Fracture Group Research Articles

Elevated Expression of CCN3 in Articular Cartilage Induces Osteoarthritis in Hip Joints Irrespective of Age and Weight Bearing.

Osteoarthritis (OA) occurs not only in the knee but also in peripheral joints throughout the whole body. Previously, we have shown that the expression of cellular communication network factor 3 (CCN3), a matricellular protein, increases with age in knee articular cartilage, and the misexpression of CCN3 in cartilage induces senescence-associated secretory phenotype (SASP) factors, indicating that CCN3 promotes cartilage senescence. Here, we investigated the correlation between CCN3 expression and OA degenerative changes, principally in human femoral head cartilage. Human femoral heads obtained from patients who received total hip arthroplasty were categorized into OA and femoral neck fracture (normal) groups without significant age differences. Gene expression analysis of RNA obtained from femoral head cartilage revealed that CCN3 and MMP-13 expression in the non-weight-bearing part was significantly higher in the OA group than in the normal group, whereas the weight-bearing OA parts and normal cartilage showed no significant differences in the expression of these genes. The expression of COL10A1, however, was significantly higher in weight-bearing OA parts compared with normal weight-bearing parts, and was also higher in weight-bearing parts compared with non-weight-bearing parts in the OA group. In contrast, OA primary chondrocytes from weight-bearing parts showed higher expression of CCN3, p16, ADAMTS4, and IL-1β than chondrocytes from the corresponding normal group, and higher ADAMTS4 and IL-1β in the non-weight-bearing part compared with the corresponding normal group. Acan expression was significantly lower in the non-weight-bearing group in OA primary chondrocytes than in the corresponding normal chondrocytes. The expression level of CCN3 did not show significant differences between the weight-bearing part and non-weight-bearing part in both OA and normal primary chondrocytes. Immunohistochemical analysis showed accumulated CCN3 and aggrecan neoepitope staining in both the weight-bearing part and non-weight-bearing part in the OA group compared with the normal group. The CCN3 expression level in cartilage had a positive correlation with the Mankin score. X-ray analysis of cartilage-specific CCN3 overexpression mice (Tg) revealed deformation of the femoral and humeral head in the early stage, and immunohistochemical analysis showed accumulated aggrecan neoepitope staining as well as CCN3 staining and the roughening of the joint surface in Tg femoral and humeral heads. Primary chondrocytes from the Tg femoral head showed enhanced expression of Ccn3, Adamts5, p16, Il-6, and Tnfα, and decreased expression of Col2a1 and -an. These findings indicate a correlation between OA degenerative changes and the expression of CCN3, irrespective of age and mechanical loading. Furthermore, the Mankin score indicates that the expression level of Ccn3 correlates with the progression of OA.

Frequency and Etiology of Zygomatic Complex Fractures in Oral and Maxillofacial Trauma Patients in Tertiary Care Hospital Karachi

Aim: To determine the frequency and etiology of zygomatic complex fractures in oral and maxillofacial trauma patients. Methods: This cross sectional study was conducted at Oral and Maxillofacial department on 116 patients presenting with oral and maxillofacial trauma. Frequency and etiology of zygomatic complex fractures in these patients were determined. Frequencies and percentages were used for categorical data while mean and SD was calculated for numerical data. Chi Square test for applied for association between categorical data. Results: Mean age of the patients was 31.52±8.19. The frequency of zygomaticomaxillary complex fractures in our study was 64 (29.3%). Most common etiology was traffic accident 16 (47.1%) followed by fall from height 11 (32.4%). Conclusion: Traffic accident was the leading etiological factor of zygomaticomaxillary complex fractures. Age groups of 20 to 30 years is the most vulnerable age group for zygomaticomaxillary complex fractures. Keywords: Etiology, Zygomaticomaxillary Complex Fractures, Oral and Maxillofacial trauma

Handgrip strength effectiveness and optimal measurement timing for predicting functional outcomes of a geriatric hip fracture

Handgrip strength (HGS) now draws attention as one of the predictors of outcomes following geriatric hip fracture; however, its effectiveness and the optimal time to assess HGS remain unknown. Herein, we aimed to determine the usefulness of HGS in predicting the outcomes of geriatric hip fracture and to find the most effective time to measure HGS in both the low muscle strength and normal hip fracture groups. The study was performed prospectively for 79 geriatric hip fracture patients. HGS was measured during the admission period and the one-week postoperative period. Walking ability and quality of life were assessed using Koval scores and the European Quality of Life Five Dimension (EQ-5D) scale at the admission period and postoperatively at 3, 6, and 12 months, respectively. The relationship between pre/postoperative HGS and functional outcomes was assessed, and the functional score between the “low muscle strength” and “normal muscle strength” groups was compared. The association between HGS asymmetry and low strength with functional limitations was determined. For the preoperative HGS, the Koval score showed a significant relationship in the postoperative 6-month (r = −0.295, P = 0.008) and 12-month (r = −0.266, P = 0.019) periods; also, the EQ-5D score showed a significant relationship in the postoperative 6-month and 12-month periods (r = 0.344, P < 0.001, and r = 0.386, P = 0.001, respectively). For the postoperative HGS, the Koval score showed a significant relationship in the 6-month (r = −0.432, P < 0.001) and 12-month (r = −0.344, P = 0.002) postoperative periods. Also, the EQ-5D score showed a significant relationship in the 3-month (r = 0.340, P = 0.010), 6-month (r = 0.476, P < 0.001), and 12-month (r = 0.471, P < 0.001) postoperative periods. The incidence of preoperative and postoperative low HGS was 78.5% and 70.9%, respectively. The “low-strength” group had poor Koval scores and EQ-5D at postoperative month 12 and poor functional outcomes earlier in the follow-up (postoperative 6- and 12-month Koval scores and postoperative 3-, 6-, and 12-month EQ-5D), respectively (P = 0.008 and P = 0.003; P = 0.003, P = 0.001, and P = 0.001). The effect of HGS asymmetry and low strength on functional limitations remained undetermined. Both preoperative and postoperative HGS reflected functional outcomes of patients with hip fracture during the 12-month follow-up. Postoperative HGS had a higher prognostic value than preoperative HGS.

Correlation between psoas muscle area and contralateral hip fracture after intertrochanteric fracture

To investigate the relationship between the area of psoas major muscle(PMI) and recurrent contralateral hip fracture in the initial intertrochanteric fracture. Total of 87 patients with intertrochanteric fracture of femur from January 2008 to January 2011 were selected for CT scanning of lumbar spine and hip at the time of the first fracture, and then divided into two groups according to whether there was fracture in the contralateral hip, 13 patients in the contralateral hip fracture group, 5 males and 8 females, aged(82.30±5.66) years;there were 74 cases in the non contralateral hip fracture group, including 32 males and 42 females, with an age of (79.70±5.84) years. The gender, age, preoperative blood albumin value, operation side, body mass index(BMI), Harris score of hip joint one year after operation, Barthel index before operation and medical diseases before operation were observed and compared between two groups. The PMI was used to compare the area of psosa major on CT before operation in two groups, and the correlation between the area of PMI at the time of initial fracture and the fracture of the contralateral hip was evaluated. The two groups were followed up for more than 2 years after operation. There was a significant difference in PMI between two groups(P<0.05). There was a significant positive correlation between preoperative PMI and the time of re fracture of the contralateral hip(r=0.641, P=0.018). There are differences in the area of PMI in patients with contralateral hip fracture, so the area of PMI can be regarded as an important risk factor for contralateral hip fracture.

Different types of hip fragility fractures have different values of 25-hydroxyvitamin D and parathyroid hormone

BackgroundVitamin D insufficiency/deficiency is related to fragility fracture. In most previous studies, there was no assessment of vitamin D deficiency status separately for hip fracture types. The first aim is to evaluate vitamin D and parathyroid hormone (PTH) status in patients with hip fracture. The second objective is to determine whether there are differences in vitamin D and PTH between the femoral neck fracture and the femoral metaphyseal fracture group. Methods62 men and 248 women with fragility hip fractures were enrolled. 25-hydroxyviamin D [25(OH)D] and intact PTH (iPTH) values were evaluated, and femoral neck bone mineral density (BMD) was measured on the uninjured side. Vertebral fractures (VFs) were assessed using radiographs of the thoracic and lumbar spine. We examined the relationships of 25(OH)D value with the number of prevalent VFs, T-score of femoral neck, and iPTH level. These analyses were also performed, neck fracture and trochanteric fracture separately. ResultsMean age was 85 years. The mean 25(OH)D was 11.2 (range, 4.0–26.1) ng/ml, whereas the mean iPTH value was 48.9 pg/ml (range, 9–429 pg/ml). The mean number of VFs was 1.5 (range, 0–11), and the mean T-score was −3.3 (range, −5.2 to −0.5). There was a weak correlation between the 25(OH)D value and the number of VFs. There was a weak but significant correlation between 25(OH)D and iPTH values. In the patients with trochanteric fractures, 25(OH)D value was significantly lower and iPTH value was significantly higher than those with neck fractures. There was a significant correlation between the 25(OH)D value and number of the VFs, 25(OH)D, and iPTH values only in trochanteric fractures. ConclusionsVitamin D deficiency was severe and PTH levels were higher in the trochanteric fractures. Both vitamin D deficiency and high PTH levels were suggested to have association with bone fragility.

Risk factors of primary and recurrent fractures in postmenopausal osteoporotic Chinese patients: A retrospective analysis study

BackgroundAs postmenopausal osteoporotic fractures can cause higher rates of disability and mortality in women; it is essential to analyze the factors associated with primary and recurrent fractures in postmenopausal osteoporosis (PMOP) patients.MethodsRetrospective analysis of 2478 PMOP patients aged ≥ 50 years who attended the Shanghai General Hospital from January 2007 to December 2016, including 1239 patients with no fractures and 1239 patients with histories of fractures (1008 in the primary fracture group and 231 in the re-fracture group). All patients' basic clinical data, serum biochemical and bone metabolic markers, bone mineral density (BMD), and other indicators were recorded uniformly. Comparing the differences between the clinical characteristics of patients with primary and recurrent fractures, as well as the differences in the clinical characteristics of patients with primary and recurrent fractures in combination with different diseases, further analyses the risk factors for primary and recurrent fractures in PMOP patients. SPSS.26 was used for statistical analysis.ResultsCompared to the unfractured group, the fractured group was older and had lower height and bone mineral density (all P < 0.01), with the re-fractured group having lower BMD at each key site than the primary fracture group (all P < 0.01). Analysis of the combined disease subgroups showed that serum BGP levels were lower in the primary and re-fracture patients with diabetes than in the non-diabetic subgroup (P < 0.05), and serum CTX levels were lower in the re-fracture group with diabetes than in the primary fracture group with diabetes (P < 0.05). Patients with recurrent fractures with cardio-vascular diseases had lower BMD than the subgroup without cardio-vascular diseases (P < 0.05) and also had lower BMD than the group with primary fractures with cardio-vascular diseases (P < 0.05). Multiple logistic regression analysis showed that advanced age, overweight, low lumbar spine and total hip BMD were risk factors for primary and recurrent fractures; and comorbid chronic liver and kidney diseases were risk factors for primary fractures.ConclusionPMOP patients with advanced age, overweight, low bone mineral density, and comorbid chronic liver and kidney diseases are at greater risk of fractures and require early intervention to reduce fractures occurrence. Moreover, those who are elderly, overweight, and have low bone density should also be aware of the risk of re-fractures.

Effect of Simvastatin Administration on ALP (Alkaline Phosphatase) Level in Wistar Rat's Femur Fracture

Metabolism of the bone healing process can be monitored by Bone formation marker, such as alkaline phosphate (ALP). Simvastatin is known to increase bone marker formation in the repair phase, but its effects on the ALP level have not been known yet. This study aimed to determine the effect of oral simvastatin administration on the expression of ALP level in femur fracture healing in a rat model of femur fracture. The research method was experimental post-test only using 18 Rattus norvegicus rats which were divided into 3 groups, namely the control group for femur fracture (Control), femoral fracture group and giving simvastatin 0.36 mg/day for 2 weeks (Treatment I), and femur fracture group and administration of simvastatin 0.36 mg/day for 4 weeks (Treatment II). ALP levels were measured at 0, 2, and 4 weeks. The results showed an increase in ALP levels in the simvastatin treatment group compared to the control group (p&lt;0.05). It can be concluded that the administration of simvastatin increased ALP levels in rat femoral fractures.

Complications of standard versus long cephalomedullary nails in the treatment of unstable extracapsular proximal femoral fractures: A randomized controlled trial

AimsTo compare in a prospective randomized trial the mechanical complications in patients with unstable extracapsular proximal femur fractures without subtrochanteric extension (AO/OTA 31-A2 and 31-A3) MethodsWe prospectively studied 182 patients with unstable extracapsular proximal femur fractures without fractures lines extending more than 3 cm below the lesser trochanter, randomized to receive either a ‘standard’ (240 mm) nail or a long nail and followed them up for 1 year. ResultsWe found no difference in the incidence of mechanical or general complications between the two groups, no cut-outs, no fractures of the tip the implant, 1 cut-through and 2 malrotations in the LN group, 2 non-unions that were reoperated, one on each group. The commonest complication was blade lateral migration, 13 (14%) patients in SN and 6 (9%) in the LN. The operating time was shorter in the SN group 51 minutes compared to 67 minutes in the LN group (p=0.000075). The mortality at 1,3 and 12 months in the SN group was of 2%, 6%, 12% while in the LN group was 12%, 18% and 22%. These differences where significative at 1 (p=0.007) and 3 months (p=0.013), but not at 12 months (p=0.075). ConclusionsWe recommend the use of standard nails (240 mm) for this group of fractures, since it does not produce more mechanical complications, and it is faster, cheaper and easier to interlock distally.

The role of geographic disparities in outcomes after orthopaedic trauma surgery

IntroductionHealthcare disparities linked to patient rurality and socioeconomic status are known to exist, but few studies have examined the effect of urban versus rural status on outcomes after orthopedic trauma surgery. The aim of this study was to examine the correlation between patient rurality, socioeconomic status, and outcomes after orthopedic trauma. Materials and methodsThis is a retrospective cohort study of patients diagnosed with a hip or long bone fracture between January 2016 and December 2017. Data were collected from the Nationwide Inpatient Sample (NIS), a 20% weighted sample of 95% of the U.S. inpatient population. Patients were stratified into 3 groups: isolated hip fracture, isolated long bone fracture, and polytrauma. Bivariate analysis was completed using chi-squared tests for categorical variables and t-tests for continuous variables. Multivariable analysis was completed using population-weighted logistic regression models, based on a conceptual model derived selection of covariates. ResultsWe included 235,393 patients diagnosed with a hip or extremity fracture. These were weighted to represent 1,176,965 patients nationally. In the hip fracture group, rural patient status was associated with higher odds of mortality (OR 1.32, P < 0.001) but not complications (OR 0.95, P = 0.082). In the extremity fracture and polytrauma groups, rural patient status was not associated with significantly higher odds of mortality or complications. In the urban polytrauma group, zip code with below-median income was associated with increased odds of mortality (OR 1.23, P = 0.002) but not complications. In the rural polytrauma group, zip code with below-median income was not associated with significantly increased odds of mortality or complications. In the hip fracture and extremity fracture groups, below-median income was not associated with significantly higher odds of mortality. ConclusionWe found that rural patients with hip fracture have higher mortality compared to urban patients and that socioeconomic disparities in mortality after a polytrauma exist in urban settings. These results speak to the ongoing need to develop objective measures of disparity-sensitive healthcare and optimize trauma systems to better serve low-income patients and patients in rural areas.

Periprosthetic acetabular fractures and defects : Trauma meets ortho

Periprosthetic acetabular fractures are considered to be asevere and challenging complication in total hip arthroplasty. To date, there are no internationally applicable standardized recommendations which can assist orthopedic surgeons and trauma surgeons in the treatment of patients. The aim of this article is to report on the current state of knowledge on periprosthetic acetabular fractures, to present the commonly used classification systems and to demonstrate appropriate treatment algorithms together with personal experiences. Aselective search of the existing literature was carried out and the commonly used classification systems and treatment options for periprosthetic acetabular fractures were compiled and are discussed in relation to the in-house cases. The comparison of the classification systems showed that frequently only fractures which have a purely traumatic origin are included among periprosthetic acetabular fractures. Insufficiency fractures within the framework of acetabular defects, which also belong to the group of acetabular fractures, are frequently included in revision arthroplasty. The management of defects with appropriate implants represents a challenge. By the combination of osteosynthesis and implant replacement, the selection of implants can often be de-escalated. Periprosthetic acetabular fractures represent a complex operation for both trauma surgeons and for specially trained orthopedic surgeons, which necessitate a high level of expertise. By the cooperation between trauma surgeons and orthopedic surgeons good treatment results can be achieved and recommendations for the selection of implants can be made.

Correlation of Psoas Muscle Index with Fragility Vertebral Fracture: A Retrospective Cross-Sectional Study of Middle-Aged and Elderly Women.

To investigate the correlation of psoas muscle index (PMI) with fragility vertebral fracture. A total of 184 middle-aged and elderly women were included in the study. We measured the bilateral psoas muscle area on the picture archiving and communication system (PACS) from computed tomography images and calculated PMI. We observed lateral radiographs of the thoracolumbar spine and assessed vertebral fractures using the Genant semiquantitative method. The T-score, bone mineral density (BMD) of the lumbar (L)1-4, femoral neck, and trochanter were measured by dual-energyX-ray absorptiometry (DXA). The data was collected and then statistically analyzed. The PMI of the nonosteoporosis group was higher than that of the osteoporosis group (P value = 0.006). Height in the nonosteoporosis group was higher than that in the osteoporosis group (P value = 0.013). Weight, body mass index (BMI), left psoas muscle area, BMD of the L1-4, femoral neck, femoral trochanter, and T-score in the nonosteoporosis group were higher than those in the osteoporosis group (P value <0.001). The right psoas muscle area in the nonosteoporosis group was higher than that in the osteoporosis group (P value = 0.008). The incidence of combined thoracolumbar fracture was significantly higher in the osteoporosis group than that in the nonosteoporosis group (P value <0.001). For nonosteoporosis subjects, the PMI of the vertebral fracture group was lower than that of the nonvertebral fracture group (P value = 0.034). A decrease in height, weight, BMI, bilateral psoas muscle area, and PMI is associated with osteoporosis. Combined thoracolumbar fractures are more common in osteoporosis. Sarcopenia may be an independent risk factor for nonosteoporotic vertebral fractures.

Comparisons Between Different Anti-osteoporosis Medications on Postfracture Mortality: A Population-Based Study.

Osteoporosis is becoming a global epidemic in aging societies. Anti-osteoporotic medications can prevent fractures, and their pleiotropic effect on mortality is interesting but not well compared among each other. To provide real-world evidence on the pleiotropic effect of different anti-osteoporotic medications on all-cause mortality, stratified by fracture site, sex, and age. This longitudinal population-based postfracture cohort study, included mega-data from subjects ≥40 years of age with osteoporotic fracture who used anti-osteoporotic medications as recorded in Taiwan's National Health Insurance Research Database from 2009 to 2017 and followed until 2018. A multivariate Cox proportional hazards model with immortal time bias was used to assess the relationship between fracture sites and mortality stratified by anti-osteoporosis medication. A total of 46 729 subjects with an average age of 74.45 years (80.0% female) and a mean follow-up period of 4.73 years were enrolled. In the total fracture group, compared with raloxifene and bazedoxifene, we found that alendronate/risedronate (hazard ratio [HR] 0.83; 95% CI, 0.79-0.88), denosumab (HR 0.86; 95% CI, 0.81-0.91), and zoledronic acid (HR 0.78; 95% CI, 0.73-0.84) resulted in significantly lower mortality. Similar trends were observed in the hip, vertebral, or nonhip/nonvertebral fracture groups. Subjects receiving long-acting zoledronic acid showed the lowest mortality in the subanalysis according to sex or age over 65 years. This real-world mega-data study suggests that the usage of osteoporotic medication, especially a long-acting regimen, may lower postfracture mortality.

Reduced trabecular bone mineral density and thinner cortices in men with distal forearm fractures.

Men with distal forearm fractures have reduced bone density, an increased risk of osteoporosis and of further fractures. The aim of the study was to investigate the structural determinants of these observations using quantitative CT (qCT). Ninety six men with low-trauma distal forearm fracture and 101 age-matched healthy control subjects were recruited. All subjects underwent a quantitative CT on a standard 64-slice whole body CT scanner. These were analysed on Mindways QCT PRO™ Software to generate volumetric and geometric data at the lumbar spine, femoral neck and total hip, ultra-distal and distal 33% radius. Biochemical investigations, health questionnaires and measurements of bone turnover were made. Men with fracture had significantly lower total and trabecular vBMD at all sites. The greatest percentage reduction was at the ultra-distal radius (13.5% total and 11.7% trabecular vBMD). In the fracture group cortical vBMD was significantly higher in the femoral neck (p<0.001) and maintained at the ultra-distal radius compared with control subjects. However, cortical cross-sectional area (CSA) and thickness were significantly reduced at the femoral neck (p<0.001 and p=0.002 respectively) and forearm sites (CSA ultradistal radius p=0.001, cortical thickness p=0.002, CSA distal one third radius p=0.045 and cortical thickness p=0.005). Cross sectional moment of inertia (CSMI) and section moduli were significantly reduced at the femoral neck (CSMI1 p=0.002, CSMI2 p=0.012 and section moduli Z1 p<0.001, Z2 p=0.004) and the ultra-distal radius (CSMI1 p=0.008 and section moduli Z1 p=0.018, Z2 p=0.007). In stepwise logistic regression analysis distal forearm fracture showed the strongest association with a model comprising ultra-distal forearm trabecular vBMD (negative), procollagen type I N-terminal propeptide (PINP, positive) and sex hormone binding globulin (SHBG, negative). In conclusion, these observations explain the structural reasons for the increased fracture risk in men with distal forearm fractures.

ODP097 Hyperparathyroidism as a major risk factor of fracture and its prevalence in patients with hip fracture

Abstract Introduction Hyperparathyroidism is a risk factor of osteoporosis. Excess parathyroid hormone (PTH) accelerates bone loss via bone reabsorption and increases the risk of fragility fracture. Fragility fractures are associated with serious consequences in older patients. [1] This study aimed to look at the prevalence of hyperparathyroidism and vitamin D deficiency in geriatric patients (age &amp;gt;60) who presented with hip fractures in an Irish tertiary hospital. Methods Data was collected from Irish hip fracture Database (IHFD) and the Ortho-geriatric Electronic Patient Medical System (EPMS) between July 2019 and April 2020 (n=207). Demographic data and bone health profile (PTH, Vitamin D, and Calcium) were analysed using SPSS for statistical analysis. Results The median age of patients was 81 years (SD 8.7), and 68.3% of patients were female. Median 10-year probability of major osteoporotic and hip fracture risk is 22.5% and 12.2%, respectively. 29.9% was diagnosed with hyperparathyroidism with prevalence of primary and secondary hyperparathyroidism of 6.7% and 23.1%, respectively. The majority of these (87.3%) were normocalcaemic hyperparathyroidism. 50.7% were vitamin D deficient, with 11.5% being severely deficient (Vitamin D &amp;lt;20nmol/L). Conclusion The prevalence of hyperparathyroidism is higher in the hip fracture group than in the general population. [2] Vitamin D deficiency is also prevalent in this group. FRAX score indicated significant proportion of patients with high major osteoporosis and hip fracture risks. Routine bone health profile checks in this high-risk group allow early identification and management of hyperparathyroidism and vitamin D depletion, which can potentially reduce the risk of future fracture. Reference: 1. Bukata SV, DiGiovanni BF, Friedman SM, Hoyen H, Kates A, Kates SL, Mears SC, Mendelson DA, Serna Jr FH, Sieber FE, Tyler WK. A guide to improving the care of patients with fragility fractures. Geriatric Orthopaedic Surgery &amp; Rehabilitation. 2011 Jan;2(1): 5-37.2. Press DM, Siperstein AE, Berber E, Shin JJ, Metzger R, Jin J, Monteiro R, Mino J, Swagel W, Mitchell JC. The prevalence of undiagnosed and unrecognized primary hyperparathyroidism: a population-based analysis from the electronic medical record. Surgery. 2013 Dec 1;154(6): 1232-8 Presentation: No date and time listed

Is single-stage minimally invasive plate fixation safe in open distal radius fractures with metadiaphyseal involvement?: Retrospective evaluation of 54 patients.

The aim of this study was to evaluate the safety and results of one-stage surgery in Gustilo grade 1 and 2 open distal radius fractures with metadiaphyseal involvement. This retrospective study included 54 patients with AO-2R3 and metadiaphyseal involvement according to the AO fracture classification. All fractures were treated with a long volar plate using the minimally invasive plate osteosynthesis (MIPO) technique. The patients were divided into two groups as open fracture group (25 patients) and closed fracture group (29 patients), and the groups were compared for their union time and complications and functional and radiological results. There was no statistically significant difference between the groups in terms of clinical and radiographic results (P > .05 for both). The mean union time was 12.77 (range, 8-20) weeks in the open fracture group and 12.75 (range, 8-18) weeks in the closed fracture group. There was no statistically significant difference between the groups in terms of union time (P > .05). Moreover, there was no statistically significant difference between the two groups in terms of major and minor complications. All fractures healed without the need for bone and/or soft tissue grafts. As a result of this study, using with long volar plate immediately minimally invasive plate osteosynthesis might be safely used as a single-stage definitive treatment for Gustilo grade 1 and 2 open distal radius fractures with metadiaphyseal involvement. Level IV, Therapeutic Study.

Does a relationship between type of hip fracture and osteoarthritis exist?

Background/Aim: Many factors have been associated with the etiology of falls and hip fractures in the elderly. However, only a few studies have examined the relationship between osteoarthritis and hip fractures, which are common in this age group. The aim of this study was to determine the relationship between the knee and hip osteoarthritis (OA) and the type of hip fracture. Methods: Patients who underwent surgery in the Orthopedics and Traumatology Department between January 2017 and December 2021 were eligible to participate in this retrospective cohort study. Patients who were 60 years and older with a hip fracture and adequate medical records and radiographs of bilateral hip and knee joints met the inclusion criteria. Data concerning patient co-morbidities, type of hip fracture, whether they had OA in their hip and knee joints, and the severity of their OA were assessed. The severity of the osteoarthritis presence was categorized with using the Kellgren–Lawrence (KL) classification. To categorize the patients, three groups were identified: (1) femoral neck, (2) trochanteric, and (3) subtrochanteric fracture groups. The presence and severity status of OA in the hip and knee joints and co-morbidity data were compared between the groups. Results: Three-hundred forty-one patients with a M/F ratio of 148/193 are included in this study. Femoral neck fractures occurred in 142 (41.6%), trochanteric fractures in 147 (43.1%), and subtrochanteric fractures in 52 (15.2%) patients. The mean age of the cohort was 76.72 (10.165); The mean age of the patients in the trochanteric group was higher than in the subtrochanteric group (P = 0.001). No effect of any existing co-morbidities on fracture type was observed. The overall prevalence of OA in the cohort that was observed in the hip joint was 34.3% with 33.7% in males and 35.3% in females. These rates were 66.6%, 53.4%, and 76.7% in the knee joint, respectively. No difference could be observed between hip OA presence and any type of hip fracture group (P = 0.833 for right hip, P = 0.865 for left hip). Similar rates of moderate and severe hip OA were found in the femoral neck and trochanteric fracture groups. However, the frequency of moderate hip OA was lower and the frequency of severe hip OA was higher in subtrochanteric fracture group compared to other groups (P = 0.164 for right hip, P = 0.241 for left hip. Knee OA was observed to be more common in the trochanteric fracture group (P = 0.003 for the right knee, P = 0.002 for left knee) and also, the rate of severe OA was higher in the trochanteric fracture group compared to other groups (P = 0.013 for right knee, P = 0.006 for the left knee). Conclusion: In contrast to OA presence in the hip, knee OA presence and severity can be significant risk factors for occurrence of trochanteric type fractures in the elderly.

Clinical Outcomes of Revision Total Knee Arthroplasty among Different Etiologies and Treated with a Condylar Constrained Knee Implant Supported with Cones

The first objective of this paper is to report the clinical and functional results of a cohort of patients who underwent total knee arthroplasty revision at mid–long-term follow-up. The second objective is to investigate possible differences in postoperative functional and clinical outcomes between preoperative-cause-of-revision groups. Methods: we collected data from 105 surgeries performed between January 2008 and December 2014. Eighty-five of these patients were divided into subpopulations according to the causes of revision in order to study differences regarding their outcome. All the patients underwent a standard follow-up protocol with clinical and radiological exams at 1, 3, 6, 12, 24, and 36 months and at last follow-up. During the last follow-up, patient-reported outcome measures (PROMs) were used. We implemented the functional outcomes obtained with clinical data determined by the Oxford knee score (OKS), EQ-VAS, EQ-5D-5L, Knee Society Score (KKS), and range of motion (ROM). Statistically significant differences among the medians of the groups of OKS, EQ-VAS, EQ-5D-5L, KKS, and ROM (p &lt; 0.05) were noticed. The Dunn’s test was used to perform post hoc comparisons, and it determined where the differences lie. Results: the median follow-up was 99 months (interquartile range (IQR) 80–115). The median age was 71.5 IQR 65.1–74.8)) with no relevant differences between the groups. More patients presented a preoperative diagnosis of aseptic loosening (29%), malpositioning (28%), and infection (24%), while a preoperative diagnosis of instability (11%) and periprosthetic fracture was observed in fewer cases. For OKS, the highest median value was in the periprosthetic fracture group (43.25, IQR 32.7–45.3) and the lowest median value was in the infection group (24.8, IQR 17.4–34.8). For EQ-VAS, the highest median value was in the periprosthetic fracture group (73.0, IQR 67.0–78.0) and the lowest median value was in the instability group (39.0, IQR 36.0–48.0). For EQ-5D-5L, the highest median value was in the aseptic loosening group (0.81, IQR 0.74-0.85) and the lowest median value was in the infection group (0.44, IQR 0.32–0.60). For KKS, the highest median value was in the aseptic loosening group (84.0, IQR 81.0–88.0) and the lowest median value was in the malpositioning group (56.5, IQR 49.4–66.0). For ROM, the highest median value was in the periprosthetic fracture group (105.0°, IQR 96.0–111.0°) and the lowest median value was in the infection group (88.5°, IQR 77.5–98.0°). Conclusion: Constrained condylar knee (CCK) prostheses can also be considered a good option to manage difficult cases of total knee arthroplasty revision, with satisfactory results being maintained over time; a preoperative diagnosis of infection is associated with a worse clinical and functional outcome.

Quality of Reduction of Posterior Malleolar Fractures: A CT-Based Case-Control Study Comparing AP-PA Screw Fixation vs Posterolateral Approach

Category: Trauma; Ankle Introduction/Purpose: Classically, the standard of care in posterior malleolar fracture consisted in indirect reduction and percutaneous anteroposterior (AP) or posteroanterior (PA) fixation. There is a current trend to use a posterolateral approach (PL) for direct visualization of the fragment to obtain superior anatomical reduction. Comparative studies between both strategies of management have usually benefit the PL approach for obtaining superior articular reduction. Nonetheless, most of these studies are retrospective and tend to compare different group of fractures since percutaneous AP or PA groups are usually used for smaller fragments and PL for bigger PM fractures. There are no radiologic studies comparing the quality of reduction of AP-PA screws versus direct PL fixation on similar fracture-specific morphology and size patterns. Methods: A retrospective case-control study was performed including 228 trimalleolar ankle fractures treated in a level 1 trauma center between 2012 and 2021. Demographic and clinical data was obtained. Fractures were classified using the Bartonicek and Rammelt classification. The study group was conformed by 27 patients with PM fractures fixed with percutaneous AP-PA screws (PER). The control group was conformed by 27 patients matching the study group in terms of type of fracture morphology and age treated using a posterolateral approach (PL). Post operative ankle CT images were analyzed and quality of reduction was evaluated in both groups. Quality of reduction was defined according to the articular step-off, graded as excellent (less than 1 mm), satisfactory (1 to 2 mm) or poor (more than 2 mm) in sagittal and axial planes. Differences between groups was evaluated using Fisher's test with statistical significance defined as p &lt;0.05 using SPSS V24.0 analysis software. Results: The average age of both groups was 44.4 years old with 53% of patients being females. According to Bartonicek and Rammelt classification, 2 patients were graded as type 1, 21 as type 2, 3 as type 3 and 1 as type 4. In the PL approach group, the tibio talar reduction was described as excellent in 19 patients, satisfactory in 7 and poor in 1 patient, while the fibular notch reduction was described as excellent in 20 patients, satisfactory in 6 and poor in 1 patient. In the PER group, the tibiotalar reduction was described as excellent in 22 patients and satisfactory in 5, with no patients with poor reduction. The fibular notch reduction was described as excellent in 25 patients, with 1 patient each with satisfactory and poor reduction. No significant difference (p= 0.52) in the articular reduction quality was detected considering the classification mentioned and the demographics variables. Conclusion: In this case-control study there were no significant differences regarding quality of reduction in morphologically matched displaced PM fractures fixed with AP-PA screws versus a PL approach. Further clinical prospective studies are needed to define the clinical relevance of these results and define the optimal strategy of fixation.

Data on inter-locking nail in humeral shaft fractures among Indian patients.

Humeral shaft fractures are commonly seen orthopaedics injuries. Open reduction with internal fixation (ORIF) with plating is a gold standard procedure despite various issues such as infection, radial nerve palsy and no-nunion. Close reduction with interlocking nails (ILN) is not a very popular procedure. Therefore, it is of interest to collect data on the significance of interlocking nail in different pattern of humerus shaft fracture. 30 patients with closed humeral shaft fracture participated in this study. The fractures were classified according to their descriptive location as proximal, middle and distal. All surgeries were performed by a single surgeon familiar with the ILN procedure. All patients had appropriate clinical, radiological and pre and postoperative assessment. Data on patients were collected at 2, 6weeks, 12weeks, 18 weeks and 6 months. 19 cases with middle third and distal third fractures were united within 10-14 weeks. 6 cases of proximal shaft fracture were united in 14-18 weeks. According to Rodrı ´guez-Merchant criteria - Middle shaft fracture has shown good results (n=9, 75%) followed by distal third shaft fracture (n=6, 60%) and proximal third fracture (n=1, 12.5%). Though there is decrease in mean ASES score in all three groups of fractures but the Mid shaft fracture has shown significant decline in ASES score suggesting improvement in pain and ROM after 6 months. Thus, ILN of humerus is a simple and a safe procedure for treating fractures of middle and distal third shaft humerus. However, this study does not support ILN for the management of proximal third humerus fracture.

Cervical Spine Fracture Prediction by Simple Plain X-Ray in Ankylosing Spondylitis Patients after Low-Energy Trauma.

Timely diagnosis is essential in the management of cervical spine fracture (CSF) in ankylosing spondylitis (AS) patients. However, the value of simple plain X-ray in the early management of ASCSF has not been well-studied. This study aimed to explore the prediction ability of simple plain X-ray for CSF in AS patients who suffer from low-energy trauma (LET). From January 2010 to December 2020, AS patients who experienced LET were retrospectively reviewed. Clinical data including gender, age, body mass index, time interval between AS diagnosis and trauma, smoking or not, and a presence of continuous bony bridge between anterior margin of C1 and C2 body or not were collected. Morphological features including atlanto-occipital gap, Pavlov ratio of C2-7, Angle A-D, Borden's index, and Harrison's value were measured by the lateral cervical X-ray. All data was compared between patients who had CSF and those who did not. Binary logistic regression analysis and receiver operator characteristic (ROC) curves were applied to discriminate and assess the predictive parameters. A total of 129 AS patients were divided into Fracture group (41 cases) and Non-fracture group (88 cases) based on whether CSF existed. Twelve parameters showed significant differences between two groups (p < 0.05). According to the binary logistic regression model, four of the 12 parameters showed a further correlation with the occurrence of CSF, namely, mean Pavlov ratio (p < 0.001, OR=0.067, 95% CI: 0.023 to 0.194), Angle D (p=0.031, OR=1.057, 95% CI: 1.005 to 1.112), Borden's index (p=0.042, OR=1.131, 95% CI: 0.994 to 1.287), the time interval between the AS diagnosis and the trauma (p < 0.020, OR=0.935, 95% CI: 0.883 to 0.990). The ROC curve further revealed the mean Pavlov ratio had the largest AUC (0.793) with the cut-off of 0.72. While the optimal cut-off value was 45.65° for Angle D (sensitivity=61.0%, specificity=78.4%), 9.79 for Borden's index (sensitivity=87.8%, specificity=37.5%), 15.50 years for the time interval between AS diagnosis and trauma (sensitivity=70.7%, specificity=56.8%). The time interval between the AS diagnosis and the trauma, mean Pavlov ratio, Angle D, and Borden's index showed predictive ability for the occurrence of CSF in AS patients who encounter LET. Surgeons should consider measuring these parameters in the management of AS patient.