Low-energy Trauma Research Articles

Post-traumatic spinal hematoma in diffuse idiopathic skeletal hyperostosis (DISH)

ObjectivesTo determine the incidence of spinal hematoma and its relation to neurological deficit after trauma in patients with spinal ankylosis from diffuse idiopathic skeletal hyperostosis (DISH).Materials and methodsA retrospective review of 2256 urgent or emergency MRI referrals over a period of 8 years and nine months revealed 70 DISH patients who underwent CT and MRI scans of the spine. Spinal hematoma was the primary outcome. Additional variables were spinal cord impingement, spinal cord injury (SCI), trauma mechanism, fracture type, spinal canal narrowing, treatment type, and Frankel grades during injury, before and after treatment. Two trauma radiologists reviewed MRI scans blinded to initial reports.ResultsOf 70 post-traumatic patients (54 men, median age 73, IQR 66–81) with ankylosis of the spine from DISH, 34 (49%) had spinal epidural hematoma (SEH) and 3 (4%) had spinal subdural hematoma, 47 (67%) had spinal cord impingement, and 43 (61%) had SCI. Ground-level fall (69%) was the most common trauma mechanism. A transverse, AO classification type B spine fracture (39%) through the vertebral body was the most common injury type. Spinal canal narrowing (p < .001) correlated and spinal cord impingement (p = .004) associated with Frankel grade before treatment. Of 34 patients with SEH, one, treated conservatively, developed SCI.ConclusionsSEH is a common complication after low-energy trauma in patients with spinal ankylosis from DISH. SEH causing spinal cord impingement may progress to SCI if not treated by decompression.Clinical relevance statementLow-energy trauma may cause unstable spinal fractures in patients with spinal ankylosis caused by DISH. The diagnosis of spinal cord impingement or injury requires MRI, especially for the exclusion of spinal hematoma requiring surgical evacuation.Key Points• Spinal epidural hematoma is a common complication in post-traumatic patients with spinal ankylosis from DISH.• Most fractures and associated spinal hematomas in patients with spinal ankylosis from DISH result from low-energy trauma.• Spinal hematoma can cause spinal cord impingement, which may lead to SCI if not treated by decompression.

A retrospective epidemiological cohort study of ankle fractures in children and teenagers.

Ankle fracture is one of the most frequent pediatric lower-limb fractures and may result in serious complications. This study aimed to determine the epidemiology of ankle fractures, defining fracture types, treatments, and complications in a pediatric population below 16 years old. Medical records of all the ankle fracture patients treated in our hospital during 2004-2020 were retrospectively reviewed. Data regarding age, sex, mechanism of injury, fracture type, treatment modalities, and complications were collected. We examined records involving 328 children with 331 ankle fractures, with a ratio of 1:2 male per female. Mean annual prevalence was 24.3 per 100,000 children. Mean patient age was 11.2 ± 4.2 years, with 75.3% of them aged over 10 years. Sports activities accounted for the largest percentage of fractures (162 cases; 49.4%), followed by falls (67; 20.4%) and road traffic accidents (37; 11.3%). Physeal fractures were the most frequent type of lesion (223 cases). Most ankle fractures (60%) were managed using closed reduction and casting; for the remaining 40% of cases, fracture fixation was performed after closed or open reduction to correct the articular step-off and ensure the anatomical restoration of the physis. The main ankle fracture complication was premature growth arrest (12.1% of all physeal fractures). Pediatric ankle fractures primarily affect children older than 10 years. Most of these fractures were caused by sports injuries or low-energy trauma. The majority of these fractures are physeal, and the distal tibial physis is affected 10 times more frequently than the distal fibular physis. Level III.

AO/OTA 31A3 fractures and postoperative complications in older patients

BackgroundAO/OTA 31A3 fractures (A3 fractures) have risk for postoperative complications with major impact on morbidity and mortality. For older patients, limited information is available for factors associated with postoperative complications. We aimed to assess factors associated with postoperative complications after surgery using cephalomedullary nails. MethodsA retrospective cohort study was conducted using the information on patients aged ≥65 years who underwent surgery using cephalomedullary nails for trochanteric fractures due to low-energy trauma in three hospitals. Postoperative complications were diagnosed when patients were identified as nonunion, cutout of lag screw, or nail breakage. First, we compared differences including age, sex, body mass index, American Society of Anesthesiologists physical status classification system, preoperative waking ability, fracture type, nail length, neck shaft angle, reduction method, reduction quality and tip apex distance between patients with and without postoperative complications. Second, multivariable logistic regression analysis was employed to assess factors associated with postoperative complications resulting from A3 fractures. ResultsAmong 120 patients with A3 fractures, postoperative complications were identified in 12 patients (10.0%). Postoperative complications were significantly more likely to develop among patients with poor reduction quality (adjusted odds ratio [95% confidence interval], 35.0 [4.43–275.9]) and a tip-apex distance ≥25 mm (16.4 [1.92–140.3]). ConclusionsThese findings suggest that surgeons should aim to perform appropriate postoperative reduction and to prevent postoperative complications when using a cephalomedullary nail for A3 fractures among older patients.

Septic Arthritis of the Hip Following Closed Acetabulum Fracture Treated Conservatively: A Case Report

Nowadays, fractures of the acetabulum associated with low energy trauma are common in older adults. The indication for surgical or conservative treatment depends on multiple factors, such as patient age and comorbidities, type and location of the fracture, and socioeconomic environment. Regardless of the treatment chosen, none is free of complications. A patient with a conservatively treated acetabular fracture that resulted in septic arthritis of the quadrilateral joint is described below.

Hip Fracture Due to Osteomalacia Secondary to Celiac Disease

Background: Hip fracture is uncommon among younger patients but can have devastating consequences. Therefore, hip fracture caused by minimal trauma requires examinations on calcium metabolism to identify the primary cause. Methods: We present a clinical case of an 18-year-old male patient who suffered a subcapital fracture of the left hip due to minimal trauma while playing soccer. The patient immediately underwent surgery, which is closed reduction and internal fixation with two cancellous screws installed. Subsequently, metabolic tests showed severe vitamin D deficiency (27.1 nmol/L - normal above 75 nmol/L) and high levels of IgA anti-transglutaminase antibodies (2502.40 U/mL). Digestive biopsy confirmed the diagnosis of celiac disease, and he was treated with a gluten-free diet and calcium and vitamin D supplements. Results: After two years of follow-up, the patient is pain-free, with full hip mobility. There were no complications (osteosynthesis failure, avascular necrosis or pseudarthrosis) and serum levels of vitamin D, and IgA anti-transglutaminase antibodies had normalized. Conclusion: In young patients presenting with low energy trauma fractures, vitamin D deficiency should be considered as a possible etiology, and the reason for such osteomalacia, such as celiac disease, should be identified.

Outcomes, risk factors, and conversion rate in acetabular fractures in patients over 65 years of age. Analysis at a mean follow-up of 6 years

IntroductionAcetabular fractures are devastating injuries that can affect patients of different ages, as well as being associated with high or low energy trauma. Conversion to total hip arthroplasty (THA) results in increased complication rates, resource use and costs compared to primary THA due to osteoarthritis. The aim of this paper is to describe a retrospective cohort of patients over 65 years of age who presented with an acetabular fracture and were treated with open reduction and internal fixation (ORIF). MethodsA retrospective cohort study was conducted from January 2002 to December 2017. The study identified all patients over 65 years of age who suffered an acetabular fracture and were treated primarily with ORIF. The quality of reduction, fracture pattern and associated poor prognostic factors for fracture were analyzed. ResultsA total of 50 cases of acetabular fractures in patients over 65 years of age were included. Six of them required conversion to THA (12%). In 3 of these cases conversion surgery was performed because of pre-existing osteoarthritis, pain, and postoperative progression of osteoarthritis. The main factors involved in the conversion cases were intra-articular fragments, femoral head protrusion and posterior wall comminution. Postoperative intra-articular gap had a p = 0.01 in linear regression analysis for conversion to arthroplasty. ConclusionThe conversion rate reported in our cohort of elderly patients is similar to that reported in the literature in patients of all age ranges. The quality of reduction was a significant factor in predicting progression to conversion to THA.

Minimally Invasive Surgery for Thoracolumbar Spinal Fractures in Patients With Ankylosing Spondylitis.

Patients with ankylosing spondylitis (AS) are prone to spinal fractures even after low-energy trauma. Posterior fusion through open surgery has been the standard procedure for spinal fractures in patients with AS. Minimally invasive surgery (MIS) has been proposed as an alternative treatment option. There are few literature reports regarding patients with AS being treated for spinal fractures with MIS. This study aims to present the clinical outcome of a series of patients with AS treated with MIS for spinal fractures. We included a consecutive series of patients with AS who underwent MIS for thoracolumbar fractures between 2014 and 2021. The median follow-up was 38 (12-75) months. Medical records and radiographs were reviewed, and data on surgery, reoperations, complications, fracture healing, and mortality were recorded. Forty-three patients (39 [91%] men) were included with a median (range) age of 73 (38-89) years. All patients underwent image-guided MIS with screws and rods. Three patients underwent reoperations, all due to wound infections. One patient (2%) died within 30 days and 7 (16%) died within the first year after surgery. Most patients with a radiographic follow-up of 12 months or more (29/30) healed with a bony fusion on computed tomography (97%). Patients with AS and a spinal fracture are at risk of reoperation and have significant mortality during the first year. MIS provides adequate surgical stability for fracture healing with an acceptable number of complications and is an adequate choice in treating AS-related spinal fractures.

The Korean hip fracture registry study

BackgroundThe purpose of the Korean Hip Fracture Registry (KHFR) Study is to establish a nationwide, hospital-based prospective cohort study of adults with hip fracture to explore the incidence and risk factors of second osteoporotic fractures for a Fracture Liaison Service (FLS) model.MethodsThe KHFR, a prospective multicenter longitudinal study, was launched in 2014. Sixteen centers recruited participants who were treated for hip fracture. The inclusion criteria were patients, who were treated for proximal femur fracture due to low-energy trauma and aged 50 or more at the time of injury. Until 2018, 5,841 patients were enrolled in this study. Follow-up surveys were conducted annually to determine occurrence of second osteoporotic fracture, and 4,803 participants completed at least one follow-up survey.DiscussionKHFR is a unique resource of individual level on osteoporotic hip fracture with radiological, medical, and laboratory information including DXA (dual energy x-ray absorptiometry), bone turnover marker, body composition, and hand grip strength for future analyses for FLS model. Modifiable factors for mortality after hip surgery is planned to be identified with nutritional assessment and multi-disciplinary interventions from hospitalization to follow-ups. The proportions of femoral neck, intertrochanteric, and subtrochanteric fractures were 517 (42.0%), 730 (53.6%), and 60 (4.4%), respectively, from 2014 to 2016, which was similar in other studies. Radiologic definition of atypical subtrochanteric fracture was adopted and 17 (1.2%) fractures among 1,361 proximal femoral fractures were identified. Internal fixation showed higher reoperation rate compared to arthroplasty in unstable intertrochanteric fractures (6.1% vs. 2.4%, p = 0.046) with no significant difference in mortality. The KHFR plans to identify outcomes and risk factors associated with second fracture by conducting a 10-year cohort study, with a follow-up every year, using 5,841 baseline participants.Trial registrationPresent study was registered on Internet-based Clinical Research and Trial management system (iCReaT) as multicenter prospective observational cohort study (Project number: C160022, Date of registration: 22th, Apr, 2016).

The effect of shoulder prosthesis stem length on failure due to torsional loading. A biomechanical study in composite humeri

Shoulder arthroplasty is becoming increasingly common. With evolving implant designs, multiple humeral stem options exist for the surgeon to choose from. New stemless and short-stem systems are modular, remove less native bone stock, and better adapt to patient anatomy. It has been suggested that shorter stem implants may be protective against periprosthetic fracture; however, this has not been mechanistically evaluated. Therefore, this study aimed to biomechanically test synthetic humeri with long-stem, short-stem, and stemless arthroplasty components in a torsional manner to evaluate their response to loading and characterize failure. Twenty-four synthetic humeri were implanted with long stem, short stem, or stemless uncemented prosthesis, 8 in each group. Humeri were mounted in a custom testing jig with a morse taper interfacing with a mechanical testing system. After a 20N axial force, specimens were torsionally loaded to failure at 15 degrees/sec, with 50 Hz collection. Torque vs. rotation curves were generated for each specimen, and stiffness, yield, ultimate strength, and failure load were measured. ANOVA and post hoc pairwise comparisons were used to assess effect of stem type on mechanical test variable. The association of the stem type with fracture type was analyzed by a Fisher's Exact test. Statistical significance was set at P<.05. During torsional loading, long-stem implants were significantly stiffer than short or stemless implants. The angle of implant yielding was similar across stem designs; however, stemless implants had a lower yield torque. This correlated with a decreased yield energy in stemless compared to short stems as well. Maximum torque and failure torque was also significantly higher in short-stem and long-stem implants compared to stemless. Periprosthetic fractures in shoulder arthroplasty are a concern in low-energy trauma, and stem design likely plays a significant role in early implant-bone failure. Our results suggest stemless implants under torsional load fail at lower stress and are less stiff than stemmed implants. The failure mechanism of stemless implants through metaphyseal cancellous bone emphasizes the effect bone quality has on implant fixation. There is likely a balance of torsional stability to survive physiologic loads while minimizing diaphyseal stress and risk of diaphyseal periprosthetic fracture. This combined with revision and fixation options represent decisions the surgeon is faced with when performing shoulder arthroplasty.

PECULIARITIES OF THE TREATMENT APPROACH FOR HUMERAL DIAPHYSIS FRACTURES IN PATIENTS WITH COMORBIDITIES

Humeral diaphysis fractures are one of the frequent components of the low-energy trauma in people of different age and gender groups with comorbid pathology. Pathological autoimmune and trophic processes that disrupt the reparative capabilities of the body have a negative impact on the formation of connective tissue. The purpose of this study is to identify the peculiarities of the treatment for humeral diaphysis fractures in patients with comorbid pathology. Methods and Material. 42 patients with humeral diaphysis fractures, aged 18 to 88 years, have been involved in the study. All patients were diagnosed to have comorbid pathology affecting the regenerative processes of bone and connective tissues. Type 1 and Type 2 diabetes mellitus was diagnosed in 71.4% (30) and 28.6% (12) patients, respectively. In 28.8% (12) cases, erythrodermic psoriasis without psoriatic arthro- and enthesopathies was diagnosed. The treatment for humeral diaphysis fractures in all studied cases was carried out using the surgical techniques. Results and Discussion. 2 clinical groups of patients were distinguished depending on the applied method of osteosynthesis. The evaluation of the treatment outcomes was carried out according to a number of parameters, namely the presence of complications of combined genesis during the healing of postoperative wounds and prolongation of the repair phase for fracture consolidation and bone callus formation. Conclusions. The risk for postoperative complications among patients with injuries of the humeral diaphysis with underlying erythrodermic psoriasis and Type1 and Type 2 diabetes mellitus can be reduced by minimizing the surgical interventions and applying minimally invasive surgery.

The use of whole-body trauma CT should be based on mechanism of injury: A risk analysis of 3920 patients at a tertiary trauma centre

BackgroundMechanism of injury (MOI) plays a significant role in a decision to perform whole-body computed tomography (CT) imaging for trauma patients. Various mechanisms have unique patterns of injury and therefore form an important variable in decision making. MethodsRetrospective cohort study including all patients >18 years old who received a whole-body CT scan between 1 January 2019 and 19 February 2020. The outcomes were divided into CT ‘positive’ if any internal injuries were detected and CT ‘negative’ if no internal injuries were detected. The MOI, vital sign parameters, and other relevant clinical examination findings at presentation were recorded. Results3920 patients met the inclusion criteria, of which 1591 (40.6%) had a positive CT. The most common MOI was fall from standing height (FFSH), accounting for 23.0%, followed by motor vehicle accident (MVA), accounting for 22.4%. Covariates significantly associated with a positive CT included age, MVA >60 km/h, motor bike, bicycle, or pedestrian accident >30 km/h, prolonged extrication >30 min, fall from height above standing, penetrating chest or abdominal injury, as well as hypotension, neurological deficit, or hypoxia on arrival. FFSH was shown to reduce the risk of a positive CT overall, however, sub-analysis of FFSH in patients >65 years showed a significant association with a positive CT (OR 2.34, p < 0.001) compared to <65 years. ConclusionsPre-arrival information including MOI and vital signs have significant impact on identifying subsequent injuries with CT imaging. In high energy trauma, we should consider the need for whole-body CT based on MOI alone regardless of the clinical examination findings. However, for low-energy trauma, including FFSH, in the absence of clinical examination findings which support an internal injury, a screening whole-body CT is unlikely to yield a positive result, particularly in the age group <65yo.

P64 PERSISTENT ST–ELEVATION WITH HIGH MYOCARDIONECROSIS MARKERS: A CASE OF MYOCARDIAL CONTUSION

Abstract Myocardial contusion (MC) is a note rare and potentially fatal complication of blunt chest trauma (BCT). The spectrum of manifestations of post–traumatic cardiac injury varies widely: from clinically silent injuries to severe reductions in cardiac function, myocardial hematomas, heart ruptures, and life–threatening arrhythmias1. There is no unique definition for this entity, and the diagnostic criteria proposed by different authors vary widely. Some authors define MC as a mild increase in cardiac biomarkers in the context of chest trauma, while for others the diagnosis requires evidence on imaging of pathologic findings2. Consequently, the true incidence of MC remains unknown, varying in reports between 8% and 71%3. We describe a case of cardiac contusion secondary to a low–energy trauma manifested as persistent ST elevation and pathologic elevation of myocardiocytosis markers, with consequent myocardial stunning of the right ventricular free wall. As there is no consensus regarding the correct diagnostic pathway, it is essential to integrate first–level pathologic examinations (ECG and laboratory diagnostics) with cardiac magnetic Resonance Imaging (MRI) to define the presence of cardiac contusion and its extent, especially if the echocardiographic data are unconclusive.

Evaluation of functional results of different treatment modalities in Intra- articular fracture of distal end of radius in adults at a tertiary care hospital in Eastern India

Fractures of the distal radius (DRF) are the most common orthopedic injuries: one out of every six fractures presented at emergency department is a distal radius fracture. Almost two-thirds of these fractures are displaced and need to be reduced. Epidemiological studies point out that the age rate curve is bimodal and that the highest incidences are found in children and the elderly. DRF constitute 14% of all extremity injuries. They occur as a result of high or low energy trauma resulting in significant injury and impairment of function of the upper extremity. Randomized controlled trial has been attempted to scrutinize the best method for treating DRF, ranging from methods of conservative treatment to advanced strategies of plate osteo-synthesis.124 Patients with 126 intra-articular distal radius fractures were studied, who met with predefined inclusion and exclusion criteria at Department of Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar from 1st October 2017 to 30th September 2019. They underwent different treatment interventions. The cases were followed for 12 months at regular intervals for serial clinical &amp; radiological evaluation. Functional grading and pain scoring was done for different treatment modalities. Radiological grading was made based on union/ non-union of fracture.Majority with wrist fracture were of age 20-40 years followed by the age group 61-80 years. Grip strength was reported better in surgical group(79.2%). Mode of treatment is statistically significant with Palmar flexion (p = 0.015), Supination (p=0.025) and Pronation (p&amp;#60;0.001) of wrist post surgical treatment. Plating group experience significantl less pain (p=0.012). Mean function score for surgical group is 19.8.The impetus for the inclination towards treatment of wrist fracture by surgery, mainly plating method, stands multifactorial and might bring better outcomes in terms of range and degree of movement, expedited recovery, lower chances of malunion and in a way, better prognosis and quality of life in case of DRF.

The effect of pre-fracture proximal femur geometry on hip fracture type in elderly patients.

This study aimed to analyze the relationship between fracture type by determining data on the geometry of the proximal femur in the pre-fracture period in patients over 65 years of age who had hip fractures as a result of low-energy trauma. A total of 127 patients who were admitted to the hospital for reasons other than hip pathology within 1 year before the occurrence of hip fracture and who had an anterior-posterior pelvic X-ray were included in the study. Measurements were made to evaluate the proximal femur geometry, neck shaft angle, central edge angle, femoral head diameter, femoral neck diameter, femoral neck length, femoral offset length, femoral neck axial length, hip axis length, and femoral shaft diameter. As a result of these measurements, analyses were performed to determine the relationship between the control group and fracture types. The mean Neck shaft angle scores were significantly higher in both fracture types than in the control group (P = .034, P = .002). The mean Femoral offset length values of both fracture types were lower than those of the control group (P = .002, P = .011, respectively). Multiple logistic regression analysis revealed that the risk of collum femoris fracture increased as the Femoral head diameter value increased. (OD = 0.21, P = .002). The geometric parameters of the proximal femur play an important role in the formation of hip fracture types. Therefore, differences in proximal femur geometry in hip fracture types should be considered, and patient-focused choices should be made regarding the surgical procedures and implants to be used during fracture fixation.

Trends and treatments of pelvic and acetabular fractures in Taiwan: facing an aging society

SummaryPelvic-acetabular fractures lead to high mortality in elders and their association between different groups is not known. Our results indicate that older age with pelvic-acetabular fracture was significantly associated with mortality. This finding may help planning and allocating healthcare resources, risk stratification, and optimizing the treatment of pelvic fractures.PurposePelvic or acetabular fractures are among main outcomes of low-energy trauma such as falls, especially in older adults. They represent approximately 3–8% of all fractures and are associated with a high mortality rate ranging from 4 to 28%. This study is aimed at comparing the incidence and trends of hip fractures and pelvic-acetabular fractures in the Taiwanese general population, gender differences in adults aged over 65 years, and mortality risk between pelvic or acetabular fractures and hip fractures and surgery trends in patients with these fractures.MethodsA retrospective study was conducted extracting data from the National Health Insurance Research Database of patients diagnosed with hip fracture and pelvic acetabular fracture between 2000 and 2018.ResultsOlder age with pelvic-acetabular fracture was significantly associated with increased mortality. No significant differences were found in comorbidities between the two fracture groups. Results provide clear epidemiological evidence for trends in pelvic-acetabular fractures in Taiwan and demonstrate the need for better strategies to manage these fractures and comorbidities, particularly in older adults.ConclusionFindings of this study may aid in planning and allocating healthcare resources, risk stratification, and optimizing the treatment of pelvic fractures among older adults in Taiwan.

A Novel Classification of Cervical Spine Trauma in Ankylosing Spondylitis and Corresponding Surgical Outcomes

Currently, there are no reports on the specific classification of cervical spine trauma (CST) in ankylosing spondylitis (AS) based on the trauma mechanism. In this study, we aimed to describe a novel classification of CST in AS with more details, and put forward the corresponding surgical outcomes related to different types, hoping to provide a practical reference for clinical decision-making and academic communication. From January 2008 to December 2021, AS patients who experienced CST were retrospectively reviewed and included. Clinical data including gender, age, reason of trauma, time interval between AS diagnosis and trauma were collected. The American Spinal Injury Association (ASIA) grade system was used to describe patients' neurological status. Based on the combination of surgical experience and follow-up observation, the lower cervical spine trauma in AS patients was divided into three main types, namely single level fracture-dislocation (type 1), spinal cord injury without fracture-dislocation (type 2), and Andersson lesion (type 3). Furthermore, we performed detailed subtypes according to whether cervical spine was completely fused and the location of injury. Meanwhile, according to different approaches, surgical methods mainly included Anterior Cervical Discectomy and Fusion (ACDF), Anterior Cervical Corpectomy and Fusion (ACCF), Posterior Expansive Open-door Cervical Laminoplasty (PEOLP), Posterior Cervical Laminectomy Decompression and Fusion (PCLDF), and their combination. Postoperative general and surgery-related complications were also recorded. A total of 102 patients were enrolled, including 91 males and 11 females, with an average age of 51.9 years. Their average interval time between AS diagnosis and injury was 27.8 years. Patients with high-energy and low-energy trauma were 54 and 48 respectively. There were 79 patients suffering spinal cord nerve impairment after trauma. With regard to the distribution of different types, the number of patients in type 1, type 2, and type 3 were 86, 14, and two, respectively. For different types, PCLDF was the most commonly used surgical method, accounting for 55.9%, while ACCF was only applied for one time. In type 1, the frequencies of ACDF, ACCF, PCLDF, and ACDF+PCLDF were 10.5%, 1.2%, 55.8%, and 32.5%. In type 2, the frequencies of ACDF, PCLDF, ACDF+PCLDF, and PEOLP were 7.1%, 50.0%, 7.1%, 35.8%. Postoperatively, 21 patients achieved neurological function improvement. The incidences of general and surgery-related complications were 19.6% and 5.9%, respectively. All patients achieved bone fusion and durable decompression at the last follow-up. Our novel classification could enrich the scope of CST in AS patients and provide valuable references to the corresponding clinical management. Besides, there are strict indications of different surgical methods, factors like patient's physical condition, trauma type, surgical purpose, and expected efficacy were all required to consider before making a clinical decision.

Osteophyte-related medial collateral ligament injury in asymptomatic osteoarthritis following minor trauma: a case report.

A 78-year-old Thai female presented with left knee pain 1h after a low-energy trauma caused by a fall. The MRI showed deep MCL and medial meniscal root injuries, a nondisplaced lateral femoral condyle, and also revealed a large osteophyte near the midpart of the MCL, with a blunt persistent projection from the osteophyte pushing against the MCL where the injury was located. She was treated with a knee brace, a gait aid for walking, and analgesic pain control. Her symptoms gradually improved over the next few weeks. If an osteophyte touches a ligament, it can cause degenerative changes to the ligament from chronic irritation, resulting in reducing the strength of the ligament and may be causing some degree of degenerative changes and tightening of the MCL in its at-rest state, resulting in an increased chance of injury when it is required to resist a sudden external force, even from a minor trauma. When there is an osteophyte pushing against a ligament, there is an increased chance of ligament injury when even a minor trauma stresses that ligament.

Risk of Fracture After Bilateral Oophorectomy.

Fragility fractures, resulting from low-energy trauma, occur in approximately 1 in 10 Danish women aged 50 years or older. Bilateral oophorectomy (surgical removal of both ovaries) may increase the risk of fragility fractures due to loss of ovarian sex steroids, particularly estrogen. We investigated the association between bilateral oophorectomy and risk of fragility fracture and whether this was conditional on age at time of bilateral oophorectomy, hormone therapy (HT) use, hysterectomy, physical activity level, body mass index (BMI), or smoking. We performed a cohort study of 25,853 female nurses (≥45 years) participating in the Danish Nurse Cohort. Nurses were followed from age 50 years or entry into the cohort, whichever came last, until date of first fragility fracture, death, emigration, or end of follow-up on December 31, 2018, whichever came first. Cox regression models with age as the underlying time scale were used to estimate the association between time-varying bilateral oophorectomy (all ages, <51/≥51 years) and incident fragility fracture (any and site-specific [forearm, hip, spine, and other]). Exposure and outcome were ascertained from nationwide patient registries. During 491,626 person-years of follow-up, 6600 nurses (25.5%) with incident fragility fractures were identified, and 1938 (7.5%) nurses had a bilateral oophorectomy. The frequency of fragility fractures was 24.1% in nurses who were <51 years at time of bilateral oophorectomy and 18.1% in nurses who were ≥51 years. No statistically significant associations were observed between bilateral oophorectomy at any age and fragility fractures at any site. Neither HT use, hysterectomy, physical activity level, BMI, nor smoking altered the results. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

CLINICO-RADIOLOGICAL AND FUNCTIONAL OUTCOME OF INTERTROCHANTERIC FEMUR FRACTURES TREATED BY PROXIMAL FEMORAL NAIL ANTIROTATION2 (PFNA2)

Introduction: Intertrochanteric femur fractures commonly occurin the elderly patients usually due to low energy trauma and in young patients due to high velocity trauma. It is treated by extramedullary as well as intramedullary implants. Among intramedullary implants, proximal femoral nail antirotation (PFNA2) is become much popular due to better functional outcome. Purpose of this study is to analyze clinico-radiological and functional outcome of intertochanteric fractures treated by PFNA2.Material and Methods: The study was conducted at the Department of Orthopaedics, Assam Medical College &amp; Hospital, Dibrugarh from June,2019 to May,2020.Results: The functional outcome was assessed with Harris hip score. The mean Harris hip score was 87.9 at nal follow-up Conclusion:PFNA2 is safe and effective xation implant for treatment of intertrochanteric femur fracture due to less blood loss, less intraoperative complications, minimal soft tissue damage and good union rate.

Investigating the effectiveness of anterolateral distal tibia plate in treating distal tibial fractures in adults: a prospective study

Background: “Pilon” fractures of the distal tibia are a term used usually by orthopaedic surgeons. High-energy trauma and related soft tissue injuries are the main causes. It might be challenging to treat distal one-third of tibial fractures that affect the articular process or not. The objective of this work is to analyze the result of the Anterolateral Distal Tibia Plate in distal tibial fracture treatment in adults. Methods: After receiving permission from the ethical committee, this prospective interventional analysis was conducted among 25 patients who satisfied the inclusion standards and were given anterolateral distal tibia plates. The scoring system created by “Ovadia and Beals” was used to evaluate patients at the conclusion of the follow-up period. Results: The participants in this research varied in age from 18 to 64, with a mean age of 36. 13 patients had a left tibia fracture and 12 patients had a right tibia distal end fracture. There were 4 open GA-I fractures and 21 closed GA-I fractures. 18 patients got fractures as a result of road traffic accidents (“high energy trauma”), and 7 patients sustained a fracture due to a fall (low energy trauma). The union of fracture occurred in 24(96%) patients and 1(4%) case showed delayed union. The average period of union was 18 weeks with the radiological signs of callus formation. 2 patients developed superficial and 1 patient developed deep infection. Conclusions: Distal end tibial fractures especially with intra-articular involvement may be effectively treated by anterolateral plating within a single stage, offers advantages such as adequate fracture exposure, soft tissue preservation, and reliable fracture healing.