callus formation. Patients were divided into control group and study group having 20 patients each. The control group received usual modified diet for maxillofacial fracture and study group received same diet along with whey protein for 6weeks. There was mean weight loss of 3.15kg in control group whereas there was no weight loss of in the study group. There was statistically significant increase in bite force in the study group compared to the control group with p value < 0.05. Early callus formation was seen in study group compared to control group. Our results showed that patients who were supplemented with whey protein had no loss of body weight, better masticatory efficiency, better healing of the fracture sites and overall early recovery.

Sleep quality and psychological health in patients with pelvic and acetabulum fractures: a cross-sectional study

Background and objectivesIt is known that difficulty sleeping after a fracture can have negative effects on both mental and physical health and may prolong the recovery process. The objective of this study is to explore how sleep quality and psychological health are linked in patients with pelvic and acetabulum fractures.MethodsA study was conducted on 265 patients between 2018 and 2022 who had suffered pelvic and acetabulum fractures. The study examined various factors, including age, gender, cause of injury, post-operative complications, and injury severity. The study employed ordinal logistic regression to examine the relationship between various pelvic fractures and seven subscales of the Majeed Pelvic Score (MPS), as well as the Sleep Disorder Questionnaire (SDQ) and Beck Depression Inventory (BDI). The study focused on the postoperative outcome one year after surgery, and each patient was assessed at the one-year mark after surgical intervention. Additionally, the study evaluated the functional outcome, sleep quality, and psychological disorders of the patients.ResultsFrom 2018 to 2022, a total of 216 patients suffered from pelvic and acetabulum fractures. Among them, 6.6% experienced borderline clinical depression, and 45.2% reported mild mood disturbances. Anxiety was found to be mild to moderate in 46% of Tile C and posterior acetabulum wall fracture patients. About 24.8% of patients reported insomnia, while 23.1% reported sleep movement disorders. However, no significant correlation was found between fracture types and sleep disorders. The mean Majeed pelvic score (MPS) was 89.68.Conclusions Patients with pelvic and acetabular fractures typically experience functional improvement, but may also be at increased risk for insomnia and sleep movement disorders, particularly for certain types of fractures. Psychological well-being varies between fracture groups, with signs of borderline clinical depression observed in some cases. However, anxiety levels do not appear to be significantly correlated with pelvic and acetabular fractures.

Chronic Obstructive Pulmonary Disease as a Significant Marker of Prevalent Vertebral Fracture in Patients with Spinal Degenerative Disease: Preoperative Risk Factors Involved in Lifestyle-Related Diseases

Objectives: It is important to recognize prevalent vertebral fractures before spinal surgery due to the possible complications related to bone fragility. Recently, it has been noted that lifestyle-related diseases are associated with vertebral fractures. In this study, we analyzed prevalent vertebral fractures among patients with spinal degenerative disease and investigated their association with lifestyle-related diseases. Methods: We included patients aged ≥60 years who underwent surgery for spinal degenerative disease between March 2019 and February 2021 at our hospital. The primary outcome measure was radiographically prevalent vertebral fractures from T10 to L5. Univariate analyses were performed for variables obtained from preoperative data related to lifestyle-related diseases between the vertebral fracture and non-fracture groups. Multiple logistic regression was performed with adjustments for variables including patient age, sex, and surgical site, and variables that were found to have a p-value of &lt;0.2 in univariate analyses. Results: A total of 220 patients were enrolled, of which 121 had prevalent vertebral fractures. Multiple logistic analysis was conducted with patient age, sex, and surgical site, and those variables identified p &lt; 0.2 in univariate analyses: eGFR &lt;60 mL/min/1.73 m2 serum uric acid &gt;7.0 mg/dL, FEV1/FVC &lt;70%, and bone mineral density (BMD) T-score &lt;–1.0. Patients with vertebral fractures were significantly older and had lower BMD, and lower FEV1/FVC. Conclusions: Patients with FEV1/FVC &lt;70% characterizing COPD had a significantly higher risk of vertebral fractures, independent of sex, age, and BMD. The risk of postoperative complications related to bone fragility should be considered in patients with COPD.

Five-Year Mortality Rates Following Elective Shoulder Arthroplasty and Shoulder Arthroplasty for Fracture in Patients Over Age 65.

To effectively counsel patients prior to shoulder arthroplasty, surgeons should understand the overall life trajectory and life expectancy of patients in the context of the patient's shoulder pathology and medical comorbidities. Such an understanding can influence both operative and nonoperative decision-making and implant choices. This study evaluated 5-year mortality following shoulder arthroplasty in patients ≥65 years old and identified associated risk factors. We utilized Centers for Medicare & Medicaid Services Fee-for-Service inpatient and outpatient claims data to investigate the 5-year mortality rate following shoulder arthroplasty procedures performed from 2014 to 2016. The impact of patient demographics, including fracture diagnosis, year fixed effects, and state fixed effects; patient comorbidities; and hospital-level characteristics on 5-year mortality rates were assessed with use of a Cox proportional hazards regression model. A p value of <0.05 was considered significant. A total of 108,667 shoulder arthroplasty cases (96,104 nonfracture and 12,563 fracture) were examined. The cohort was 62.7% female and 5.8% non-White and had a mean age at surgery of 74.3 years. The mean 5-year mortality rate was 16.6% across all shoulder arthroplasty cases, 14.9% for nonfracture cases, and 29.9% for fracture cases. The trend toward higher mortality in the fracture group compared with the nonfracture group was sustained throughout the 5-year postoperative period, with a fracture diagnosis being associated with a hazard ratio of 1.63 for mortality (p < 0.001). Medical comorbidities were associated with an increased risk of mortality, with liver disease bearing the highest hazard ratio (3.07; p < 0.001), followed by chronic kidney disease (2.59; p < 0.001), chronic obstructive pulmonary disease (1.92; p < 0.001), and congestive heart failure (1.90; p < 0.001). The mean 5-year mortality following shoulder arthroplasty was 16.6%. Patients with a fracture diagnosis had a significantly higher 5-year mortality risk (29.9%) than those with a nonfracture diagnosis (14.9%). Medical comorbidities had the greatest impact on mortality risk, with chronic liver and kidney disease being the most noteworthy. This novel longer-term data can help with patient education and risk stratification prior to undergoing shoulder replacement. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.