Low Fracture Research Articles

Mendelian-randomization study revealed causal relationship between nonalcoholic fatty liver disease and osteoporosis/fractures.

Patients with nonalcoholic fatty liver disease (NAFLD) are reported to have a higher risk of osteoporosis/fractures; however, the causal relationship remains unclear. Publicly available genome-wide association studies (GWASs) were used for Mendelian randomization (MR) analysis. GWASs of NAFLD and fractures were obtained from the FinnGen Consortium. GWASs of bone mineral density (BMD) were derived from a meta-analysis. GWASs of obesity, diabetes, liver function, and serum lipid-related metrics were used to clarify whether the accompanying NAFLD symptoms contributed to fractures. Moreover, two additional GWASs of NAFLD were applied. A causal association was not observed between NAFLD and BMD using GWASs from the FinnGen Consortium. However, a causal relationship between NAFLD and femoral neck-BMD (FN-BMD), a suggestive relationship between fibrosis and FN-BMD, and between NAFLD and osteoporosis were identified in replication GWASs. Genetically proxied body mass index (BMI), high-density lipoprotein (HDL), and hip circumference increased the likelihood of lower limb fractures. The waist-to-hip ratio decreased, whereas glycated hemoglobin (HbA1C) and homeostasis model assessment of β-cell function (HOMA-B) increased the risk of forearm fractures. Low-density lipoprotein (LDL) reduced, whereas HbA1C increased the incidence of femoral fractures. Alkaline phosphatase (ALP) raised the risk of foot fractures. However, after a multivariate MR analysis (adjusted for BMI), all the relationships became insignificant. NAFLD caused reduced BMD, and genetically predicted HDL, LDL, HbA1C, HOMA-B, ALP, hip circumference, and waist-to-hip ratio causally increased the risk of fractures. BMI may mediate causal relationships. Larger GWASs are required to verify this finding.

Effect of long-term aging on the microstructure evolution and fracture mechanism of 9% Cr steels

The fracture toughness of pressure pipe steels is vital for their design and safe operation. Understanding the deterioration of the fracture toughness and the corresponding fracture mechanisms is instructive and meaningful for material selection and development. The elastic–plastic fracture toughness of 9% Cr steels aged at 873 K and 923 K from the initial state to 20000 h was investigated at ambient temperature and 873 K. The deterioration of the fracture toughness and the corresponding fracture mechanisms are discussed in detail. For 9% Cr steels, voids mainly initiated from primary inclusions such as silicides, sulfides, alumina and manganides in as-received state, while voids initiated from both primary inclusions and secondary particles such as the Laves phase after long-term aging. These voids grew and coalesced with neighboring voids and crack tips subsequently until ultimately fracture. After aging at 873 K, the fracture toughness values tested at 873 K decreased from the initial state to 3000 h and then increased to 10000 h. The peculiar deterioration of the fracture properties after 3000 h of aging at 873 K can be attributed to the high number density of Laves phase particles in the steels. It was found that the densely distributed hard Laves phase particles induced strain concentration at the interface between the Laves phase and the matrix under plane-strain tension condition and promoted nucleation of voids. It was suggested that the spatial distribution of the Laves phase played a significant role on the void formation. 9% Cr steels with a denser distribution of Laves phases brings about voids with shorter interspaces, which are more susceptible to coalesce into crack tip, resulting in lower fracture resistance. After aging at 923 K from 10000 h to 20000 h, the number density, size and volume fraction of precipitates, block size, misorientation angle and dislocation density remained almost constant. The slight increase in the fracture toughness from 10000 h to 20000 h can be mainly ascribed to the coarsening of the martensite lath in this stage.

Clinical Application and Evaluation of Specialised Ring Fixators for the Management of Upper and Lower Limb Bone Fractures in Dogs

Present study was conducted on nine-clinical cases of humerus (n=4), femur (n=3) and radius-ulna (n=2) fractures in dogs of either sex, weighing 5.5 to 18 kg. Both closed (n=6) and open (n=3) fractures were treated in this study. The fracture was reduced and stabilized by transfixation using modified ring fixators. Semicircular (n=4) and hybrid fixators (n=5) were used for upper limb and lower limb bones respectively. The main component of fixator i.e. aluminium rings were designed locally at Bikaner using 4-mm aluminium sheets and fabricated accordingly. Full rings were used for distal radial (n=2) and distal femoral (n=1) fractures whereas semicircular rings were made through cutting the full ring during surgery for specific humeral (n=4) and femoral (n=2) fractures. Specialised wire fixation bolt (iron based; weighing 5.5g) was also designed locally at Bikaner for transcortical pin and ring articulation. Humeral and distal femoral fractures are challenging while bone plating of distal radial fracture demands further surgeries therefore external fixators were modified and applied in present study. Operated limbs were evaluated clinically with serial postoperative radiographs at regular intervals. Fixator-assembly evaluation and functional recovery of operated limbs were considered as objectives of this study.

The initial response of a local hospital in the earthquake zone during the February 6, 2023 Kahramanmaraş earthquakes: Injuries and challenges.

This study aimed to describe the type and number of traumatic injuries seen after devastating earthquakes and to evaluate the difficulties experienced in the treatment process in a primary affected center. Out of the 2176 patients who were treated in the emergency department, 372 (199 male and 173 female) patients with complete data were included in this single-center retrospective study. In addition to the demographic characteristics of the patients, orthopedic injuries, other organ system injuries, type of injury, treatments, mechanisms of injury, and time of presentation to the emergency department were recorded. The most common age group for injury was 20-30 years old, consisting of 73 patients (19.62%), and the second most common age group was between 40 and 50, with 72 patients (19.35%). Injury after being trapped under rubble was seen in 152 (40.86%) patients, while non-debris causes were more common in 220 patients (59.14%). The most common site of injury was in the lower extremities, with 111 patients (29.84%), while multiple injuries were seen in 109 patients (29.3%). Lower extremity fractures were mostly seen in long bones such as the femur (12.28%) and tibia (11.4%). Upper extremity fractures, especially those due to falls, were most frequently in the distal radius (8.77%). After triage, 117 patients (31.45%) were hospitalized, whereas the majority of patients (58.33%) were discharged from the emergency department. This study has shown us that injuries following major earthquakes are of a wide spectrum and occur in large numbers and in a very short time. Even in a well-equipped hospital that is not affected by an earthquake, there are many barriers to appropriate management. The first 24 hours after an earthquake are critical. This period should be kept in mind while organizing and taking necessary precautions, and early responses to earthquakes should be meticulously planned.

Ankle arthroscopy does not elevate complication rates in ankle fractures

IntroductionAnkle fractures rank as the second most common lower limb fractures, and surgical intervention is essential for unstable ankle fractures. The use of ankle arthroscopy in such cases offers several advantages. This study aim is to assess whether arthroscopy influenced on complication rates in 171 ankle fractures treated with arthroscopic assistance. MethodsThis retrospective epidemiological analysis encompassed adult ankle fractures between December 2018 and December 2021. Initially, 173 patients were considered, but two were excluded, leaving a final sample of 171 patients. Postoperative complications were categorized as major or minor. ResultsThe study included 171 patients with surgically treated ankle fractures assisted by arthroscopy, comprising 76 females and 95 males, with an average age of 41.9 years. Syndesmosis injuries were treated in all diagnosed cases (55.0%), and deltoid ligament injuries received attention when identified (33.7%). Arthroscopic techniques were preferred over open techniques (47.4%). Ten patients experienced complications, consisting of 2 major and 8 minor complications (5.8%). DiscussionOur study's epidemiological findings align with prior literature, demonstrating that intra-articular injuries accompany 63% to 79% of ankle fractures. Arthroscopy allows for both diagnosis and treatment within the same procedure, including joint lavage to reduce inflammation. We diagnosed 57 deltoid injuries and identified a statistical relationship between chondral, syndesmotic, and deltoid ligament injuries. Infection is a common complication in ankle fracture surgery, with rates ranging from 1.44% to 16%. Our study yielded a 5.8% complication rate, comprising 1.2% major and 4.6% minor complications. Patients undergoing ORIF with arthroscopic assistance had a lower prevalence of infection. ConclusionThe use of arthroscopic assistance in the surgical treatment of ankle fractures does not increase the overall complication rate. Level of evidenceIV

Our experience with the surgical management of lower cervical spine fractures: fifty case series.

Trauma to the lower cervical spine is a serious lesion due to its neurological consequences which jeopardize the vital and functional prognosis. They constitute a public health problem due to their frequency and seriousness requiring rapid and adequate treatment. The aim of our study is to (1) describe the epidemiological, clinical, and radiological characteristics of lower cervical spine trauma patients; (2) support the therapeutic management of these patients and show our experience in surgery for lower cervical spine trauma; and (3) analyze the anatomical and functional results and discuss them with literature data. This is a retrospective descriptive study of 50 patients with lower cervical spine trauma treated surgically over a period of five years from January 1, 2016, to December 2020. The average age of our patients was 34.5 years, with a sex ratio of 1.7. The etiologies are dominated by accidents on public roads (58%). They show neurological disorders such as spinal cord damage in 30% of cases and root damage in 20% of cases. The radiological assessment revealed eight tear drops, ten comminuted fractures, 12 severe sprains, 12 biarticular dislocations, six uniarticular dislocations, and two herniated discs. Treatment was surgical in all patients with an anterolateral approach and anterior arthrodesis. The evolution was favourable in 21 patients and stationary in 29 patients. Our study concluded that dislocations and fracture dislocations were the predominant type of injury in cases of AVP. Tetraplegia was mainly observed with uni- and biarticular dislocations. The variation in consolidation time was not correlated with trauma-to-surgery time. Better neurological recovery was observed with mild initial neurological damage than with initially severe damage. The appearance of an adjacent syndrome is less frequent with monosegmental arthrodesis than with multisegmental arthrodesis. Cage arthrodesis was an alternative to iliac harvesting with similar results.

Orthopedic Injuries Caused by Electric Scooters: A Systematic Review

Background: Orthopedic-related injuries are a significant proportion of electric scooter (e-scooter) injuries that present to hospitals. There is a lack of global regulatory consensus for e-scooter use. Aims: We aimed to synthesize existing data on orthopedic injuries due to e-scooters and identify modifiable risk factors that will help guide policymaking, reduce hospital burden, and aid clinicians in the management of these injuries. Methods: A systematic review of the literature was conducted to identify studies pertaining to e-scooter injuries. The U.S. National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried for publications from January 1980 to November 2022, utilizing keywords pertinent to electric scooter, orthopedic or musculoskeletal injuries, incidence, and prevalence. Results: In total, 30 studies met inclusion criteria. Among all riders, 5.5% were helmeted. Among those injured, 26.3% were intoxicated at the time of injury, 7.6% required inpatient admission, and 20.5% required surgery. The most common orthopedic injuries were to the distal extremities, with wrist fractures being the most reported upper extremity fractures (average 14.9%) and ankle fractures being the most reported lower extremity fractures (average 8.3%). Conclusions: Orthopedic injuries caused by using e-scooters are commonly encountered in the hospital setting. These injuries may continue to rise with the increased accessibility of e-scooters. Lawmakers should instill strict usage guidelines to help prevent injuries from e-scooter use.

The Effect of Topical Antibiotic Powder Application in the Emergency Department on Deep Fracture-Related Infection in Type III Open Lower Extremity Fractures.

Despite advances in management, open fractures are at an elevated risk for deep fracture-related infection (FRI). Time to systemic antibiotic (ABX) administration and intraoperative topical administration of ABX powder have been used to decrease FRI risk. The purpose of this study was to determine whether topical application of antibiotic powder to type III open lower extremity fractures immediately on presentation to the emergency department (ED) reduces the rate of FRI. Prospective cohort compared with retrospective historical control. Level I trauma center. Application of 1 g of vancomycin and 1.2 g of tobramycin powder directly to open fracture wounds on presentation to the ED. Patients with type III open lower extremity fractures treated from July 1, 2019, to September 17, 2022, who received topical ABX powder in the ED were compared with patients from a 4-year historical cohort from July 1, 2015, to June 30, 2019, who were treated without topical ABX powder. Development of a FRI within 6 months of follow-up. Patient demographics, injury characteristics, and postoperative data were analyzed as risk factors for FRI. Sixty-six patients received topical ABX powder in the ED and were compared with 129 patients who were treated without topical ABX powder. The rate of FRI in the trial group was 6/66 (9.09%) versus 22/129 (17.05%) in the control cohort ( P = 0.133). Multivariate analysis demonstrated higher body mass index as a risk factor for development of FRI ( P = 0.036). No statistically significant difference in rates of FRI in open lower extremity fractures treated with immediate topical ABX administration in the ED versus standard-of-care treatment without topical ABX was found. These findings may have been limited by insufficient power. Further large-scale study is warranted to determine the significance of topical antibiotic powder application in the ED. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Fix or Replace? Patient Preferences for the Treatment of Geriatric Lower Extremity Fractures: A Discrete Choice Experiment.

When considering treatment options for geriatric patients with lower extremity fractures, little is known about which outcomes are prioritized by patients. This study aimed to determine the patient preferences for outcomes after a geriatric lower extremity fracture. We administered a discrete choice experiment survey to 150 patients who were at least 60years of age and treated for a lower extremity fracture at a Level I trauma center. The discrete choice experiment presented study participants with 8 sets of hypothetical outcome comparisons, including joint preservation (yes or no), risk of reoperation at 6 months and 24months, postoperative weightbearing status, disposition, and function as measured by return to baseline walking distance. We estimated the relative importance of these potential outcomes using multinomial logit modeling. The strongest patient preference was for maintained function after treatment (59%, P < .001), followed by reoperation within 6months (12%, P < .001). Although patients generally favored joint preservation, patients were willing to change their preference in favor of joint replacement if it increased function (walking distance) by 13% (SE, 66%). Reducing the short-term reoperation risk (12%, P < .001) was more important to patients than reducing long-term reoperation risk (4%, P = .33). Disposition and weightbearing status were lesser priorities to patients (9%, P < .001 and 7%, P < .001, respectively). After a lower extremity fracture, geriatric patients prioritized maintained walking function. Avoiding short-term reoperation was more important than avoiding long-term reoperation. Joint preservation through fracture fixation was the preferred treatment of geriatric patients unless arthroplasty or arthrodesis provides a meaningful functional benefit. Hospital disposition and postoperative weightbearing status were less important to patients than the other included outcomes. Geriatric patients strongly prioritize function over other outcomes after a lower extremity fracture.

Early diagnosis of occult pulmonary embolism secondary to lower limb fractures: summary of 18 cases.

Pulmonary thromboembolism is a severe but probably underdiagnosed disorder. Patients with lower limb fractures are at high risk for pulmonary thromboembolism. This study aimed to demonstrate the early identification strategies for occult pulmonary thromboembolism. From January to December 2022, 18 patients diagnosed with pulmonary thromboembolism were reviewed for this study. Data on patients' demographics, laboratory test results, and radiographic findings were collected. Finally, the data was analyzed. Eighteen patients with lower limb fractures were included in this study. All of them present different symptoms, including 12 cases (12/18, 66%) of unexplained decrease in oxygen saturation; 16 patients had deep vein thrombosis in the lower limbs, with nine cases involving proximal veins and seven involving distal veins. One patient had an antithrombin III level of 35%. Thirteen cases were diagnosed with pulmonary embolism using CT pulmonary angiography. Four patients had pulmonary embolisms incidentally detected during coronary CT angiography, and one patient during aortic CT angiography. Patients with lower limb fractures showing chest tightness and unexplained decrease in finger pulse oxygen levels should be assessed for pulmonary thromboembolism. Simultaneously, selecting appropriate diagnostic tools is essential to guaranteeing quick and accurate diagnosis.

A 10-Year Experience of an Integrated Geriatric Hip Fracture Treatment Protocol: Outcomes at a Minimum 2-Year Follow-Up.

Increasing incidence of fragility fractures has spurred development of protocols, largely focused on peri-operative care, with numerous proven benefits. The purpose of this investigation was to evaluate outcomes of our hip fracture treatment program regarding successful protocol implementation, compliance, effect on subsequent fracture rates, and mortality during the first decade of adoption. A retrospective review identified patients >65years old with fragility hip fractures between 2010 and 2022. The HiROC (+) cohort consisted of patients who received a "High-Risk Osteoporosis Clinic" (HiROC) referral for bone health evaluation and bisphosphonate initiation as indicated. Additional fracture rates and mortality at 3 years were calculated. Protocol implementation and compliance over the first 10years was analyzed in the four identified cohorts. A total of 1671 fragility hip fractures were identified, with 386 excluded due to insufficient follow-up, with an average age of 81.6 years and a median follow-up of 36.4 months. Of the 1280 included cases, 56% (n = 717) had a HiROC referral placed. HiROC(+) groups had lower subsequent fracture rates at two years, compared to those without referral (28% vs 13%, P < 0.0001) and those completing more steps of the protocol had lower subsequent fracture rates (28% vs 15% vs 13% vs 5%, P < 0.0001). No statistically significant difference was observed between the cohorts for anatomic site of subsequent fractures. Greater than half of all eligible patients were successfully captured by the protocol. Patients completing more steps of the protocol had lower subsequent fracture rates. Captured patients demonstrated reduced mortality rates when compared to current literature. Successful implementation of this geriatric hip fracture protocol was associated with reduced additional fractures and mortality rates. Identifying steps of process failures in the protocol can provide opportunities for increased compliance and reduction in future fracture occurrences.

Evaluation and Quantifying the Difference between Male and Female Agility in Football Players: A Cross-sectional Pilot Study

Introduction: Football is an intermittent sport which requires agility as essential trait for player conditioning, selection and prevention of injury. Agility is a conditional motoric attribute classified as a locomotor skill combining both a muscular and cognitive component. Previous study, revealed that Illinois and T-test were most significant tests to evaluate agility. Aim: To evaluate and quantify the difference in agility between male and female footballers. Materials and Methods: Purposive sampling was used in this crosssectional study. 30 professional football players, aged between 18- 25 years with normal BMI and had atleast 3 years of systematic football training with 3-4 training sessions weekly and 8 hours of football training per week were included. Those players who had visual/hearing impairments, history of lower limb fractures, Anterior Cruciate Ligament (ACL) reconstruction and meniscectomy were excluded from the study. Illinois and T-test was used to access agility of football players. Normality of data was checked using ShapiroWilk test. Descriptive statistics in form of Mean±SD were used to find normative value and Independent T-test was utilised to quantify the difference. Results: Reference value of male and female player’s agility in T-test was 10.35±0.58 and 14.52±0.50 whereas for Illinois test it is 16.34±0.79 and 18.12±1.02 respectively. Independent T-test showed significant difference in male and female agility for both Illinois and T-test (p&lt;0.001). Conclusion: Normative values are established for both genders. It is concluded that female players are clinically and statistically less agile when compared to male players (p-value &lt;0.001).

Clearance of senescent cells enhances skin wound healing in type 2 diabetic mice.

Background: Diabetic foot ulcers (DFUs) pose a substantial healthcare challenge due to their high rates of morbidity, recurrence, disability, and mortality. Current DFU therapeutics continue to grapple with multiple limitations. Senescent cells (SnCs) have been found to have a beneficial effect on acute wound healing, however, their roles in chronic wounds, such as DFU, remain unclear. Methods and results: We collected skin, fat, and muscle samples from clinical patients with DFU and lower limb fractures. RNA-sequencing combined with qPCR analyses on these samples demonstrate a significant accumulation of SnCs at DFU, as indicated by higher senescence markers (e.g., p16 and p21) and a senescence-associated secretory phenotype (SASP). We constructed a type 2 diabetic model of db/db mice, fed with a high-fat diet (Db-HFD), which were wounded using a 6 mm punch to the dorsal skin. HFD slightly affected wound healing in wild-type (WT) mice, but high glucose significantly delayed wound healing in the Db-HFD mice. We injected the mice with a previously developed fluorescent probe (XZ1208), which allows the detection of SnCs in vivo, and observed a strong senescence signal at the wound site of the Db-HFD mice. Contrary to the beneficial effects of SnCs in acute wound healing, our results demonstrated that clearance of SnCs using the senolytic compound ABT263 significantly accelerated wound healing in Db-HFD mice. Conclusion: Collectively, these findings suggest that SnCs critically accumulate at wound sites, delaying the healing process in DFUs. Thus, targeting SnCs with senolytic therapy represents a promising approach for DFU treatment, potentially improving the quality of life for patients with DFUs.

УСПЕШНАЯ ОТКРЫТАЯ РЕПОЗИЦИЯ ОСКОЛЬЧАТОГО ВНУТРИСУСТАВНОГО ПЕРЕЛОМА БОЛЬШЕБЕРЦОВОЙ КОСТИ С ПОСЛЕДУЮЩИМ ОСТЕОСИНТЕЗОМ ТИТАНОВОЙ ПЛАСТИНОЙ И ВИНТАМИ

Pilon fractures are intra-articular fractures of the distal tibial metaepiphysis account for about 1 % of all lower extremity fractures. A typical sign of a pilon fracture is a large number of fragments of bone structures in the injured area as a result of the impact of the talus on the tibia. The study aims to assess antiinflammatory and antibacterial therapy, timely pain relief for an injured patient, prevention of thromboembolic complications, aseptic dressings, and the patient’s movement as soon as feasible before the suture material is removed. The assessment was based on the data from the medical documentation of the trauma hospital, instrumental research, and the results of dynamic observation of surgery on open reduction of a comminuted intra-articular fracture of the tibia of the left leg, osteosynthesis with a titanium plate and screws performed under regional spinal anesthesia. In the early postoperative period, an integrated approach to rehabilitation therapy was used. Intra-articular injuries of the distal metaepiphysis of the tibia are one of the most burning issues in traumatology. This type of injury requires the active implementation of modern diagnostic methods and surgical treatment through the use of metal osteosynthesis techniques in various variations.

Evaluation of Mechanical Performance of Asphalt Emulsion Stabilized Base Course Composed of Reclaimed Asphalt Pavement and Asphaltenes

Abstract Reclaimed asphalt pavement (RAP) is a material that is produced by milling old asphalt pavement that can be mixed with virgin asphalt binder and aggregates to fabricate a recycled asphalt mixture. Using RAP in pavement structure can promote sustainability and reduce construction costs. In this study, asphaltenes, which is a waste material derived from oil sands deasphalting operation, was added as a modifier to recycled mixtures composed of different contents of RAP. A proctor test was conducted to determine the optimum fluid contents. Mix designs were performed for mixtures with 50 %, 75 %, and 100 % RAP with asphalt emulsion and different asphaltenes contents. Mechanical properties of the modified mixtures were evaluated by conducting the indirect tensile strength (ITS) test, creep compliance and strength test, indirect tensile asphalt cracking test (IDEAL-CT), and Hamburg wheel tracking test. The optimum emulsion content was determined to be 1.5 % based on sample performance using the ITS test. The results indicate that asphaltenes improves the strength up to the design-specified limits. The asphaltenes-modified samples show lower creep compliance and fracture energy (FE) values than the unmodified sample, indicating these samples are potentially more prone to cracking. Further, statistical analysis shows the difference in FE is significant at the lowest testing temperatures (−20°C). Asphaltenes-modified mixtures have greater cracking resistance at the intermediate temperature (25°C) and rutting performance at high temperature (40°C) than the unmodified mixture. However, based on FE and rutting resistance index, the improvements are not significant. Overall, the 100 % RAP mix with 1 % asphaltenes had the best tensile strength, cracking resistance, rutting resistance, and low temperature properties compared to other modified mixes.

Analysis Of Efficacy Of Cork Screw Tipped Telescopic Nailing In Lower Limb Fractures In Cases Of Osteogenesis Imperfecta In Children–Case Series

Analysis Of Efficacy Of Cork Screw Tipped Telescopic Nailing In Lower Limb Fractures In Cases Of Osteogenesis Imperfecta In Children–Case Series

VIABILITY OF CARDBOARD SPLINTS IN THE EMERGENCY MANAGEMENT OF LOWER LIMB FRACTURES

At Mbarara Regional Referral Hospital Uganda, 60% of all admissions are due to severe trauma, 30-35% of which are from tibia/fibular fractures. Emergency splinting of these fractures can be lifesaving and ideally, Plaster of Paris (P.O.P) is the gold standard. Improvised cardboard splints have replaced P.O.P, since they were more readily available and thought to be less expensive to apply especially during the covid 19 pandemic supply chain crisis. While anecdotal evidence exists dating since the First World War, scarce published works exist in measuring the clinical effectiveness of cardboard splints in comparison to P.O.P. The aim of this study was to find out if cardboard can be an effective and cheaper emergency alternative splint to P.O.P especially during the supply chain crises frequent in low resource environments. A prospective, experimental, cadaveric study was done where 44 open tibia-fibular fractures were splinted with both cardboard and P.O.P. The clinical effectiveness of cardboard and P.O.P splints was found through the measurement of immobilization at a fracture site via the use of 5 angular and 9 linear measurements. Cost comparisons of the splint were also done. Cardboard proved to be the non-inferior splint in 9 of the 14 measures of effectiveness. In the other 4 measures, no statistically significant differences were seen, while P.O.P was superior in 1 measurement. Cardboard proved to be the least expensive splint. During extreme shortages, cardboard could be considered as an emergency material for adequate splinting of lower limb fractures.

Development and validation of a nomogram for predicting the risk of postoperative fracture blister after pilon fracture.

Fracture blister (FB) is one of the most common complications in pilon fractures. This study aimed to construct and validate a nomogram for predicting postoperative FB risk in patients with pilon fractures. We retrospectively collected information on 1,119 patients with lower extremity fractures in the 3rd Hospital of Hebei Medical University between January 2023 and January 2024. Patients with FBs were considered as the FB group and those without FB as the non-FB group. Variables with a significance level of P < 0.05 in the univariate analysis were included in the multivariate logistic regression analysis. The backward stepwise regression method was applied to identify independent risk factors associated with FB. The selected predictors were then entered into R software for further analysis and Nomogram construction. In our research, the rate of FB (119 of 1,119) was 10.63%. Several predictors of FB were found using univariate analysis, including body mass index (BMI) (p < 0.001), the presence of DVT (p < 0.001), closed fractures (p < 0.001), time from injury to admission (p < 0.001), smoking history (p < 0.01), not utilizing dehydrating agents (p < 0.010), fixation mode of fracture (p < 0.001), the mode of surgical suture (p < 0.001), postoperative infection (p < 0.001) and Elixhauser comorbidity index (ECI) (p < 0.01). In addition, FB group exhibited significantly higher levels of blood serum indicators, such as EOS (p = 0.029), HCT (p < 0.01), LYM (p = 0.01), MPV (p = 0.014), NEU (p < 0.01), CKMB (p < 0.01), PLT (p < 0.01), ALB (p < 0.01), ALP (p < 0.01), AST (p < 0.01), CK (p = 0.019), CREA(p < 0.01), DBIL (p < 0.01), GLU (p < 0.01), Na (p < 0.01), P (p < 0.01), TC (p = 0.024), ALT (p < 0.01), TCO2 (p < 0.01), TG (p < 0.01), TP (p < 0.01), UA (p = 0.018), UREA (p = 0.033) compared to the non-FB group. According to the stepwise logistic regression analysis, higher BMI (p = 0.011, OR 0.873, 95% CI 0.785-0.970), NEU (p = 0.036, OR 0.982, 95% CI 0.865-0.995) and CKMB (p < 0.014, OR 0.994, 95% CI 0.989-0.999) were associated with increased FB risk, while plate fixation (p = 0.017, OR 0.371, 95% CI 0.123-0.817), the mode of surgical suture (p < 0.01, OR 0.348, 95% CI 0.161-0.749), and postoperative infection (p = 0.020, OR 0.406, 95% CI 0.190-0.866) were also correlated with increased FB risk. The nomogram was established based on 6 predictors independently related to FB. Our investigation has shown that BMI, NEU, CKMB, plate fixation, the mode of surgical suture, and postoperative infection are independent risk factors for FB in patients with pilon fractures. The predictors identified by the nomogram could potentially be used to assess the possibility of blister formation, which could be a sign of fascial compartmental pressure release.

康复护理对下肢骨折患者的临床效果及膝关节功能改善情况分析

康复护理对下肢骨折患者的临床效果及膝关节功能改善情况分析

Trends and Factors Associated With Extremity Fractures and Post-Acute Care Utilization of Nevada Older Adults: Insights of Age-Friendly State Planning in U.S.

Along with the trend of a steady utilization decline in the U.S. nursing home beds, post-acute care (PAC) utilization at the skilled nursing facilities has declined. This study was a cross-sectional, retrospective review of hospital discharge-based claim data. We evaluate the factors associated with utilizing post-acute care at rehabilitation facilities among those with extremity fractures in the state of Nevada. All Nevada hospital discharges of aged ≥65 years with extremity fractures between 2018 and 2021 were divided to post-acute care locations by (1) rehabilitation facilities (skilled nursing facility and inpatient rehabilitation facility) and (2) homes (with and without services). PAC utilization at facilities declined from 55.1% in 2018 to 49.7% in 2021 (P < .001). In response, PAC utilization at homes continuously upwards, particularly, homes with services from 18.8% in 2018 to 24.5% in 2021 (P < .001). Older age, female, lower extremity fractures, comorbidities, and Medicare beneficiaries were associated with higher probabilities of utilizing post-acute rehabilitation facilities. Racial minorities, COVID-19 pandemic, upper extremities, Medicaid beneficiaries, rural hospitals, and prolonged hospital length of stay were associated with lower probabilities of PAC utilization at facilities. Caregiver burdens and workforce training is urgently warranted to respond to this utilization shift. Effective geriatrics workforce training might advance care efficiency of older adults with extremity fractures and guide to the insights of establishing the age-friendly state of Nevada in response to this utilization shift trends.