Fracture Type Research Articles

Intracapsular and extracapsular fracture types and inpatient mortality in failed hemiarthroplasty

BackgroundIncreasing life expectancy has led to a rise in hip fractures and an associated increase in hemiarthroplasty procedures aimed at restoring mobility and preventing muscle loss. Despite the extensive literature on failed hemiarthroplasty, limited data address the influence of pre-operative fracture types—intracapsular versus extracapsular—on outcomes, including inpatient mortality. This study investigates the revisions of uncemented bipolar hemiarthroplasties concerning fracture type and identifies risk factors for inpatient mortality.MethodsThis retrospective cohort study included 68 patients (16 males and 52 females) who underwent revision of uncemented bipolar hemiarthroplasties at a single institution between 2017 and 2024. Data on demographics, comorbidities, fracture type, surgical details and outcomes were analysed. Statistical analyses included t tests, chi-square tests and logistic regression, with significance set at p < 0.05.ResultsOf 1,690 hemiarthroplasties performed, 68 required revision (revision rate: 4%). Revisions for extracapsular fractures were associated with a higher prevalence of diabetes mellitus (p = 0.01) and elevated Almelo Hip Fracture Score (AHFS; p = 0.01). The overall inpatient mortality rate was 19%, significantly higher in males (43.75%) than females (11.54%; p = 0.00). Deceased patients demonstrated higher AHFS and American Society of Anaesthesiologists scores but lower Parker Mobility Scores (p = 0.01). Prolonged intensive care unit (ICU) stays were also linked to increased mortality (p = 0.02). Logistic regression identified male sex as an independent predictor of mortality (odds ratio: 9.37; p < 0.05).ConclusionsPre-operative fracture type significantly influences revision outcomes in failed hemiarthroplasties. Moreover, extracapsular fractures are linked to diabetes mellitus and higher AHFS, whereas male sex, ICU stay duration and comorbidity scores predict inpatient mortality. These findings highlight the need for tailored perioperative care to mitigate risks.Trial registrationNot applicable.

Management of extremity and pelvic fractures in earthquake: our observations and recommendations

BackgroundEarthquakes frequently cause injuries to the musculoskeletal system. Studies conducted after earthquakes often report on injured limbs, fractures, and surgeries. This study aimed to enhance preparedness for future earthquakes by acquiring knowledge about the prevalence of fractures and the relationship between fracture types and injury mechanisms.MethodsA retrospective analysis was conducted on medical records of patients with fractures admitted to our hospital following the 2023 Kahramanmaraş Earthquake. Patients with fractures resulting from traffic accidents or other causes unrelated to earthquakes were excluded. The recorded data included age, gender, fracture site, fracture type, mechanism of injury, date, duration of surgery, and peak creatine kinase (CK) level. The injury mechanisms were classified into four main categories: injured by falling objects, falling while running, falling from height, and being trapped under rubble. The study investigated the relationship between fractures and other factors.ResultsThe study included 185 patients with a mean age of 39.62 ± 20.83 years. The most frequent mechanism of injury was being trapped under rubble. In total, there were 214 fractures, with pelvic fractures being the most common (21.50% of all fractures). Tibia fractures were the most common fractures in the lower extremities (15.89%). Women had a significantly higher occurrence of pelvic fractures (33.3%) compared to men (14.5%) (p = 0.003). The frequency of pelvic fractures significantly increased as age decreased (p = 0.007). Patients with pelvic fractures had a significantly greater peak CK concentration (p = 0.006). Open fractures were more common in the first few days, and Kirschner wires were the first treatment applied at a mean of 74 h and external fixators at a mean of 94.3 h.ConclusionInjuries from falling objects from roofs and jumping from heights are important in earthquakes. In addition to lower extremity fractures, pelvic fractures are common in earthquake disasters. Most pelvic fractures are simple lateral compression fractures and it is important to follow the patients for crush syndrome in the first days instead of focusing on definitive fracture treatment. Open fractures should be prioritized for fracture surgery within the first few days. External fixators and Kirschner wires are recommended. Closed fractures should be treated conservatively and definitive surgical procedures should be postponed to the following weeks.

Etiological factors and clinical outcomes in extracapsular and intracapsular hip fractures among older adults: A gender-specific analysis.

Compared to patients with intracapsular fractures (ICFs), those with extracapsular fractures (ECFs) had worse outcomes. However, most studies of risk factors for these fractures lacked relevant potential reasons, particularly nutritional status, and adjustment for confounding factors. Furthermore, less is known about their effects on clinical outcomes. To conduct a gender-specific analysis of community-dwelling individuals admitted with hip fractures to examine the association of clinical risk factors and health care measures. Monocentric cross-sectional study. Orthopedic trauma department. A total of 787 women and 318 men of similar mean age (±SD): 83.1 years (±8.6) and 82.5 years (±9.0), respectively. Multivariable logistic regression analyzed risk factors including age, gender, dementia, stroke, ischemic heart disease, diabetes, prefracture mobility, alcohol consumption, American Society of Anesthesiologists grades, drug history, and nutrition status for assessing risk factors and outcomes associated with ECFs and ICFs. Compared to ICFs, for each additional year of age, women had a 3% and men 4% greater association with ECFs. Among women only, ECFs were associated with risk of malnutrition: odds ratio [OR] = 1.70 (95% CI, 1.17-2.48) or malnourishment: OR = 1.93 (95% CI, 1.06-3.52), stroke: OR = 1.85 (95% CI, 1.16-2.97), and diabetes: OR = 1.92 (95% CI, 1.21-3.06). Women with ECFs were less likely to be discharged to their own homes: OR = 0.56 (95% CI, 0.38-0.83); but more likely to be discharged to a rehabilitation unit: OR = 1.81 (95% CI, 1.21-2.71) and readmitted to hospital within 30 days of discharge ≥1 time: OR: 2.39 (95% CI, 1.27-4.50) or ≥2 times: OR = 3.48 (95% CI, 1.05-11.57): they did not differ in discharge to residential or nursing care or in-hospital mortality. Among men, there were no differences in discharge destinations or readmissions between types of fractures. Compared to ICFs, a greater number of risk factors associated with ECFs were identified more often in women than in men, and ECFs also have greater influences on clinical outcomes in women.

Risk factors for the development of premature physeal closure after a McFarland fracture in children.

In 1931, McFarland reported on medial malleolar physeal fractures and resulting deformities, which were later classified as Salter-Harris Type III and IV fractures of the medial malleolus. Ongoing controversy surrounding the factors that increase the risk for PPC in children with McFarland (MF) fracture.The retrospective study aimed to investigate the radiological and clinical outcomes of children treated surgically for MF fracture and evaluate the potential factors that increase the risk for premature physeal closure (PPC). We retrospectively reviewed 48 children who were surgically treated for MF fracture. Demographic data, including age at injury, gender, mechanism of injury, laterality, initial displacement, fracture type, time from injury to surgery, method of reduction, fixation method, time of hardware removal, and whether or not the patient developed PPC, were retrieved from the charts. PPC occurred in 35.4% (17/48) of the patients. Our analysis revealed that patients with PPC were significantly younger than those without PPC (P < 0.001). Furthermore, our analysis revealed age and initial displacement as independent factors that increased the risk for PPC. Notably, age less than 11.5 years and initial displacement of more than 4.5mm represented the cut-off points for an increased incidence of PPC. Overall, 11 out of 48 patients had limited ankle range of motion (ROM); mean ankle ROM in patients with PPC was lower than those without PPC (P = 0.006). Lower limb discrepancy was 2.5cm in children, although three patients with PPC had a lower limb discrepancy measuring more than 2cm, and five patients with PPC complained of postoperative pain. Age and initial displacement are independent factors that increase the risk for PPC in children with MF fracture. Specifically, children aged under 11.5 years and those with initial displacement exceeding 4.5mm are at a higher risk for PPC. Observational study.

Epidemiology of pediatric thoracolumbar spinal fractures and associated injuries: a single-center experience.

This retrospective study aimed to investigate the epidemiology of pediatric patients with thoracolumbar spinal fractures and the characteristics of associated injuries. Sixty-one patients under 18years old with thoracolumbar spinal fractures were included in the study. Patients were divided into two groups: ≤ 8years (Group 1) (n = 13) and > 8years (Group 2) (n = 43). Patients were analyzed for age, gender, fracture type, fracture level, etiology, and associated injuries. The mean age was 158.7 (± 53.1) months, and the male/female ratio was 1.26. The most common fracture etiology was motor vehicle accidents (39.4%) and falls from height (18%). There was no correlation between the fracture type, the number of fractured vertebrae, and age. The most common associated injury was orthopedic injuries (34.3%). In Group 2, associated injuries developed more frequently in the presence of a major fracture, whereas in Group 1, associated injuries could occur even in isolated minor fractures. In Group 1, intrathoracic injuries associated with fractures (36.4%) were significantly higher than in Group 2 (4.2%). Surgical intervention was required in 9.8% of patients. Although thoracolumbar spinal fractures are rare in children, they are essential because preventable accidents essentially cause them and can have devastating consequences. There are significant differences in epidemiologic and clinical features between age groups. In this study, we have shown that even minor thoracolumbar vertebral fractures may be accompanied by associated injuries in children under 8years of age. In contrast, major fractures are more frequently related to other organ injuries in older children. This may be because more severe trauma is required for a fracture of the thoracolumbar spine, which is more flexible and elastic in young children compared to adolescents. Our study has provided current and essential results regarding the etiology of pediatric thoracolumbar spine fractures. More multicenter studies are needed to understand the characteristics of thoracolumbar fractures in pediatric patients.

Comparison of locking plate and conservative treatment in elderly patients with displaced proximal humerus fractures.

This study aimed to compare the outcomes of conservative treatment and locking plate osteosynthesis in displaced proximal humerus fractures in elderly patients. The study included patients over the age of 60 who were admitted to a tertiary trauma centre between 2020 and 2023, all diagnosed with 2-, 3-, or 4-part proximal humerus fractures. A total of 45 patients underwent either conservative management or locking plate fixation. In the older cohort, patients with Neer Type 2-4 fractures were treated conservatively using Velpeau immobilization. Displaced fractures, specifically 3- and 4-part fractures per the Neer classification, were treated surgically with locking plate fixation. Functional outcomes were evaluated using the Constant Shoulder score, the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and the American Shoulder and Elbow Surgeons (ASES) score, with a minimum follow-up period of one year. Radiographic assessment focused on varus collapse, medial cortex displacement, greater tubercle displacement, absence of fracture lines, and callus formation. Complications, including nonunion, malunion, and avascular necrosis, were also recorded. Of the 45 patients, 22 underwent locking plate fixation (Group A), while 23 were managed conservatively (Group B). In terms of fracture type, 20 patients were classified as Neer Type 2, 23 as Neer Type 3, and 2 as Neer Type 4. The mean patient age was 73.38 years. Functional scores (DASH, ASES, and Constant) were similar between the two groups, and no significant differences were observed in radiographic parameters. However, complications were significantly more frequent in the locking plate group compared to the conservative group. Two patients who underwent surgery experienced nonunion at the humeral neck. Additionally, secondary surgery was required in one patient due to postoperative infection and in another due to screw penetration into the joint. While no correlation was found between humeral neck malunions and functional outcomes, a negative correlation was observed between tubercle malunions and functional scores. In elderly patients with proximal humerus fractures, no significant differences in functional outcomes were observed between locking plate fixation and conservative treatment. However, locking plate fixation was associated with a higher incidence of complications and secondary surgeries. Thus, it appears that locking plate fixation does not offer superior outcomes compared to conservative management in this patient population.

Healing of Comminuted Fractures of Long Bones in Dogs

Fracture healing in dogs is a complex process influenced by factors such as age, weight, fracture type, and underlying conditions. Among fractures, complex diaphyseal comminuted fractures stand out due to their susceptibility to complications like delayed union or nonunion. Despite the recognized complexities, veterinary-specific data on their incidence, complications, and effective treatment strategies remain surprisingly scarce. This retrospective study analyzed 99 comminuted fractures among 542 long bone fractures treated at the Small Animal Clinic of the Freie Universität Berlin (2007–2014). The femur (n = 42) was most affected, followed by the tibia/fibula (n = 29), radius/ulna (n = 24), and humerus (n = 4). Plates (n = 81) and intramedullary pins or external fixators (n = 16) were used for osteosynthesis. Healing occurred without complications in 72%, while 28% experienced issues such as implant failure or delayed union. Open fractures, high-energy trauma, and &gt;3 fragments were associated with higher complication rates (p &lt; 0.05). Fractures treated with plates healed slower (p = 0.016), and implants were removed later compared to other methods (p = 0.049). This study highlights the challenges of managing complex fractures and emphasizes the need for tailored surgical approaches. It provides new insights into their treatment and outcomes, paving the way for future research to establish standardized veterinary protocols.

Prognosis of Fragment Reattachment in Anterior Crown Fractures: A Retrospective Study.

Although several studies have compared fragment attachment with resin build-ups in anterior crown fractures, none have specifically investigated the outcome of reattached fragments. This retrospective study aimed to evaluate long-term outcomes of fragment reattachment in anterior crown fractures and determine the prognostic affecting their success. We retrospectively analyzed clinical records of patients who underwent fragment reattachment for crown fractures in anterior teeth (maxillary and mandibular central and lateral incisors) between 2008 and 2023. All procedures were performed by experienced professors and residents following a standardized protocol. Kaplan-Meier survival curves and Cox proportional hazards regression analyses were performed to evaluate fragment retention outcomes and identify potential prognostic factors. Among 75 anterior crown fractures, the estimated fragment retention rates were 83.7% at 2 years, 75.2% at 5 years, and 56.4% at 10 years. Multivariate Cox regression analyses identified patient age and extent of crown fracture as significant factors affecting outcomes. The 5-year estimated fragment retention rates were 82.8% and 67.0% for uncomplicated and complicated crown fractures, respectively. Fragment reattachment remains a viable treatment option for anterior crown fractures. Treatment success decreased with patient age, and complicated crown fractures demonstrated lower retention rates than uncomplicated ones. Fragment reattachment can provide predictable outcomes in anterior crown fractures when cases are carefully selected, particularly considering the patient's age and the type of crown fracture.

International, consensus-based, indications and treatment options for knee arthroplasty in acute fractures around the knee.

In the landscape of knee-related health issues there has been a notable shift in treatment protocols. Nowadays, there is a growing trend toward primary total knee arthroplasty (TKA) in the event of periarticular knee fractures. A review of the literature on TKA in acute knee fractures has been done in order to provide scientific evidence to the four statements submitted for voting to the members of the European Knee Society (EKS). A literature review has been performed around four topics of TKA in acute knee fractures, specifically: 1) The indications for TKA in acute knee fractures are undoubtful and clear; 2) Pre-existing osteoarthritis is not mandatory for the indication of TKA in acute fractures, while age, co-morbidities and type of fracture are; 3) A series of established criteria with scores to give indication for TKA (approved algorithm) is needed; and 4) This (complex) surgery must be performed in referral centers with all technical options and specific peri-operative management and post-operative care. The panel of experts therefore believes that the indications cannot be considered undoubtful and clear. According to the literature up to the time of the consensus vote, there was no objective method for deciding on the treatment to offer the patient (Agree: 34.1%, Disagree: 61%, Abstain: 4.9%). It emerges that there are no mandatory conditions for the treatment of acute knee fractures with TKA (Agree: 32.3%, Disagree: 51.6%, Abstain: 16.1%). However, there are several characteristics to consider for a multifactorial evaluation rather than being limited to a single condition. While the consensus has highlighted a need for a scoring system to guide surgical decisions in periarticular knee fractures (Agree: 88.24%, Disagree: 8.82%, Abstain: 2.94%), research in the literature has confirmed that, to date, no validated algorithm exists. After the vote, a score was proposed, which requires validation. Although the panel of experts does not deem it necessary for this surgery to be reserved for reference centers (Agree: 32.35%, Disagree: 50%, Abstain: 17.65%), literature suggests that it is crucial that before undertaking knee arthroplasty in the setting of an acute fracture around the knee, the orthopedic surgeon is confident with all the necessary skills for a complex intervention that requires advanced knowledge and practical competence in osteosynthesis and revision TKA. This discussion on the questions voted by the panel of experts has allowed for an in-depth exploration of a topic of interest, assessing indications, contraindications, types of possible treatment, and the critical aspects to consider when treating an acute fracture around the knee with a prosthesis. It is important to consider that the choice must be carefully weighed, evaluating the risks and benefits, with an increasingly need for a scoring system for selecting the most appropriate treatment.

Cast-OFF 2: One Week Versus 3-5 Weeks of Plaster Cast Immobilization for Non- or Minimally Displaced Distal Radius Fractures-A Stepped Wedge Cluster Randomized Controlled Trial.

Implementation of 1 week of cast immobilization followed by gradually increasing wrist mobilization for non- or minimally displaced distal radius fracture (DRF) and comparison of the functional outcomes and pain scores with the usual care (3-5 weeks of cast immobilization). A randomized stepped wedge cluster design, prospective cohort. Academic and peripheral hospitals in levels 1, 2, and 3 trauma centers. All patients between 18 and 85 years old with an isolated non- or minimally and nonreduced DRF were eligible for inclusion. Participating hospitals were randomized to transition from usual care (3-5 weeks of cast immobilization) to 1 week of cast immobilization, following the stepped wedge design. Patient characteristics, secondary dislocation, surgical treatment, visual analog scale, Patient Rated Wrist Evaluation (PRWE), Patient Reported Outcomes Measurement Information System Pain Interference, Pain Catastrophizing Scale 4, and patient satisfaction were compared between control and intervention group at weeks 1, 3-5, 6, months 3, 6, and 12. A difference around 11 points on the PRWE scale was considered clinically significant. Four hundred two patients were included (control n = 197 vs. intervention n = 205, 267/135, female/male). There were no differences in age (53.7 ± 18.6 vs. 53.3 ± 19.5, P = 0.27), sex (66% vs. 67% female, P = 0.44), dominant hand fractured (44% vs. 53%, P = 0.39), and type of fracture (39% vs. 41% extra-articular, P = 0.44). After 6 weeks, the PRWE score showed no clinically significant differences (-4.5 [confidence interval -12.9 to 4.02], P = 0.30). No significant differences were observed for function, pain scores, and patient satisfaction between groups (all P > 0.05). Furthermore, there was no significant difference in secondary dislocation rate (control 1.5% vs. intervention 1.0%, P = 0.32) and operation rate (control 1.5% vs. 1.5% intervention, P = 0.92). This study compared 1 week of cast immobilization followed by gradually increasing wrist mobilization to the usual care of 3-5 weeks for nonreduced DRF. No clinically significant differences in function, pain scores, patient satisfaction, secondary dislocation, and operations were observed. Therefore, 1 week of plaster immobilization can be safely recommended for the non- or minimally displaced and nonreduced DRF treatment. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Fracture type and excitation and detachment forces of Chinese walnuts under dynamic conditions in vibration harvesting

Fracture type and excitation and detachment forces of Chinese walnuts under dynamic conditions in vibration harvesting

Isolated posterior stabilization of the pelvic ring in type III/IV fragility fractures of the pelvis are beneficial compared to 360° antero-posterior surgical approaches. A dual-center cohort analysis.

BackgroundFragility fractures of the pelvis (FFP) in elderly patients are an increasing concern due to their association with osteoporosis and the aging population. These fractures significantly affect patients’ mobility and quality of life. This study evaluates different surgical techniques in patients suffering from FFP to provide standardized recommendations for treatment strategies. In addition, we compared therapeutic concepts and their outcome between two major trauma centers in Germany. MethodsWe conducted a retrospective analysis of 882 patients aged over 65 years who suffered from FFP between 2003 and 2020 at a level I and level III trauma center in a german metropolis. Fractures were classified according to Rommens and Hofmann. Data collection included patient demographics, fracture type, treatment strategy, and length of hospital stay. ResultsFFP I fractures were predominantly treated conservatively at both centers. Significant variability was noted in the treatment of type II and III fractures, with level III trauma center having a higher surgical intervention rate for FFP II in 27.6% compared to the level I trauma center in 9.9% of the cases. The most common procedure at both hospitals was the stabilization of the posterior pelvic ring. Patients who underwent less invasive posterior-only stabilization had shorter length of hospital stay than those who received combined anterior and posterior stabilization. ConclusionsThe study reveals substantial differences in the treatment approaches for FFP between two major trauma centers. Less invasive surgical methods, particularly posterior-only stabilization, are associated with shorter hospital stays and potentially better outcomes for elderly patients with unstable FFP. Clinical RelevanceThis study underscores the importance of minimally invasive surgical techniques in managing FFP in elderly patients, highlighting their potential to reduce the length of hospital stay and improve recovery.

Deep learning for automated hip fracture detection and classification : achieving superior accuracy.

The aim of this study was to develop and evaluate a deep learning-based model for classification of hip fractures to enhance diagnostic accuracy. A retrospective study used 5,168 hip anteroposterior radiographs, with 4,493 radiographs from two institutes (internal dataset) for training and 675 radiographs from another institute for validation. A convolutional neural network (CNN)-based classification model was trained on four types of hip fractures (Displaced, Valgus-impacted, Stable, and Unstable), using DAMO-YOLO for data processing and augmentation. The model's accuracy, sensitivity, specificity, Intersection over Union (IoU), and Dice coefficient were evaluated. Orthopaedic surgeons' diagnoses served as the reference standard, with comparisons made before and after artificial intelligence assistance. The accuracy, sensitivity, specificity, IoU, and Dice coefficients of the model for the four fracture categories in the internal dataset were as follows: Displaced (1.0, 0.79, 1.0, 0.70, 0.82), Valgus-impacted (1.0, 0.80, 1.0, 0.70, 0.82), Stable (0.99, 0.95, 0.99, 0.83, 0.89), and Unstable (1.0, 0.98, 0.99, 0.86, 0.92), respectively. For the external validation dataset, the sensitivity and specificity were as follows: Displaced (0.83, 0.94), Valgus-impacted (0.89, 0.90), Stable (0.88, 0.95), and Unstable (0.85, 0.99), respectively. The overall means (Micro AVG and Macro AVG) for the external dataset were Micro AVG (0.83 (SD 0.05), 0.96 (SD 0.01)) and Macro AVG (0.69 (SD 0.02), 0.95 (SD 0.02)), respectively. Compared to human diagnosis alone, our study demonstrates that the developed model significantly improves the accuracy of detecting and classifying hip fractures. Our model has shown great potential in assisting clinicians with the accurate diagnosis and classification of hip fractures.

The stent-screw assisted internal fixation (SAIF) technique: A treatment option for OF5, the three-column unstable osteoporotic vertebral fractures - A case series.

The OF5 type of vertebral osteoporotic fracture (AO Spine-DGOU classification) represents a three-column lesion and as such is considered as highly unstable. These lesions, however, tend to affect elderly, frail patients, in whom invasive management options are limited. The stent-screw-assisted internal fixation (SAIF) technique has previously been reported as a minimally invasive treatment for osteoporotic and neoplastic vertebral fractures. Here, we sought to assess the safety and efficacy of the SAIF technique in a retrospective series of patients with thoracic OF5-fractures. Retrospective identification, in a prospectively maintained database, of patients with OF5-fractures treated with SAIF. Intra- and post-operative complications were reported. Clinical outcome using NRS pain scale and Patient's Global Impression of Change (PGIC) and radiological outcome, with local kyphotic angle (LKA) and VB height (VBH) correction were analyzed. N = 22 consecutive patients were identified. All fractures were located in the thoracic spine. No intra-procedural complications occurred, although hospitalization-related complications did occur in 2 patients (9 %). There was a statistically significant pain reduction on follow-up. VBH restoration range was 0-12 mm (mean 5.5 mm). The mean postoperative LKA correction was 7.5°, which was maintained at last follow-up. The SAIF technique appears to be a viable alternative in the management of OF5-fractures. Although it does not address all elements of OF5 instability, it appears that the stabilisation of the anterior and middle vertebral columns, coupled with the stabilising effect of the ribcage in the hypomobile thoracic spine, are biomechanically sufficient to treat OF5-fractures in this section of the spine.

Differences between Posterior Malleolus and Posterior Pilon Fractures-A Review

Based on our last 7 years (2015-2022) 98 consecutive trimalleolar ankle fracture data base, we did a review of literature review trying to elucidate the differences between posterior malleolus fractures and posterior Pilon fractures. Posterior malleolus fractures are commonly caused by rotational forces on the ankle joint with foot in different positions, leading to different injuries from tearing of the posterior inferior tibiofibular ligament (PITFL) to an avulsion fracture of the posterior malleolus (PM). This is generally a low-energy injury and actually does not involve the joint articular surface. Posterior Pilon fractures result from a combination of rotational and vertical compression forces on the ankle joint, causing an intra-articular fracture of the distal posterior tibia. This type of fracture is commonly missed on plain gradiographs and often misdiagnosed. This review aims to provide an overview of the differences between posterior malleolus fractures and posterior Pilon fractures and some issues of clinical concerns such as how to make correct diagnosis for planning managements.

Global epidemiology of lower limb fractures: Trends, burden, and projections from the GBD 2021 study.

Lower limb fractures are a significant global public health issue, imposing considerable social and economic burdens. Despite their prevalence, comprehensive analyses of the global epidemiology of lower limb fractures remain scarce. This study aims to address this gap. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we analyzed four types of lower limb fractures: fractures of foot bones excluding the ankle (FFB), hip fractures (FH), fractures of the patella, tibia or fibula, or ankle (FPTFA), and femur fractures excluding the femoral neck (FF), and conducted a detailed assessment of them. FPTFA was the most burdensome fracture type, with Slovenia showing the highest age-standardized incidence rate (ASIR), and Saudi Arabia having the highest age-standardized prevalence rate (ASPR) and years lived with disability rate (ASYR). The burden of lower limb fractures increased with age, but FFB and FPTFA showed a "double peak" age distribution, with FFB most common in the 20-24 age group. Lower limb fractures were more prevalent in males among younger individuals and in females among older populations. From 1990 to 2021, the burden of lower limb fractures, excluding FH, decreased (EAPC <1), though the incidence of FF is projected to increase (EAPC = 0.14, 95 % CI 0.1-0.18) over the next decade. Although the global burden of lower limb fractures, excluding FH, has decreased in recent years, vigilance is still needed. Given the projected rise in FF incidence over the next decade, preventive measures should be implemented early.

First fracture in patients with osteoporosis : How does the "fracture career" of our patients with osteoporosis begin?

Given that aprimary osteoporotic fracture can result in subsequent fractures and that the precise etiology of the typical fracture cascade remains uncertain, it is pertinent to determine the initiating factor and the specific fracture involved in this cascade. All patients with afracture of along bone were consecutively screened over the 12-month study period. All participants were asked about existing risk factors (including previous fractures) in accordance with the applicable guidelines of the Umbrella Organization Osteology (DVO). The existing risk factors were employed to calculate the fracture risk and this formed the basis of the diagnosis and indications for treatment. Atotal of 613 patients were included in the study. Of the total number of patients 378 were deemed to require pharmacological treatment for osteoporosis. In this cohort 182 fractures were reported. Among the previous fractures distal radius fractures were the most common, occurring in 54patients followed by fractures of the proximal femur (n = 40) and proximal humerus (n = 27). As anticipated, abreakdown of the data by gender revealed adifferent picture. In line with the incidences it can be seen that men have fewer distal radius fractures and more fractures close to the hip joint. The results indicate that women with adistal radius fracture have the potential to facilitate an early diagnosis and subsequent treatment for osteoporosis. In contrast, in men fractures in the region of the hip joint were the most common initial presentation, precluding the possibility of deriving an early indication of the presence of osteoporosis from previous fractures.

Influence of thread pitch on material flow and mechanical properties of stationary shoulder friction stir lap welded dissimilar joint

To investigate the influence of varying pitch values on the flow behavior of materials and the mechanical attributes of stationary shoulder friction stir lap welded (SSFSLW) joints. In this paper, three kinds of tools with different pitches are designed, and the lap joint of a 6061-T6 aluminum alloy plate and an AlSi10MnMg alloy plate was realized by stationary shoulder friction stir welding. Different computational fluid dynamics (CFD) models of friction stir lap welding were founded and the connection between the pitch and material flow behavior was investigated. The increased pitch pin boosts the velocity of material in the shear layer, expands flow area of aluminum alloy material, and promotes materials flow upward along the orientation of pin thread. The pin with a 1 mm pitch results in a joint that featuring the shortest hook extension distance, the largest effective sheet thickness (EST), and the largest effective lap width (ELW). The fracture locations of shear testing are all on the base material of AlSi10MnMg alloy. Numerous dimples could be seen at the fracture appearance, and the type of fracture is ductile fracture.

Double Fluoroscopy Techniques for Closed Reduction and Percutaneous Pinning in Pediatric Supracondylar Humeral Fractures: Fluoroscope Positioning and a Case Series

Objective: Percutaneous pinning for supracondylar humeral fractures (SHFs) requires precise pin insertion while maintaining reduction making fluoroscopy indispensable for this procedure. However, it is currently difficult to obtain good-quality two-directional images with one fluoroscopy. This study aimed to report the outcomes of a closed reduction and internal fixation technique using 2 fluoroscopes simultaneously for pediatric SHF. Patients and Methods: Thirty-eight children were identified as having SHF (aged &lt;16 y) who underwent closed reduction and percutaneous pinning. Regarding fracture type (Gartland classification), 10 patients had type II fractures, and 28 patients had type III fractures. The first fluoroscope used for the anteroposterior view was positioned from the patient’s cephalad side. The second fluoroscope used for the lateral view was positioned from the patient’s caudal side. By arranging 2 fluoroscopes from the craniocaudal side, it was possible to secure sufficient standing space for operators who maintained the reduction and inserted the pins. Results: Although this method was intricate and time-consuming for preoperative positioning during fluoroscopy, it was possible to monitor accurate images in 2 directions simultaneously during surgery. Consequently, we were able to confirm the insertion position and direction of the Kirschner wire easily and accurately while confirming the reduction. There were no complications. Conclusion: Procedures using 2 fluoroscopes simultaneously make it possible to confirm the insertion position and direction of the Kirschner wire easily and accurately while confirming the reduction.

Possible complications of frontal sinus fractures after conservative or surgical treatment: retrospective study

Background Frontal sinus fractures are rare. Although they can manifest as isolated fractures, they mostly occur as a part of larger panfacial injuries of the facial bones. Objective Considering the relative rarity of this type of fracture, we decided to perform a retrospective analysis of patients with this type of injury at our institution, focusing on post-injury complications. Material and methods We retrospectively evaluated 26 patients with frontal sinus fracture (isolated or as a part of a complex injury to the facial skeleton) treated and subsequently followed up at our institution between 2016 and 2022. Results The most common complication was trigeminal nerve hypersensitivity, occurring in 7 patients (47% of patients with any complication). All patients with this complication were treated conservatively. Four patients developed cerebrospinal fluid leak, of which three were treated conservatively and one surgically. Four more patients developed a deformity, of which 3 patients underwent surgery and one was treated conservatively. Conclusion and significance The therapeutic goal is to restore the conditions of the mucosa and to preserve the drainage of the frontal sinus.