High Incidence Of Fractures Research Articles

Patients’ thoughts about assessment of fracture risk in a dental setting using FRAX—a qualitative interview study

SummaryFRAX is a tool based on questions that identifies persons at risk of fragility fractures. We interviewed patients about their thoughts on doing FRAX in a dental setting. They were generally positive but had some concerns that need to be considered before introducing FRAX in a dental setting.PurposeTo investigate patients’ thoughts about assessing the risk of fragility fractures using the FRAX tool in a dental setting. Sweden has a high incidence of fragility fractures, but many of these are preventable. The most common method for identifying persons with a high risk of sustaining fragility fractures is FRAX, a validated instrument for assessing the risk of suffering fragility fractures within 10 years. In the Nordic countries, most of the adult population has regular contact with their dentist, which could be useful in identifying high-risk individuals.MethodsA qualitative inductive approach to content analysis, with individual semi-structured interviews, was used. Seven women and three men, aged 65–75 years, were interviewed and assessed with FRAX.ResultsAn overarching theme was that patients considered a FRAX assessment in the dental setting a good service but doubted that the dentists would have the interest, time, and knowledge to do it. The patients had little knowledge and experience of osteoporosis and fragility fractures. They were positive towards assessing the fracture risk with the FRAX instrument. If they were found to have a high fracture risk, they expected the dentist to send a referral for further investigation and to collaborate in the risk assessment with their family physician. They thought risk assessment in a dental context would be a good service if the fee was the same as that in primary care.ConclusionMost participants were positive about having FRAX and other health assessments done in the dental clinic, but this study shows that patients have concerns that need to be addressed before introducing FRAX in this context.

Smoking induces increased apoptosis in osteoblasts: changes in bone matrix organic components

Clinical studies demonstrate the impact of smoking on bone tissue fragility and higher incidence of fractures. However, it is not totally understood which physiological mechanisms could be involved in these events. Previously, we showed important changes in bone tissue components in experimental model of cigarette smoke (CS) exposure. CS exposure induces worsening in bone mineralization and a decrease in collagen type I deposition, leading to bone fragility. Considering that the majority of clinical studies described bone structural changes by radiographic images, in this study we performed analyses “in situ” using tissue samples from smokers, former smokers and non-smokers to better understand how the increase in inflammatory mediators induced by smoking exposure could interfere in bone cells activity leading bone structural changes. We observed increased levels of IL-1β, IL-6 and TNF-α in bone tissue homogenates with a concomitant increase in osteoblast apoptosis in smokers and former smokers compared with non-smokers. Histological changes in both smokers and former smokers were characterized by reduction in collagen type I. Only in smokers, it was observed decrease in trabecular area, suggesting increased bone resorption and increase in collagen type V. These results showed that osteoblasts apoptosis in association with increased bone resorption leads bone structural changes in smokers.

Analysis of the clinical characteristics of adult patients with hangman's fractures: A retrospective study based on multicenter clinical data.

There are few reports on the clinical characteristics of adult patients with hangman's fractures. The clinical data of adult patients were collected from the hangman's fracture database of 7 medical centers. Data on patients who met the inclusion and exclusion criteria were retrospectively analyzed. Data, including gender, age, mechanism of injury, fracture classification, and treatment, were statistically analyzed. A total of 216 eligible patients (160 males and 56 females, with a mean age of 49.7 years) were selected. There was no statistically significant difference in gender distribution of different age groups. The male-to-female ratio was similar in the young group (18-44 years) and the middle-aged group (45-64 years) (both about 3:1) but decreased in the elderly group (65 years and above) (about 2:1). Overall, high-energy injury was the main mechanism of injury. There was a statistically significant difference in the percentage of patients with high-energy injury in various age groups (the highest in the young group, and the lowest in the elderly group). Overall, unstable fracture was the main fracture type, with a higher proportion in the young and elderly groups than that in the middle-aged group, but there was no statistically significant difference. From the perspective of treatment options, the percentage of patients receiving surgery was higher in the young and elderly groups than that in the middle-aged group. Hangman's fracture is predominant in males of all age groups, with high-energy injury as the main mechanism of injury. Unstable fracture is common fracture type. The percentage of patients receiving surgery in the young and elderly groups is higher than that in the middle-aged group, which may be correlated with the high incidence of unstable fracture and the life characteristics of the patients in the young and elderly age groups.

Wounding characteristics and treatment principles of ground anti-armored vehicle ammunition against armored crew

The wound mechanism, injury characteristics and treatment principles of anti-armored vehicle ammunition against armored crew in the past 20 years are summarized in this paper. Shock vibration, metal jet, depleted uranium aerosol and post armor breaking effect are the main factors for wounding armored crew. Their prominent characteristics are severe injury, high incidence of bone fracture, high rate of depleted uranium injury, and high incidence of multiple/combined injuries. During the treatment, attention must be paid on that the space of armored vehicle is limited, and the casualties should be moved outside of the cabin for comprehensive treatment. Especially, the management of depleted uranium injury and burn/inhalation injury are more important than other injuries for the armored wounds.

Outcomes of Total Hip Replacement for Failed Hemiarthroplasty.

Our study aims to analyze the outcomes of conversion total hip replacement (THR) done for failed hemiarthroplasty. We retrospectively analyzed 104 consecutive patients who underwent conversion THR for failed hemiarthroplasty between January 2012 and December 2018. The patient's records were analyzed for demographic information, index surgery details, preoperative functional status, and perioperative complications. Patients were analyzed according to the various modes of failure of hemiarthroplasty. The radiographs were analyzed for any progressive osteolysis, cup migration and stem subsidence. All the patients were evaluated using the modified Harris hip score (HHS) for clinical outcome. Complications, revision or reoperation in the follow-up period was recorded. A total of 73 patients were included in the study for final analysis after exclusion criteria. The average follow-up was 48.2 ± 29.6months. There was a significant improvement in mean HHS from 38.5 ± 9.1 preoperatively to 80.9 ± 4.3 at the last follow-up (p < 0.05). The different modes of failure had no statistically significantdifference in the postoperative Harriship score (p = 0.393). None of the patients had progressive radiolucent lines more than 2mm or significant subsidence in the final follow-up compared to the initial postoperative radiograph. There was one deep infection, one patient had grade 2 heterotopic ossification, intraoperative calcar fracture was fixed with cerclage wiring in 11 patients, and postoperative periprosthetic fracture in two patients was treated with plate osteosynthesis. There were no neurovascular complications or dislocation during the follow-up. Conversion THR for failed hemiarthroplasty is a challenging procedure and results in good functional outcome and provides reliable pain relief. Conversion THA for septic loosening by two stage revision have comparable postoperative outcomes like THA for aseptic loosening. Caution is required owing to high incidence of peri-prosthetic fracture during conversion THA. Dislocation rate is negligible even with smaller head provided the prosthesis is implanted in the proper orientation and adequate soft tissue balancing is achieved.

High incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis. A case-control study.

To estimate the incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis (RA) and analyze risk factors for fracture. Incidence of clinical fragility fractures in 330 postmenopausal women with RA was compared to that of a control population of 660 age-matched postmenopausal Spanish women. Clinical fractures during the previous five years were recorded. We analyzed associations with risk factors for fracture in both populations and with disease-related variables in RA patients. Median age of RA patients was 64years; median RA duration was eight years. Sixty-nine percent were in remission or on low activity. Eighty-five percent had received glucocorticoids (GCs); 85%, methotrexate; and 40%, ≥1 biologic DMARD. Fifty-four patients and 47 controls had ≥1 major osteoporotic fracture (MOF). Incidence of MOFs was 3.55 per 100 patient-year in patients and 0.72 in controls (HR: 2.6). Risk factors for MOFs in RA patients were age, previous fracture, parental hip fracture, years since menopause, BMD, erosions, disease activity and disability, and cumulative dose of GCs. Previous fracture in RA patients was a strong risk for MOFs (HR: 10.37). Of every 100 postmenopausal Spanish women with RA, 3-4 have a MOF per year. This is more than double that of the general population. A previous fracture poses a high risk for a new fracture. Other classic risk factors for fracture, RA disease activity and disability, and the cumulative dose of GCs are associated with fracture development.

Electric scooter injuries: Incidence and injury patterns at a level I trauma center

PurposeElectric scooters (e-scooters) have become an increasingly popular mode of public transportation in recent years. As the incidence of related injuries rises, it is important to understand specific fracture patterns unique to e-scooters and electric bikes (e-bikes) to help guide management. The purpose of this study was to review the prevalence and describe specific fracture patterns of e-scooter and e-bike related injuries at the busiest level 1 trauma center in the borough of Manhattan. MethodsChart review to determine mechanism of injury was performed on all patients for whom an orthopedic consult was requested from 1/1/2021 to 12/31/2021. All patients whose injuries were sustained due to an e-scooter or e-bike were further reviewed for demographics, injury characteristics including fracture pattern, and definitive injury management. Any patients who had an orthopedic consult placed for a reason other than an acute injury were excluded. Descriptive statistics are reported as frequency (percentage) for categorical variables and means for continuous variables. ResultsOf the 1815 orthopedic consults requested, 1357 (74.8%) were for acute injury management. Of those with acute injuries, 119 (8.8%) sustained 136 e-scooter or e-bike related injuries. There were 92 (77.3%) males at an average age of (33.8 ± 15.7) years. Approximately one-fifth of all patients presented in June 2021 (26, 21.8%). There was a 9.2% rate of open fractures. The 136 injuries were evenly split between the upper and lower extremities, with 57 (47.9%) upper extremity, 57 (47.9%) lower extremity injuries, and 5 (4.2%) concomitant upper and lower extremity injuries. The most common fracture patterns were ankle fractures (16, 11.7%), followed by tibial shaft (14, 10.2%), tibial plateau (13, 9.5%), and radial head fractures (11, 8.0%). There was a 33.3% incidence of associated posterior malleolar fractures in the spiral tibial shaft fractures, 31.0% of posterior malleolar involvement and 18.8% of isolated vertical medial malleolar fractures in the ankle fractures, and 61.5% of posterior comminution in the tibial plateau fractures. ConclusionE-scooter and e-bike related injuries have a high incidence of tibial shaft fractures, ankle fractures, tibial plateau fractures, and radial head fractures. There should be a high index of suspicion for posterior and medial involvement in lower extremity fractures sustained due to e-scooter or e-bikes. Identifying specific fracture patterns seen in e-scooter and e-bike related mechanisms will help guide management of these injuries.

STUDY OF FUNCTIONALAND RADIOLOGICAL OUTCOME OF ILIZAROV FIXATION IN MANAGEMENT OF GAP NON UNION OF LONG BONES

Due to increasing motor vehicular accidents, there is high incidence of compound fractures of long bones particularly Gustillo type 3a or 3b with extensive soft tissue damage and periosteal stripping. These type of injuries have decreased vascularity of the tissues around the fracture site and increased probability of complications. In these injuries Ilizarov xator provides single step denitive xation method that deals with gap nonunion and bone infection simultaneously. This study aims to assess functional and radiological outcome using ASAMI criteria of Ilizarov xation in gap nonunion of long bones. a total of 30 patients were included in the study suffering from gap nonunion which fullled inclusion and exclusion criteria. Patients underwent Ilizarov xation and were followed up for a period of minimum 6 months and assessed using ASAMI functional and radiological criteria. radiological results: 12 patients (40%) had excellent, 15 patients (50%) had good, 2 patients (6%) had fair and 1 (4%) had poor results. Union was achieved in all 30 patients. Functional results: 09 patients (30%) had excellent, 18 patients (60%) had good and 2 patients (6%) had fair results and 1 (4%) patients had poor results: Ilizarov ring xation is a versatile approach for patients with gap nonunion as it provides excellent results and aid in early weight bearing, decreased dependency, and increased quality of living.

IOT enabled Intelligent featured imaging Bone Fractured Detection System

In the present era, there are lots of advancements and initiatives that have been undertaken through image processing techniques and IoT (Internet of Things). Image processing has proven its valuable insights in various applications such as GIS, biomedical, security, satellite imaging, medicine, and personal image analysis. In the context of fracture detection, image improvements, feature segmentation, and feature extraction techniques are commonly implemented including in the IoT Environment. The lower long bone, hand bone, and elbow bones are the particular interest due to their high incidence of fractures. X-ray diagnosis is a common method of detecting bone fractures due to its rapid and widespread availability. X-ray imaging involves a small amount of ionizing radiation in each part of the body, which is then captured on a particular film or digital detector. X-ray images, though they may have limitations compared to other imaging modalities, provide sufficient quality for fracture detection. There are three points of motivation for this research i.e. First- ease of use of software for patients and reduce the time for doctors and patients by screening out straight forward, Second- to decrease human mistakes that can also occur from manually inspecting a massive dataset of X-ray images to become aware of fractured sections of bones in hospitals, third- use of IoT infrastructure to collecting images of X-Rays and performing processing on received data by which we can send some accurate information back to the patients. The research aims to develop an automated environment i.e IoT emulation Framework consisting of image pre-processing such as attainment of images, pre-post-processing, segment methods, feature extraction, fracture detection, and visualization. Feature Extraction algorithm includes, CLAHE object with the preferred clip limit 2.0, CLAHE to the grayscale image, Gaussian blur to overcome more noise, Canny side detection, Hough Transform for line detection, and the gradient magnitude to acquire binary edges varied out through IoT. The framework utilizes the Canny edge detection methodology and Sobel operator for image segmentation. In this heat maps of images are also observed, which provide accurate information from bone images through IoT. The proposed system illustrates extreme accuracy and effectiveness, as proved by the results acquired from numerous experiments. The automated labeling and detection of bone fractures through photo processing by way of IoT offer great potential for fast and correct diagnosis, contributing to successful treatment outcomes.

Acute Kidney Injury and Rehabilitation Outcomes among Elderly Patients with Chronic Kidney Disease

Introduction: The incidence of chronic kidney disease (CKD) is growing rapidly, along with the increasing geriatric population. CKD patients have higher incidence of fractures, stroke, and hospitalizations requiring rehabilitation. This is accompanied with the need for suitable rehabilitation programs to decrease disability and improve functionality to help elderly CKD patients maintain independence in activities of daily living. Considering that survivors of acute kidney injury (AKI) tend to experience decreased quality of life with increased frailty, rehabilitation in the elderly with kidney injury becomes even more complex. The aim of this study was to examine the impact of AKI on the outcomes of rehabilitation among elderly patients with CKD. Methods: For this retrospective, observational study, the electronic medical records of all patients who were hospitalized in the rehabilitation department were reviewed. We assessed functional status at the beginning and end of rehabilitation, renal outcome, and all-cause mortality among elderly patients with CKD who experienced an AKI and compared them to those who did not have an AKI. Results: The study cohort included 183 elderly patients with non-dialysis-dependent CKD. Patients with AKI (23% of study cohort) had a higher prevalence of heart failure and lower baseline estimated glomerular filtration rate, as compared with patients who did not have AKI. They were admitted to rehabilitation at a poorer functional capacity and were also discharged with lower functional independence measure scores. Overall odds ratio for all-cause death among patients with AKI versus without AKI was 3.2 (95% CI: 1.6–6.5; p = 0.001). Conclusion: AKI and CKD are interrelated syndromes. AKI was prevalent among elderly CKD patients and was associated with worse rehabilitation outcomes and higher mortality compared to similar patients without AKI.

Atlanto-occipital dislocation with concomitant severe traumatic brain injury: A retrospective study at a level 1 trauma center

BackgroundTraumatic atlanto-occipital dislocation (AOD) is a life-threatening injury. Although traumatic brain injury (TBI) is associated with increased mortality in AOD patients, a detailed individual analysis of these patients is lacking in the literature. MethodsPatients ≥16 years old who were diagnosed of AOD with concomitant severe TBI from 2010 to 2020 were included in this retrospective study. We examined the epidemiology, injury mechanisms, associated injuries, and outcomes of these patients. ResultsEight patients were included. Six patients died before any intervention could be performed, and two patients underwent an occipito-cervical fixation, showing a notorious neurologic improvement on follow-up. Cardiorespiratory arrest (CRA) was a strong predictor of subsequent death. CT signs of diffuse axonal injury (DAI) were present in most patients and were confirmed by magnetic resonance imaging (MRI) in survivors. Although TBI was not the main cause of death, it was responsible for the delayed neurological improvement and deferred stabilization. The average sensitivity of the different used methodologies for AOD diagnosis ranged from 0.50 to 1.00, being the Basion Dens Interval (BDI) and the Condyle-C1 interval (CCI) sum the most reliable criteria. Non-survivors tended to show greater distraction measurements. The high incidence of condylar avulsion fractures suggests that their visualization on the initial CT study should heighten the suspicion for AOD. ConclusionsOur data suggest that patients with AOD and concomitant severe TBI might be salvageable patients. In those who survive beyond the first hospital days and show neurological improvement, surgical treatment should be performed as they can achieve an important neurologic recovery.

Современная система интрамедуллярной фиксации вертельных переломов бедренной кости: Обзор литературы

The problem of treating patients with trochanteric fractures of the femur is relevant, due to the high incidence of fractures among the elderly due to increased life expectancy along with osteoporosis and the difficulty in choosing implants for osteosynthesis. Implants for intramedullary osteosynthesis are the method of choice for fixing such fractures. The purpose of this review: to study the advantages of implants for intramedullary osteosynthesis of trochanteric femoral fractures.The article provides an analysis of literature sources indexed in the Scopus, PubMed, Google Scholar, Lilacs and Cuiden databases, devoted to the study of the method of intramedullary osteosynthesis of trochanteric femoral fractures. The results made it possible to establish that modern intramedullary implants provide stable fixation of fragments even in osteoporosis, minimal blood loss during surgery, shortening of surgery time, early postoperative load and are safe and effective.The modern system of intramedullary fracture fixation is recognized as a highly effective method, especially in unstable trochanteric and subtrochanteric fractures of the femur, provides high antirotational stability of structures, overcomes the “Z” effect, medial migration of the cervical screw and minimally invasive intervention. Further research allows us to note the promising directions of the surgical method of treating patients with trochanteric fractures of the femur. Optimization of implants for intramedullary osteosynthesis of trochanteric fractures is a promising direction in traumatology and orthopedics.Key words: trochanteric fracture, femur, osteosynthesis, intramedullary osteosynthesis, metal structures, osteoporosis.

A Retrospective Analysis from A Single Center Perspective On Complications After Fixing Distal Radius Fracture In Pediatric Population.

The Distal radius fractures in the pediatric age group have similar complications to any other fracture. One interpretation of the high fracture incidence in the distal third of the radius is the relative weakness of the metaphyseal part. The aim of this study is to provide an evaluation of Surgical complications of distal radius through satisfactory reduction and proper fixation by K-wires through bone growth plates. A retrospective single-center study in a tertiary hospital in Eastern Saudi Arabia from 2000 to 2021, using the hospital's electronic records system. The Inclusion criteria of this study involve all distal radius fracture cases who underwent surgical fixation by k-wire or plating system and are up to 14 years old. The exclusion criteria include loss of follow-up, incomplete data, and age of more than 14 years. the study included 103 patients. The side of injury was almost equally distributed between the left and right sides. The odds of having at least one complication increase by 2.5 folds if the site of fracture is at the diaphysis. Further, if the distance of the fracture line to the epiphysis is more than 20 mm, the odds of reporting at least one complication post-procedure is 4.4 times higher than if it was at the level of the epiphysis. The majority of diaphyseal fractures required less than 6 weeks for radiological healing, which is significantly different from other sites which were evaluated. Complications of distal radius fracture due to Surgical intervention could be confounded by the complexity of the fracture itself. In our study, we found the distance of the fracture from the physis was inversely proportional to the likelihood of complications. For a comprehensive appreciation of physeal plate, we recommend extended follow-up for those who present with signs of severe distal radius fracture, especially in case of associated ulnar fracture.

Use and risk of side effects of antiresorptive medication in people with intellectual disabilities.

Recent studies show that adults with intellectual disabilities (ID) have high incidence of major osteoporotic fracture, especially hip fracture. In those ≥ 50 years, women and men with ID have an approximately two and four times higher rate of hip fracture than women and men without ID. Increased awareness of osteoporotic fracture risk in ID may lead to wider use of antiresorptive drugs (bisphosphonates and denosumab) in this population. We aimed to compare, between people with and without ID, the incidence of 1) major side effects, namely medication related osteoporosis of the jaw (ONJ) and oesophagitis; 2) oral pathology, which can be a risk factor for ONJ. Exploratory study investigating safety of first line osteoporosis medication within the population of a previous study comparing fracture incidence in people with and without ID in the GOLD database of the Clinical Practice Research Datalink 1998-2017. The percentage of people on antiresorptive drugs was identical in the ID and non ID group (1.4%). The number of individuals who developed ONJ and oesophagitis during the study was too low to allow an accurate estimate of incidence of the events and a comparison between the two groups. The incidence of any oral pathology was 119.31 vs 64.68/10000 person year in the ID vs non ID group. Medication related ONJ and oesophagitis are rare in people with and without ID. There is no reason based on our findings to use antiresorptives differently in people with ID as in the rest of the population. However, the potential for side effects of antiresorptives will inherently increase with wider use of these drugs. Given the higher incidence of oral pathology in people with ID, which could put them at higher risk of ONJ, precautions should be taken to prevent this complication by attention to oral health.

High Serum IL-17A Is Associated with Bone Destruction in Newly Diagnosed Multiple Myeloma Patients

Background Multiple myeloma (MM) is a malignant proliferative disease of the blood system, characterized by the abnormal growth of clonal plasma cells in the bone marrow. The bone marrow microenvironment (BMM) is highly critical in the pathological process of MM. Many studies have shown that serum Interleukin-17A (IL-17A) plays a key role in various infectious diseases, autoimmune diseases, and cancers. However, more clinical researches need to be done to further proof the influence of serum IL-17A level on multiple myeloma patients. Methods Among a total of 357 participants in our institution's MM cohort, 175 were eligible for the retrospective study. Multivariate regression models adjusted by potential confounding factors, the violin plots, the generalized additive model and smooth curve fittings, receiver operating characteristic (ROC) curve and K-M curve analysis were applied to the research. Results A total of 175 patients with newly diagnosed MM were enrolled in this study. The multivariate linear regression analysis showed that serum IL-17A level in MM patients correlated with the degree of bone lesions and fracture incidence (Fully adjusted model, Pbone lesion<0.0001, Pfracture<0.0001). Violin plot showed that MM patients with higher serum IL-17A level had more sever bone lesions and higher fracture incidence than that with lower serum IL-17A level. 171 patients were included in the study of the relationship between serum IL-17A and best overall effect (BOE). We found that serum IL-17A level were independently related to the best inductive therapeutic efficacy (Fully adjusted model, P =0.037), and the relationship was especially obvious in the light chain group (Fully adjusted model, P=0.009) and IgA (Fully adjusted model, P=0.0456). It could be deduced from the smooth curve that the higher the serum IL-17A level, the worse the BOE (P=0.0163). The ROC prediction curve suggested that serum IL-17A could predict the BOE to a certain extent (AUC=0.717, P=0.0327). A total of 148 MM patients were observed in the longitudinal study of relationship between serum IL-17A and PFS/OS. The K-M curve analysis indicated that serum IL-17A levels in MM patients were not significantly correlated with PFS and OS. However, in the light chain subgroup, MM patients with high serum IL-17A had worse PFS (P=0.015) and OS (P=0.0076) compared to that with low serum IL-17A. In IgA type subgroup, the higher IL-17A level was related to worse OS (P=0.0061). Conclusion This retrospective study found that higher levels of serum IL-17A was independently correlated with higher severity of bone disease and fractures incidence in newly diagnosed MM patients. High serum IL-17A level was related with poor best overall efficacy in light chain type. High serum IL-17A was also associated with poor PFS and OS in light chain type, and OS in IgA type subgroup.

Relationship between osteoporosis and Cushing syndrome based on bioinformatics.

Many clinical studies have reported a relatively high incidence of osteoporosis and fragility fractures in patients with Cushing syndrome (CS). However, few papers have investigated osteoporosis and CS in terms of pathogenesis, so this study explores the association between the 2 and predicts upstream micro-ribonucleic acids (miRNAs) through bioinformatics, which provides potential targets for simultaneous pharmacological interventions in both diseases and also provides a basis for pathological screening. We used Genecards, Online Mendelian Inheritance in Man and Therapeutic Target Database databases to screen the targets of osteoporosis and Cushing syndrome; import target genes to Database for Annotation, Visualization and Integrated Discovery for Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis; the intersecting genes were uploaded to Search Tool for the Retrieval of Genes and Genomes database to construct protein-protein interaction network; Cytoscape software was used to screen core genes, and Molecular Complex Detection module was used to analyze cluster modules; finally, the NetworkAnalyst data platform was used to predict the miRNAs that interact with core genes. The core genes of osteoporosis and Cushing syndrome were insulin, tumor necrosis factor, signal transducer and activator of transcription 3 (STAT3), interleukin-6, insulin-like growth factor 1, etc. A total of 340 upstream miRNAs including hsa-let-7a-5p, hsa-mir-30a-5p and hsa-mir-125b-5p were predicted. The biological processes involved include regulating the transcription of ribonucleic acid polymerase II promoter and participating in the transduction of cytokine signaling pathways, which focus on the binding of nerve system ligand, JAK-STAT signaling pathway, Rap1 signaling pathway, PI3K-Akt signaling pathway, etc. Osteoporosis and Cushing syndrome are closely related in terms of targets and molecular mechanisms. In this study, bioinformatics methods were used to identify their targets and mechanisms, providing potential targets for drug simultaneous regulation of the 2 diseases, and providing a new direction for exploring the relationship between diseases.

Assessment of Trabecular Bone Score: a 7-year follow-up study in institutionalized adults with refractory epilepsy and intellectual disability

PurposeThe aim of this longitudinal study was to assess trabecular bone scores (TBS) in institutionalized adults with refractory epilepsy and intellectual disability and to study the association of TBS and incident fractures during seven years of follow-up. MethodsIn 2009 and 2016, all institutionalized adult patients of a long-stay care facility in the Netherlands (n=261) were invited to undergo a dual-energy X-ray absorptiometry (DXA) including vertebral fracture assessment (VFA) and assessment of TBS. Vertebrae T4-L4 were analyzed using quantitative morphometry. New and worsening vertebral fractures (VFs) were considered as incident VFs. Data regarding clinical fractures were extracted from the medical files. Patients were treated with anti-osteoporosis medication according to the Dutch guideline. ResultsBaseline and follow-up DXA, VFA and TBS could be obtained in 136 patients (83 male) aged between 18 and 79 years old (44.7±15.5). At baseline, 36 patients (26.5%) were diagnosed with osteoporosis, 68 (50.0%) with osteopenia and 32 patients (23.5%) had a normal bone mineral density (BMD). As for TBS, 26 patients (19.1%) had a partially degraded microarchitecture and 26 patients (19.1%) a degraded microarchitecture. During seven years of follow-up, 80 patients (59%) sustained at least one fracture, of which 28 patients (35%) had one or more major osteoporotic fractures. Thirty-four patients (25.0%) had at least one new or worsening morphometric VF. Compared to baseline, TBS significantly decreased over seven years of follow-up in non-treated patients (-0.039±0.064, p<.001). In patients who were treated with bisphosphonates for more than one year during follow-up, TBS did not change significantly (p=.093). In multivariate analyses, no significant associations were found between TBS at baseline and incident fractures during follow-up. ConclusionIn this study, we found a high incidence of fractures and TBS decreased significantly over seven years of follow-up in non-treated institutionalized adult patients with refractory epilepsy and intellectual disability, but TBS was not associated with incident fractures.

Three-dimensional fracture mapping and analysis of coronal fractures in AO/OTA types 33-B3 and C3

BackgroundAlthough the relatively high incidence of coronal fractures in the supracondylar–intercondylar fractures is well established, little is currently known about the morphology of those fractures. Herein, we characterized the coronal fractures in AO/OTA type 33-C3 and assessed their differences with Busch–Hoffa fractures (33-B3).MethodsWe retrospectively collected 61 cases of AO/OTA type 33-B or C fractures with coronal plane fragments and generated three-dimensional fracture maps of those with coronal fractures based on CT imaging and measured angle α (the angle between the coronal fracture and the posterior condyle axis in the axis plane) and angle β (the angle between the coronal fracture and the posterior femoral cortex in the sagittal plane).ResultsThirty-three cases (32%) of AO/OTA type 33-C fractures contained coronal fragments. Most of them were type 33-C3 fractures. Angles α and β for type 33-C3 were significantly smaller than for type B3 at the lateral condyle, while the angles at the medial condyle were not significantly different. The fracture maps showed that the coronal fractures and the articular comminution area were more anterior in type 33-C3.ConclusionsThe incidence of coronal fractures was 32% and 67% in AO/OTA types 33-C and 33-C3, respectively. Our findings suggest that coronal fractures differed between both types, emphasizing the potential need for different treatment approaches.

Biomechanical Characteristics of the Femoral Isthmus during Total Hip Arthroplasty in Patients with Adult Osteoporosis and Developmental Dysplasia of the Hip: A Finite Element Analysis

This study investigated the underlying mechanisms of high fracture incidence in the femoral isthmus from a biomechanical perspective. We retrospectively analyzed a total of 923 primary total hip arthroplasty (THA) patients and 355 osteoporosis (OP) patients admitted from January 2010 to January 2018. Through a series of screening conditions, 47 patients from each group were selected for inclusion in the study. The datasets on the unaffected side and affected side of the patients with unilateral developmental dysplasia of the hip (uDDH) were respectively classified as the normal group (Group I) and he tDDH group (Group II), and that of patients with osteoporosis were classified as the OP group (Group III). In this study, first, we collected computed tomography (CT) images and measured geometric parameters (inner and outer diameters) of the isthmus. Thereafter, to study biomechanical properties, we established six finite element models and calculated values of von Mises stress for each group with the methods of data conversion and grid processing. Compared with those of patients in the normal group, the values of the inner and outer diameters of femoral isthmus of patients in the DDH group were significantly lower (P < 0.001), while the inner diameters of patients in the OP group were significantly higher (P < 0.001) and the outer diameters of patients in the OP group showed no significant difference (P> 0.05). The cortical rates of patients in the normal group and the DDH group appeared insignificant (P > 0.05), and those of patients in normal group were significantly higher than those of patients in the OP group (P < 0.001). Moreover, patients in the DDH group showed a higher von Mises stress value than patients in the normal group (P < 0.001), but statistically speaking the values between patients in the OP and normal groups were insignificant (P > 0.05). The relatively shorter inner and outer diameters of the isthmus in DDH resulted in intensive von Mises stress under the torque of the hip location, and induced a high fracture incidence. However, in patients in the OP group, the geometric morphology exhibited no anatomical variation, and the fracture was not due to the intensity of von Mises stress.

"It's Not Just a Plaster Cast, My Leg Is in It!": Patient Experiences: A Qualitative Study.

Plaster casts have been used in the treatment of fractures since 1850, and they play an important role in the healing of extremity injuries and operative repairs. Despite the high incidence of fractures and the widespread use of plaster casts in patients with fractures, the quality of counseling in patients with plaster casts has been neglected. There are few studies on the quality of this patient advisement and the nonmedical experiences of patients with plaster casts. We believe that understanding the feelings, thoughts, and experiences of patients who have had plaster casts will contribute to holistic patient care and will guide the planning of such care. The aim of this study was to describe some of the nonmedical experiences of being in a plaster cast and to illustrate these difficulties through patient quotes. This qualitative research study used a qualitative, descriptive approach guided by phenomenology to explore and describe the subjective experiences of patients with plaster casts. Participants consisted of 10 patients with lower extremity fractures, all of whom had been in a plaster cast for at least 6 weeks. Data were collected through in-depth individual interviews using semistructured questionnaires. The content analysis method was used to analyze the data. COREQ (Consolidated Criteria for Reporting Qualitative Research) was used in structuring and reporting the study. Six themes that described the experiences of patients with a plaster cast were determined in the study. These themes were the basic physiological and functional concern, self-image challenges, social roles, dependence/independence, emotions, and the experience of being in a plaster cast. We determined that many aspects of the lives of patients had been affected by being in a plaster cast and that they had experienced not only physiological issues but also psychological, social, emotional, and aesthetic issues. In addition, all the participants stated that they sought solutions to these issues by requesting support from a person or persons around them. Understanding the experiences of individuals with a plaster cast will contribute to the holistic healthcare of individuals who suffer fractures, allowing it to be more patient-centered. This understanding will also support the planning and implementation of patient-centered counseling and education.