Limb Fractures Research Articles

Progress in the Application of Portable Ultrasound Combined with Artificial Intelligence in Pre-Hospital Emergency and Disaster Sites

With the miniaturization of ultrasound and the development of artificial intelligence, its application in disaster scenes and pre-hospital emergency care has become more and more common. This study summarizes the literature on portable ultrasound in pre-hospital emergency and disaster scene treatment in the past decade and reviews the development and application of portable ultrasound. Portable ultrasound diagnostic equipment can be used to diagnose abdominal bleeding, limb fracture, hemopneumothorax, pericardial effusion, etc., based on which trauma can be diagnosed pre-hospital and provide guiding suggestions for the next triage and rescue; in early rescue, portable ultrasound can guide emergency operations, such as tracheal intubation, pericardial cavity puncture, and thoracic and abdominal puncture as well as improve the accuracy and timeliness of operation techniques. In addition, with the development of artificial intelligence (AI), AI-assisted diagnosis can improve the diagnosis level of ultrasound at disaster sites. The portable ultrasound diagnosis system equipped with an AI robotic arm can maximize the pre-screening classification and fast and concise diagnosis and treatment of batch casualties, thus providing a reliable basis for batch casualty classification and evacuation at disaster accident sites.

Thrombophilia Screening in Autoimmune Hemolytic Anemia: A Single-Center Cross-Sectional Study

Background Autoimmune hemolytic anemia (AIHA) is characterized by an increased rate of thrombosis, whose predictors are not completely clarified, although an association with active hemolysis (i.e., LDH >1.5 x ULN), anemia severity and previous splenectomy has been reported. Moreover, antithrombotic prophylaxis and its duration are not standardized in this patient-population. The value of thrombophilia screening, including congenital and acquired abnormalities, has not been established yet. Aim To investigate the prevalence of inherited and acquired thrombophilia abnormalities in a cohort of AIHA patients with or without thrombosis. Methods AIHA patients followed from January 2019 until September 2022 at a tertiary hematologic center in Milan, have been systematically tested for Factor V Leiden (FVL) and prothrombin (FII) G20210A mutation, protein C (PC), protein S (PS), antithrombin (AT) levels, and the presence of antiphospholipid antibodies (APLA, i.e., lupus anticoagulant, LAC, anti-cardiolipin and anti-b2-glycoprotein-1). Patients' hematological characteristics, additional thrombotic risk factors, history of venous/arterial thrombosis before and after AIHA diagnosis, and anticoagulant and/or antiplatelet therapies were retrospectively recorded. Results As shown in table 1, 59% of 92 enrolled patients were female with a median age at diagnosis of 70.5 years (range 24-89), and were classified as warm AIHA (50%), cold agglutinin disease (31.5%), mixed/atypical AIHA (9.8%), and Evans syndrome (association of AIHA and other immune cytopenia, 8.7%). Thrombophilia screening resulted positive in 19 patients (20.7%) including FVL (1.1%), F II (1.1%), APLA (10.8%), PC deficiency (1.1%), PS deficiency (2.2%), AT deficiency (2.2%), and more than one abnormality (2.2%). Additional risk factors considered were thrombosis prior to AIHA diagnosis, reported in 6 patients (7%, 3 venous and 3 arterial), and associated conditions (29%), including autoimmune disease (N=17), lymphoproliferative disease (N=7), myeloproliferative neoplasm (N=1), and paroxysmal nocturnal hemoglobinuria (N=1). Furthermore, 97% of subjects presented at least one risk factor (i.e., diabetes, obesity, bed rest, etc.) in addition to AIHA. Twenty-seven patients (28%) received anticoagulant prophylaxis after AIHA diagnosis, mainly short-term for hemolysis (42%) or surgery of lower limb fractures (37%), and long-term for atrial fibrillation in 24%; 22% of patients were on antiplatelet prophylaxis, and 4 patients had been splenectomized. Since AIHA diagnosis, 26 patients (28%) experienced thrombosis (77% venous, 23% arterial), with 33 total events (3 patients had > 1 event). Median hemoglobin and LDH at thrombosis were 8.6 g/dL (2-11.7), and 374 U/L (129-1873) respectively, indicating active hemolysis. No relationship was found with inherited thrombophilia abnormalities (3 patients, 8% experienced thrombosis vs 7, 10.5% who did not), whilst a significant association was noted with APLA positivity (p<0.05). Two patients with APLA experienced more than 1 event, one had 1 venous and 1 arterial event. Conclusions Along with disease activity and Evans syndrome, positivity for APLA appears the main predictor of thrombosis in AIHA and is therefore worth of testing, whilst extensive thrombophilia screening encompassing inherited abnormalities appears less useful.

Effect of Video-Assisted Isometric Strengthening Exercise Program on Pain and Muscle Strength Poststabilization of Lower Limb Fracture.

The benefits of isometric strengthening exercises (ISEs) are compromised when patient teaching on ISEs is delayed and/or ineffectively delivered due to healthcare resources constraint, especially when health resources are stretched, as occurred during the COVID-19 pandemic. This study aims to examine the effect of a video-assisted ISE program on pain and muscle strength of patients following surgical stabilization of lower limb fracture. A quasi-experimental study with repeated measures was employed. Primary study outcomes were assessed using the Brief Pain Inventory and Manual Muscle Test. Effects over time were analyzed using generalized estimating equations. In comparison with usual care group (n = 32), the intervention group (n = 33) showed better pain reduction over time (p < .001, effect size [ES] = 0.39-1.77) and muscle strength preservation (p < .05; ES = 0.8-0.9). Patient acceptance of the intervention was favorable. Integration of video clips into patient teaching on ISEs is potentially beneficial in managing pain and muscle strength; it can be easily deployed to aid early ISE initiation.

Incidence of Acute Upper Gastrointestinal Bleeding and Related Risk Factors among Elderly Patients Undergoing Surgery for Major Limb Fractures: An Analytical Cohort Study

(1) Background: Upper gastrointestinal bleeding (UGIB), a major postoperative complication after surgical fixation of major limb fractures, can be fatal but is often neglected. This study determined the incidence rates of and related risk factors for perioperative UGIB among older patients with major upper limb fractures but without a history of peptic ulcer disease (PUD). (2) Methods: We collected the data of patients aged more than 65 years who underwent surgery for major limb fracture between 1 January 2001 and 31 December 2017, from Taiwan’s National Health Insurance Research Database and excluded those with a history of UGIB and PUD before the date of surgery. The primary outcome was the incidence of UGIB requiring panendoscopy during hospitalization. A multiple logistic regression model was used to identify the independent predictors of UGIB, with adjustment for confounding factors. The final model included variables that were either statistically significant in univariate analyses or deemed clinically important. (3) Results: The incidence of UGIB was 2.8% among patients with major limb fractures. Male sex, older age, major lower limb fracture, and a history of chronic renal disease were significant risk factors for the increased incidence of perioperative UGIB. (4) Conclusions: Patients with major limb fractures who underwent surgery exhibited a higher rate of stress ulceration with UGIB, even when they had no history of PUD. Perioperative preventive protocols (e.g., protocols for the administration of proton-pump inhibitors) may be necessary for patients with these major risk factors.

The Effect of Benson's Relaxation on Pain in Patients Post Open Reduction Internal Fixation (orif) Extremity Fractures

The most common complaint felt by patients due to fractures and the main complaint of patients after surgery is pain. Pain that is felt continuously can result in clinical and psychological changes. Benson's relaxation can be an alternative intervention in patients with Post Open Reduction Internal Fixation (ORIF) limb fractures to reduce pain by stimulating the pituitary gland to release endorphins and inhibit pain impulses from the cerebral cortex and thalamus. Benson Relaxation is safe and easy to do, has no risk of injury/side effects. The purpose of this study was to determine the effect of Benson relaxation on pain in patients with Post Open Reduction Internal Fixation (ORIF) limb fractures in the Dahlia Room at Mardi Waluyo General Hospital, Blitar. The research design uses a quasi-experimental pre-post test design. The population was all post ORIF patients with extremity fractures in the Dahlia (surgical) room at Mardi Waluyo Blitar Hospital with a total of 35 patients. The sample was post ORIF extremity fracture patients in the Dahlia Room of Mardi Waluyo General Hospital Blitar with a total sample of 13 respondents in each group using the Consecutive Sampling technique. Pain measurement data uses a Numerical Rating Scale. Statistical test using independent t-test. The results showed that the mean decrease in pain score in the Benson relaxation intervention group was 1.10, while the mean decrease in pain score in the control group was 0.44 with a pvalue of 0.00 &lt;��� 0.05. It was concluded that there was an effect of Benson relaxation on pain in patients with Post Open Reduction Internal Fixation (ORIF) limb fractures. Benson relaxation is effective in reducing pain in patients with post open reduction internal fixation (ORIF) limb fractures. There needs to be a standard operating procedure regarding Benson's relaxation, so that later it can be implemented by all nurses.Keywords: Benson Relaxation, Pain, Fracture, Post ORIF

The Effect of Benson's Relaxation on Pain in Patients Post Open Reduction Internal Fixation (orif) Extremity Fractures

The most common complaint felt by patients due to fractures and the main complaint of patients after surgery is pain. Pain that is felt continuously can result in clinical and psychological changes. Benson's relaxation can be an alternative intervention in patients with Post Open Reduction Internal Fixation (ORIF) limb fractures to reduce pain by stimulating the pituitary gland to release endorphins and inhibit pain impulses from the cerebral cortex and thalamus. Benson Relaxation is safe and easy to do, has no risk of injury/side effects. The purpose of this study was to determine the effect of Benson relaxation on pain in patients with Post Open Reduction Internal Fixation (ORIF) limb fractures in the Dahlia Room at Mardi Waluyo General Hospital, Blitar. The research design uses a quasi-experimental pre-post test design. The population was all post ORIF patients with extremity fractures in the Dahlia (surgical) room at Mardi Waluyo Blitar Hospital with a total of 35 patients. The sample was post ORIF extremity fracture patients in the Dahlia Room of Mardi Waluyo General Hospital Blitar with a total sample of 13 respondents in each group using the Consecutive Sampling technique. Pain measurement data uses a Numerical Rating Scale. Statistical test using independent t-test. The results showed that the mean decrease in pain score in the Benson relaxation intervention group was 1.10, while the mean decrease in pain score in the control group was 0.44 with a pvalue of 0.00 &lt;��� 0.05. It was concluded that there was an effect of Benson relaxation on pain in patients with Post Open Reduction Internal Fixation (ORIF) limb fractures. Benson relaxation is effective in reducing pain in patients with post open reduction internal fixation (ORIF) limb fractures. There needs to be a standard operating procedure regarding Benson's relaxation, so that later it can be implemented by all nurses.Keywords: Benson Relaxation, Pain, Fracture, Post ORIF

Predictive factors of return to activity in elderly patients operated on for a fracture of the lower limb: a study of 113 patients

Background: The aim of this study was to determine the factors predictive of resumption of activity in elderly subjects operated on for a fracture of the lower limb. Methods: This was a cross-sectional study with retrospective data collection in subjects aged 56 and over who had undergone lower-limb surgery with a minimum follow-up period of six months. Patients' walking autonomy was assessed using the Parker score. The modular integrated household survey on living conditions was used to assess patients' socio-economic status. Bivariate analysis was performed using the chi-square test and the calculation of measures of association. Results: The series included 113 patients with a mean age of 70±9.54 years and a sex ratio of 1.09. Fractures of the upper end of the femur predominated in 67.6% of cases. The most common surgical procedure was intermediate hip replacement in 30 patients (26.5%). Rehabilitation sessions were performed in 95 patients (84.1%). The postoperative Parker score at the last follow-up was 9/9 in 41 patients (36.3%). Resumption of educational and productive activities and interpersonal responsibilities was achieved in 90 patients (79%). Significant associations (p&lt;0.05) were found between resumption of activities and age, sex, marital status, history of arterial hypertension, psychiatric history, preoperative Parker score, postoperative Parker score and return to a private residence. Conclusions: Older age, female gender, absence of a partner, high blood pressure, non-personal residence and poor Parker score are factors with a poor prognosis for return to activity.

Retrievable Inferior Vena Cava Filter Trapped Embolus: A Risk Factor of Detachment of Thrombus Analysis Based on a Multicenter Prospective Observational Study.

Up to now, the indications of inferior vena cava filter placement still remain controversial in the academic field. The aim of this study was to determine the risk factors of detachment of thrombus and to evaluate the necessity of inferior vena cava filter placement to prevent fatal pulmonary embolism. A total of 2892 patients participated in the multicenter prospective observational study from January 1, 2018, to December 31, 2018, and underwent retrievable inferior vena cava filter (RIVCF) placement in 103 centers in China. The primary endpoint of the study was RIVCF trapped embolus detected by inferior vena cava venography/ultrasound/computed tomography scanning or visible macroscopic thrombus before or during RIVCF retrieval. The relative factors of RIVCF trapped embolus were analyzed accordingly. The average age of the patients was 61.0 (50.0-71.0) years. Retrievable inferior vena cava filter trapped embolus occurred in 308 patients (10.65%). The fracture location, surgery location, and endovascular intervention differed between RIVCF trapped embolus and non-RIVCF trapped embolus groups (p<0.001, respectively). By multivariate analysis, RIVCF trapped embolus were less common in older patients (odds ratio [OR]=0.998; p<0.001) and more common in patients with below-the-knee fracture (OR=1.093, p=0.038), thigh fracture (OR=1.118, p=0.007), and pelvis surgery (OR=1.067, p=0.016). In addition, compared with patients without endovascular intervention, patients with percutaneous mechanical thrombectomy (PMT) + catheter-directed thrombolysis (CDT) were more prone to develop RIVCF trapped embolus (OR=1.060, p=0.010). However, RIVCF trapped embolus was less common in patients with CDT (OR=0.961, p=0.004). Lower limb fracture, pelvis surgery, and PMT + CDT are prone to cause trapped embolus. As a trapped embolus often represents the possibility of severe pulmonary embolism, lower limb fracture, pelvis surgery, and PMT + CDT could be risk factors of fatal pulmonary embolism. Due to the low incidence of trapped embolus, it is not necessary to place filters in elderly patients and CDT-only patients. The purpose of this paper is to standardize the use of inferior vena cava filter and avoid unnecessary filter implantation through the summary and analysis of a large number of clinical data. At the same time, more attention should be paid to and active treatment should be given to high-risk groups of pulmonary embolism.

Case Report: Effectiveness of physiotherapy rehabilitation in a patient with compound grade IIIC proximal third tibia fracture along with vascular injury

The proximal metaphyseal region of the bone is thought to be the location of fractures of the proximal tibia. The surgical management of proximal tibial shaft fractures and high-energy bicondylar tibial plateau fractures is still challenging . Supra-cutaneous plating, also known as a locking compression plate, has been promoted as a crucial technique in the management of challenging reconstructive scenarios since it has shown to be adjustable, concealed, and well-accepted by patients. Physical therapy rehabilitation is critically necessary for a full recovery from a range of orthopaedic issues. Physical therapy rehabilitation is a vital step in the healing process for patients with lower limb fractures. In our study , we rehabilitated a patient with Compound grade IIIC proximal third tibia fracture right side managed with Closed reduction external fixator application and vascular repair along with proximal fibula fracture. Through this study, we developed a physiotherapy rehabilitation protocol that was very helpful for these patients, produced positive results, and served to enhance the patient's quality of life.

Effect of application of short-form video health education on the health knowledge and satisfaction with nursing care of patients with lower extremity fractures

BackgroundVideo health education has been increasingly adopted in the clinic to expand patient guidance and improve perioperative outcomes. To date, however, it is unclear whether the use of short-form videos and web-based clinician-created forums actually improve the perioperative experience of patients.ObjectiveTo evaluate the effect of application of short-form video health education on the health knowledge and satisfaction with nursing care of patients with lower extremity fractures.MethodsThis study is a quasi experimental study, using convenient sampling method and grouping according to historical control., one hundred and twenty-two patients admitted with lower limb fractures to the orthopedic ward of a tertiary first-class general hospital in Fujian, China were enrolled in this study. Based on their admission order, patients admitted from September 2021 to November 2021 were enrolled into the control group (n = 61) and patients admitted from December 2021 to March 2022 were enrolled in the intervention group (n = 61). Both groups received identical admission-based patient education, perioperative care, and discharge rehabilitation instructions. The control group received the traditional education method while the intervention group received a short-form educational video in addition to the traditional education method. Patient perioperative health knowledge and patient satisfaction with nursing care during treatment of lower limb fractures were compared across the two groups.ResultsPreoperative health knowledge in the intervention group was 95.1%, compared to 82.0% in the control group (χ2 = 3.954, P<0.05). The Newcastle satisfaction with nursing scales score in the intervention group was (80.902 ± 7.016) points, compared to (78.131 ± 8.213) points in the control group. These group differences were statistically significant (P < 0.05).ConclusionThe application of a short-form educational video during the perioperative care of patients with lower limb fractures may improve patients’ understanding of perioperative health and increase satisfaction with nursing care.

Gait and strength assessment following surgical repair by intramedullary nailing of isolated tibial shaft fracture.

The objective of the study was to evaluate the long-term strength and gait outcomes after intramedullary nailing of isolated tibial diaphyseal fractures. This retrospective cohort study was conducted at an academic Level I trauma center. Fifteen participants with isolated tibial diaphyseal fractures (OTA/AO 42) at least 2 years postoperative from intramedullary nailing (IMN) provided informed consent. The average age was 40 ± 14 (range, 24-69); there were nine men and six women. Knee flexion-extension strength data were collected. Temporal-spatial, kinematic, and kinetic gait parameters were measured and compared to historic control data. Participants completed the SF-36 and shortened musculoskeletal function assessment questionnaires. The mean length of follow-up between surgery and gait analysis was 6 ± 2 years. The fractured limb demonstrated deficits in quadriceps strength between 9.8% and 23.4% compared to the unaffected limb. Temporal-spatial parameters revealed slower walking speed, shorter stride length, decreased cadence, and shorter single-limb support time in the fractured limb. Altered kinematic and kinetic findings included a knee extension shift during stance, with an increased knee flexor moment demand and decreased total knee power during loading and midstance. These findings represent deficits in concentric and eccentric knee extensor activity. Additionally, the fractured limb demonstrated decreased ankle dorsiflexion during stance and diminished ankle push-off power. Long-term outcomes after IMN of tibial diaphyseal fractures demonstrate decreased quadriceps strength and altered gait parameters that may have implications to the high incidence of knee and ankle pain in the fractured limb.

Price for Care of Open Fractures of Limbs in the Surgical Emergency of the Brazzaville Hospital and University Center

Introduction: The aim of this work was to describe the emergency management of open fractures at the Brazzaville University Hospital (CHUB). Patients and Methods: this was a descriptive study with retrospective data collection from January 1 to December 31, 2022, in the surgical unit of the medical-surgical emergency department of the CHUB. All injured people hospitalized during the study period for recent open fractures whose initial treatment was carried out at the CHUB were included. The parameters studied were epidemiological, clinical, paraclinical and therapeutic. The GUSTILO Anderson Classification was used to assess the extent of skin lesions. Results: We collected 114 patients for 121 open fractures. There were 93 men (81.57%) and 21 women (18.43%), i.e. a sex ratio of 4.42. The average age was 32.4 ± 6.23 years, the etiologies were dominated by public road accidents (73.68%). The average consultation time was 4.45 hours. The pelvic limbs were affected in 80.99% of cases. Open fractures of both leg bones were the most frequent (75.20%). Type II fractures of the GUSTILO classification were in the majority (69.42%). There was one case of vascular involvement of the leg tripod and one case of radial nerve involvement. The average time for initial treatment was 8.36 ± 1.20 hours. Types I and II lesions required emergency suture before definitive treatment in 14.87% and 46.28% of cases respectively. The average time for definitive treatment was 22.91 hours. Osteosynthesis was performed in 86.78% of cases, cast immobilization with fenestration in 12.39% of cases and transfemoral amputation in 1 case. Internal fixation using an external fixator was the most frequent surgical indication (68.59%). Conclusion: Open leg fractures are very common traumatic injuries in our daily practice. Surgical treatment with an external fixator is the most commonly performed.

Is There a Role for Heli-FX Endoanchors in Treating Type 1B Common Iliac Artery Endoleaks?

The management of type 1B endoleaks following endovascular aortic aneurysm repair (EVAR) can be challenging. The Heli-FX Endoanchor system effectively treats proximal type 1A endoleaks but has not been used for type 1B common iliac artery endoleaks. This study demonstrates that it is both safe and effective in being used in the common iliac artery (CIA) limb of an EVAR. A retrospective review of patients identified through coding and medical records was performed to extract information on demographics, aneurysmal features, operative features, and postoperative outcomes. This was then collated and analysed thoroughly and compared to existing research. Four patients with six type 1B CIA endoleaks were treated with Heli-FX Endoanchors in the CIA limbs of EVAR grafts. There was 100% technical success rate with complete exclusion of the endoleaks at 6months. With mean follow up of 714days, there were no Endoanchor-specific complications. One patient required explantation of the aortic endograft due to contralateral limb fracture, where it was found that an Endoanchor had penetrated the common iliac vein, requiring primary closure. Heli-FX Endoanchors were effective within this cohort of patients, though key risks were identified. Adjacent anatomy to the CIA must be considered, which also have nearly half the arterial thickness compared to the aorta. Pre-operative planning is essential given the theoretical risk of placing Endoanchors.

Particularities of upper extremity fractures in patients with COVID-19

Background. Treatment of the fractures in patients with COVID-19, given the novelty of this problem, is one of the most difficult tasks of modern traumatology and orthopedics. The purpose of this study was to determine the peculiarities of the course of the traumatic process in victims with fractures of the upper limbs against the background of COVID-19. Materials and methods. To carry out our research, we retrospectively analyzed the treatment of 136 trauma patients who underwent inpatient treatment in one of the city hospitals of Kyiv from 2019 to 2021. In our study, we used the generally accepted AO/ASIF classification of fractures to determine the clinical and nosological characteristics of injuries in patients with COVID-19. Results. During the COVID-19 epidemic, fractures to the distal part of the forearm (28.8 %), clavicle (17.8%) and proximal part of the shoulder (15.1 %) were most often detected. Among segmental injuries in patients with COVID-19, forearm (in 42.5 % of cases) and shoulder (in 35.6 % of cases) fractures predominated. Also, simple fractures of type A (72.6 %) were more common, and much less fragmentary fractures of type B (21.9 %) and multifragmentary type C fractures (5.5 %) were present. It is worth noting a significant decrease in the number of hand injuries during the COVID-19 pandemic by almost 7 times. In our opinion, this is due to the lockdown introduced by the authorities of Ukraine, which significantly reduced the number of industrial injuries among the research sample. Conclusions. We concluded that the COVID-19 pande­mic significantly affected the clinical and nosological structure and characteristics of bone fractures of the upper limb girdle, the analysis of cases proved that such changes in the clinical and nosological structure of fractures of the upper limb girdle are associated with changes in life activities during the pandemic and more typical for domestic trauma.

FRI679 Risks Of Incident Major Osteoporotic Fractures Following SARS-CoV-2 Infection

Abstract Disclosure: D. Lui: None. X. Xiong: None. M. Chung: None. I. Au: None. F. Lai: None. E. Wan: None. C. Chui: None. X. Li: None. F. Cheng: None. C. Cheng: None. E. Chan: None. C. Lee: None. T. Ip: None. Y. Woo: None. K. Tan: None. C. Wong: None. I. Wong: None. Objectives: Pre-clinical and small cohort studies have suggested the potential deleterious effects of SARS-CoV-2 infection on bone health. We aimed to estimate the risks of incident fractures following SARS-CoV-2 infection in a population-based cohort. Methods: This was a retrospective, propensity-score matched, population-based cohort study of COVID-19 patients and non-COVID individuals identified from the electronic database of the Hong Kong Hospital Authority from January 2020 to March 2022. The primary outcome was a composite of major osteoporotic fractures (hip, clinical vertebral, proximal humerus and wrist fractures), identified by the ICD-9-CM codes 805.x, 812.x, 813.x, 814.x, 820.x. Episodes of falls were identified by the ICD-9-CM codes 781.2, 781.3, 781.99, V15.88, E880-E888. COVID-19 patients were 1:1 matched to controls using propensity-score according to age, sex, comorbidities and medications. The cohort was followed up until the occurrence of outcomes, death, or 31 January 2023, whichever came first. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models. Results: 740,692 COVID-19 patients were included, 1:1 matched to non-COVID individuals. Upon median follow-up of 11 months, COVID-19 patients had higher risks of major osteoporotic fractures (0.35% vs 0.29%; HR 1.21, 95%CI 1.14-1.29, p&amp;lt;0.001), hip fractures (0.16% vs 0.11%; HR 1.34, 95%CI 1.23-1.47, p&amp;lt;0.001), and fall (0.89% vs 0.65%; HR 1.29, 95%CI 1.24-1.34, p&amp;lt;0.001). There was also statistically non-significant increased risk of clinical vertebral (0.03% vs 0.02%; HR 1.22, 95%CI 0.99-1.50, p=0.062) and upper limb (0.14% vs 0.12%; HR 1.08, 95%CI 0.99-1.18, p=0.081) fractures. Subgroup analyses revealed no significant interaction by age (&amp;lt;60 vs ≥60 years), presence of diabetes, fracture history, and the predominant SARS-CoV-2 variant. However, the impact of SARS-CoV-2 infection on fracture and fall risks was greater among men (p-interaction&amp;lt;0.001) and unvaccinated people (p-interaction=0.015). Among COVID-19 patients, hospitalised and dexamethasone-treated ones had higher subsequent fracture and fall risks. When dividing the follow-up period into the acute phase (within 30 days after SARS-CoV-2 infection) and the post-acute phase (beyond 30 days after SARS-CoV-2 infection), the risk of major osteoporotic fractures and falls was consistently increased in the whole cohort, particularly among the older individuals (≥60 years). Conclusions: Our study demonstrated increased risk of major osteoporotic fractures following SARS-CoV-2 infection, contributed by increased fall risk. Clinicians should be aware of musculoskeletal health of COVID-19 survivors, especially older individuals, and provide appropriate preventive actions. Presentation: Friday, June 16, 2023

Mode of Injury, Involvement of Bones and Post-Operative Surgical Outcomes of Patients presented with Lower Limbs Fractures attended at a Tertiary Care Hospital at Tourist City of Bangladesh

Background: Surgical management is very much crucial among the lower limb fracture patients.&#x0D; Objective: The purpose of the present study was to find out the mode of injury, involvement of bones and post-operative surgical outcomes of patients presented with lower limbs fractures patients.&#x0D; Methodology: This prospective hospital-based study was conducted in the Department of Orthopaedic and Traumatology at Cox’s Bazar Medical College Hospital, Cox’s bazar, Bangladesh from January 2019 to June 2022 for a period of three and half years. All the patients who were presented with the clinical features of fracture of lower limbs were selected as study population. The patients were managed by conservative or surgical way. The outcomes of both procedures were recorded.&#x0D; Results: A total number of 370 cases were recruited for this study. The mean age with SD of the study population was 18.2±11.56 years. Among these road traffic accident was the most common mode of injury which was 204(55.0%) cases. Open type of fracture was found in 141(38.0%) cases and the close was found in 229(62.0%) cases. The most common bones involved was the shaft of tibia and fibula which was 159(43.0%) cases. During conservative treatment mal-union was reported in 193(66.8%) cases and the rest of the 96(33.2%) patients had shown the stiffness. Among 81 operated cases majority were recovered which was 70(86.0%) cases. However, death was found in 2(2.0%) cases. Minor and major infection were reported in 6(8.0%) cases and 3(4.0%) cases respectively.&#x0D; Conclusion: In conclusion the most common mode of injury is road traffic accident with the involvement of shaft of tibia and fibula with majority improvement.&#x0D; [Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):60-64]

Aural microsuction: an analysis of post-procedure patient safety incidents.

Aural microsuction can be associated with delayed syncopal and vertiginous events, which can lead to serious adverse patient safety incidents. This article highlights the serious risks associated with microsuction. We performed a retrospective review of the hospital risk database over a 2-year period. Three patients experienced severe adverse events post microsuction. Two patients fell down the stairs after microsuction, with one suffering a lower limb fracture. One patient experienced loss of consciousness and subsequent head trauma post microsuction. Whilst aural microsuction is universally accepted to be a low-risk procedure, subsequent serious morbidity can occur. Implementation and awareness of local safety policies are imperative to avoid post-procedure injury.

Paediatric orthopaedic expert system.

The paediatric orthopaedic expert system analyses and predicts the healing time of limb fractures in children using machine learning. As far we know, no published research on the paediatric orthopaedic expert system that predicts paediatric fracture healing time using machine learning has been published. The University Malaya Medical Centre (UMMC) offers paediatric orthopaedic data, comprises children under the age of 12 radiographs limb fractures with ages recorded from the date and time of initial trauma. SVR algorithms are used to predict and discover variables associated with fracture healing time. This study developed an expert system capable of predicting healing time, which can assist general practitioners and healthcare practitioners during treatment and follow-up. The system is available online at https://kidsfractureexpert.com/.

Immunohistochemical evaluation of tissues following bone implant extraction from upper and lower limb.

Fractured bones can regenerate and restore their biological and mechanical properties to the state prior to the damage. In some cases, however, the treatment of fractures requires the use of supportive implants. For bone healing, three processes are essential: the inflammatory phase, the repair phase and the remodelling phase. A proper course of the first - inflammatory - stage is important to ensure a successful fracture healing process. In our study, we evaluated tissue samples immunohistochemically from the area surrounding the fractures of upper and lower limbs (bone tissue, soft tissue, and the implant-adhering tissue) for markers: CD11b, CD15, CD34, CD44, CD68, Cathepsin K, and TRAcP that are linked to the aforementioned phases. In soft tissue, higher expressions of CD68, CD34, CD15 and CD11b markers were observed than in other locations. TRAcP and Cathepsin K markers were more expressed in the bone tissue, while pigmentation, necrosis and calcification were more observed in the implant-adhering tissue. Since even the implant materials commonly perceived as inert elicit the observed inflammatory responses, new surface treatments and materials need to be developed.

Charcot arthropathy and acro-osteolysis in a 5-year-old girl with hereditary sensory and autonomic neuropathy type II: A case report

Charcot neuropathic arthropathy is a destructive process that can occur in patients with neuropathy associated with medical diseases such as diabetes. A rare cause of neuropathic arthropathy is congenital insensitivity to pain (CIP) which includes varying degrees of sensory loss and lack of pain perception contributing to absent withdrawal responses. The clinical manifestations of CIP include delayed diagnosis of fractures, joint dislocations, acro-osteolysis, avascular necrosis, osteomyelitis, heterotopic ossification, and Charcot arthropathy. We herein report a case of Charcot arthropathy of ankle joints in a 5-year-old girl with CIP due to underlying hereditary sensory and autonomic neuropathy who had recurrent upper and lower limb fractures with acro-osteolysis. She had an inability to perceive pain from the first year of her life. She also had mild developmental delay. Family history was unremarkable. Blood count, liver and thyroid function tests, erythrocyte sedimentation rate, C-reactive protein, blood electrolytes, blood sugar and other laboratory tests were normal. Charcot neuropathic arthropathy in children is rare and can be a part of congenital diseases like CIP. A high degree of suspicion may lead to early detection and can prevent joint and bone destruction and deformities.