Singh Index Research Articles

Automated Screening of Hip X-rays for Osteoporosis by Singh's Index Using Machine Learning Algorithms.

Osteoporosis is a significant and growing global public health problem, projected to increase in the next decade. The Singh Index (SI) is a simple, semi-quantitative evaluation tool for diagnosing osteoporosis with plain hip radiographs based on the visibility of the trabecular pattern in the proximal femur. This work aims to develop an automated tool to diagnose osteoporosis using SI of hip radiograph images with the help of machine learning algorithms. We used 830 hip X-ray images collected from Indian men and women aged between 20 and 70 which were annotated and labeled for appropriate SI. We employed three state-of-the-art machine learning algorithms-Vision Transformer (ViT), MobileNet-V3, and a Stacked Convolutional Neural Network (CNN)-for image pre-processing, feature extraction, and automation. Each algorithm was evaluated and compared for accuracy, precision, recall, and generalization capabilities to diagnose osteoporosis. The ViT model achieved an overall accuracy of 62.6% with macro-averages of 0.672, 0.597, and 0.622 for precision, recall, and F1 score, respectively. MobileNet-V3 presented a more encouraging accuracy of 69.6% with macro-averages for precision, recall, and F1 score of 0.845, 0.636, and 0.652, respectively. The stacked CNN model demonstrated the strongest performance, achieving an accuracy of 93.6% with well-balanced precision, recall, and F1-score metrics. The superior accuracy, precision-recall balance, and high F1-scores of the stacked CNN model make it the most reliable tool for screening radiographs and diagnosing osteoporosis using the SI.

Can a cementless partial hip prosthesis be preferred in patients with hip fractures when the Spotorno criterion is greater than 5?

Aims: Partial hip arthroplasty is preferred in elderly patients with low activity levels, numerous comorbidities, and limited mobility for hip fractures. To decide whether to use cement in femoral stem implantation, scoring systems such as Spotorno, Dorr, and Canale Flare Indices are used. Generally, cemented application is frequently for patients with over 5 points according to Spotorno criteria. In this study, our aim is to present the outcomes of patients who had a score of 5 or more according to the Spotorno criteria and required cemented prostheses but instead received cementless partial hip prostheses. Methods: Patients who underwent partial hip arthroplasty due to post-traumatic femoral neck fractures in our hospital’s orthopedics and traumatology clinic between 2017 and 2021 were retrospectively evaluated. To calculate the total score according to the Spotorno criteria, which evaluate age, sex, singh index and morphological cortical index, the radiographs of the patients included in the study were assessed, and the Singh index and morphological cortical index (MCI) were calculated.Periprosthetic fractures, prosthesis dislocations, heterotopic ossification, femoral loosening and mortality had been recorded. A total of 192 patients over the age of 70 with ASA III and ASA IV who underwent cementless partial hip arthroplasty were included in the study. Among these patients, 126 were female (% 5.7) and 66 were male (%34.3). Mean follow up was 5.8 years (0-7 years). Results: According to the Spotorno criteria, the total score for all patients was greater than 6. Periprosthetic fractures were detected in % 3.1. Heterotopic ossification was observed in %9.3. In the postoperative 1st month, mortality was observed in %5. Conclusion: Cementless hip arthroplasty in elderly patients with a Spotorno score of 5 or higher can be as effective and applicable as cemented hip arthroplasty. Although the literature generally recommends cemented hip prostheses for such patients, cementless partial hip arthroplasty can be a viable option if standard latest-generation cementing systems are not available.

Analysis of the clinical characteristics and risk factors associated with contralateral hip fracture after initial hip fracture in elderly patients: a retrospective cohort study

Fractures of the contralateral hip may easily occur in elderly patients after an initial hip fracture. The aim of this study was to investigate the clinical characteristics and major predisposing risk factors of contralateral hip fracture after initial hip fracture in the elderly, to provide a clinical basis for preventing contralateral hip fracture. The data of 1586 patients who had sustained first or second hip fractures and had been surgically treated in our department were retrospectively analyzed. Potential predictive factors for contralateral hip fracture and descriptive statistics associated with surgery (such as blood loss, operation time, and length of hospital stay) were recorded. Of these patients, 133 (8.4%) suffered contralateral hip fracture. The rates of contralateral fracture after femoral neck and intertrochanteric fracture were 5.4% and 10.7% respectively (P < 0.01). Fifty-four cases of contralateral hip fracture occurred within one year, an incidence of 40.6%, while 95 cases (71.4%) and 105 cases (78.9%) occurred within two and three years, respectively, with a interval duration of 21.6 months. The risk factors for contralateral hip fracture were found to be age, type of first fracture, bone mineral density, the Singh index, and concomitant internal medical diseases, which were found to be significantly associated with an increased risk of contralateral hip fracture in multivariate logistic regression analysis (P < 0.05). In conclusion, the presence of concomitant internal diseases, type of first fracture, bone mineral density, the Singh index, and age were found to be significant predictors of the risk of contralateral hip fracture in elderly patients after a first hip fracture.

Comparison of Singh’s index in view of osteoporosis in patient with in tertrochanteric fracture and intracapsular fracture

Background: Osteoporosis is a progressive, systemic, skeletal disease with low bone mass. Diagnosing osteoporosis in practice is a major challenge, where resources are limited and costly. Measurement of osteoporosis through Singh’s index in proximal femur fracture patients is consistent with Bone Mineral Density estimation like DEXA scan. Singh’s index is a reliable, reproducible and easily available investigation for osteoporosis. The aim of this study is to evaluate the Singh’s index of the patients with inter-trochanteric and intra-capsular fracture. Methods: A retrospective observational study of 20 IT and IC fracture each. Singh’s index evaluated from the X-rays at time of fracture presentation. Other required information collected at presentation. Results: Out of 40 Patients, 6 had Singh's Index Grade 1 (15%), 11 had Grade 2 (27.5%), 10 had Grade 3 (25%), 7 had Grade 4 (17.5%), 6 had Grade 5 (15%), 0 Patients had Singh’s index Grade 6. There was no noticeable significant variation in relation of gender with the type of fracture. Patients with higher age tend to have a lower grade of Singh’s index. Conclusions: Singh’s Index indeed represents bone quality and a fall in the grades predisposes to fractures. Inter trochanteric fractures are common in the older age group with poor Singh’s index (&lt;3) compared to the relatively younger age group with Singh’s index around 3. Gender, exercise, history of hypertension and diabetes, sunlight exposure, etc. has no significant impact on Singh's Index. Age is deciding factor for Singh’s Index.

CHARACTERISTICS OF INTERTROCHANTERIC FEMUR FRACTURE AT BALI MANDARA GENERAL HOSPITAL

Abstract: Characteristics of Intertrochanteric Femur Fracture at Bali Mandara General Hospital. An intertrochanteric femur fracture is an extracapsular fracture that occurs along the line that is located between the greater and lesser trochanters. This study aims to determine the characteristics of intertrochanteric femur fracture cases. This retrospective descriptive study evaluated the characteristics of intertrochanteric femur fracture patients at Bali. Mandara General Hospital Denpasar from January to August 2022. There were 36 intertrochanteric femur fracture patients (8.78%). Intertrochanteric femur fracture patients are mostly found in female patients (25 patients [69.4%]) and the elderly. Based on the mechanism of trauma, 33 patients had a fracture due to low-energy trauma. According to Boyd and Griffin’s classification, type 2 intertrochanteric femur fracture was more common (14 patients [38.9%]). All patients had PFNA (100%) and most of them had a grade B Singh index (16 patients [44.4%]). The incidence of intertrochanteric femur fracture was 8.78%. The intertrochanteric femur fracture was more common in the female patient, aged more than 60 years old, occurs due to low energy trauma, has a type 2 Boyd and Griffin classification, has a grade B Singh index, and was treated using PFNA.

Diagnostic Value of Radiographic Singh Index Compared to Dual-Energy X-Ray Absorptiometry Scan in Diagnosing Osteoporosis: A Systematic Review.

Since various medications can control the rate of fractures and subsequent complications of osteoporosis, the early detection of the disease is crucial. This systematic study aimed to compare the diagnostic accuracy of Singh index (SI) with dual-energy X-ray absorptiometry (DEXA) as a benchmark standard for diagnosing osteoporosis. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were utilized in the current study. A detailed search was carried out using PubMed and Scopus from inception to 30 May 2022. Examining quality of the studies was performed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). A total of 22 studies were included. In general, 50% of the studies considered SI a poor screening tool for detecting osteoporosis due to a negligible inter-observer agreement between SI and DEXA or a poor correlation of SI with the bone mineral density (BMD) category or DEXA T-score. A moderate inter-observer agreement was reported for SI in 5 (55.6%) studies. Among the studies assessing the sensitivity and specificity of SI compared to DEXA (n=13), six studies estimated a low sensitivity for SI. While there is supporting evidence indicating the potential usefulness of SI for predicting femoral neck fractures in individuals with suspected osteoporosis, numerous studies challenge its reliability and diagnostic value as a screening tool for identifying femoral neck osteoporosis. Further primary studies are required to verify the effectiveness of the SI index in identifying populations at risk of osteoporosis.

Comparison of functional and radiological outcome of unstable intertrochanteric femur fractures treated using PFN and PFNA in patients with osteoporosis.

Unstable intertrochanteric fracture poses challenges in terms of obtaining stable fixation and good post-operative outcomes. There is a paucity of clinical data comparing the commonly used proximal femoral nail (PFN) and PFN anti-rotation (PFNA) implants, especially in relation to osteoporosis. The purpose of this study is to assess the comparative performance of PFN and PFNA fixation in the treatment of unstable femur intertrochanteric fractures. This prospective observational study was conducted to understand and analyze the advantages of PFNA over PFN in the management of unstable intertrochanteric fractures from May 2021 to October 2023 at the Department of Orthopaedics, Chettinad Hospital and Research Institute, Kelambakkam. Patients presenting with an unstable intertrochanteric fracture with Singh's Index grades 1, 2, and 3 were included. Boyd and Griffin classification types 2, 3, and 4 were included in the study. The patients were randomized into two types of implant groups. All patients were operated with a standard protocol. Patients were followed up for a minimum of 6 months and any complications were noted. A comparison of functional outcomes was done using the Modified Harris Hip Score. Statistical analysis was done using the unpaired t-test/Mann-Whitney U test and Chi-square test/Fisher's exact test. A P < 0.05 was considered significant. Every follow-up period included a Harris Hip Score assessment. At 3 months, the average score of PFN was 71.9 (range 66-81) and at 6 months it was 77.86 (range 72-90). For PFNA, at 3 months, the average score was 74.87 (range 66-81), and at 6 months, it was 89.3 (range 76-94). The improvement was seen well in the PFNA group which is statistically significant (P = 0.023). The most prevalent fracture was a type 2 fracture. The results showed PFNA has better rotation stability with single screws and better functional outcomes in treating unstable intertrochanteric fractures when compared to PFN.

Evaluation of the Relationship between Osteoporosis Parameters in Plain Hip Radiography and DXA Results in 156 Patients at a Single Center in Turkey.

The aim of the current study is to determine the relationship between osteoporosis findings in plain X-ray and dual-energy X-ray absorptiometry (DXA) measurement results and to create an alternative diagnostic method for osteoporosis without DXA measurement when necessary. DXA values and hip radiographs of 156 patients were retrospectively analyzed. Singh index (SI), Dorr index (DI), cortical thickness index (CTI), and canal-to-calcar ratio (CCR) measurements from both plain hip radiographs were determined by two observers. The correlation of the DXA parameters (hip total T-score, femoral neck T-score, hip total Z-score, hip total bone mineral density [BMD], and femoral neck BMD) and osteoporosis markers on plain hip radiography (SI, DI, CTI, and CCR) was calculated. In addition, patients were evaluated by dividing them into three groups according to the level of their T-scores (normal, osteopenia, and osteoporosis). In addition, cut-off values were calculated for CTI and CCR. The mean age was 68.27 ± 8.27 (50-85) years. There was a strong correlation between hip total T-score values and SI, DI, and CTI (r = 0.683, -0.667, and 0.632, respectively), and a moderate correlation (r = -0.495) with CCR. When both hips were compared, there were strong correlations between radiographic parameters (r = 0.942 for SI, 0.858 for DI, 0.957 for CTI, and 0.938 for CCR, all with p < 0.001). When patients divided into three groups according to the T-score level were compared in terms of SI, DI, CTI, and CCR, it was found to be directly related to osteoporosis level (all p < 0.001). In the differentiation of osteopenia and osteoporosis, the cut-off values were 50.4 degrees for CTI and 60.3 degrees for CCR. Good correlations between hip total T-score values and SI, DI, CTI, and CCR (r = 0.683, -0.667, 0.632, and -0.495, respectively) indicate that the presence of osteoporosis can be detected by hip radiography findings without DXA.

Study of Contralateral Hip in Patients with Hip Fracture

Background: This study was done to know whether patients with hip injury have pre-existing osteoporosis due to which, the patient sustained the fracture, subsequent fracture of the contralateral hip, any osteoarthritic changes of the contralateral hip at the time of index fracture, and ten-year probability of a major osteoporotic fracture by calculating fracture risk assessment percentage (FRAX%).&#x0D; Methods: 34 patients were evaluated for age, gender, body mass index (BMI), fracture type, Singh index, bone mineral density (BMD), T-scores using dual-energy X-ray absorptiometry (DEXA) scan, and ten-year probability of fracture using FRAX%.&#x0D; Results: Average age of the patients with hip fractures was 72.1 years. About 85% of patients were women. 67.6% of the patients were with BMI of 18.5-25 kg/m2 . The Singh index for osteoporosis fell in grades 2 and 3 in most patients. The mean interval between index fracture and contralateral hip injury was 4.25 years. Osteoarthritis of the contralateral hip was seen in 9%. The probability in ten years of hip fracture in 30 indexed patients using the FRAX% tool was 15%, and for 4 patients who were having bilateral hip fractures was 22.75%. There was a significant relationship between FRAX% with the Singh index and osteoarthritis of the contralateral hip. FRAX% was high in female patients.&#x0D; Conclusion: Contralateral hip fracture in patients with osteoporosis was high in women and patients with low and high BMI. Fractures were also high in patients with low Singh index and T-scores. FRAX% increased with an increase in age and increased with a decrease in T-score.

Effect of Femoroacetabular Impingement on Hip Fractures

AIM: The aim of this study is to find out if there is a relationship between femoroacetabular syndrome and the risk of hip fractures that have been known with high morbidity and mortality rates.&#x0D; MATERIAL AND METHOD: Between January 1st of 2015 and January 1st of 2020, data of 243 patients with intertrochanteric fracture, 126 patients with femoral neck fracture and 250 trauma patients of over 65 years old that had admitted to our hospital’s emergency department but had no fracture on both pelvis AP x-ray and pelvis CT, were evaluated retrospectively. While central edge angle, acetabular index and singh index were measured on AP x-ray of pelvis, alfa-angle, anterior offset and anterior offset ratio were measured on pelvis CT.&#x0D; RESULTS: No significant differences were found between the groups forming the hip fracture and the control group in terms of gender, age and Singh index, indicating that these factors were homogeneously distributed between the groups and had no effect on the factors investigated (p&gt;0.05). The central edge angle, acetabular index, alpha angle, anterior offset and anterior offset ratio were found to be significantly different (p

EFFECT OF POSTEROINFERIOR LAG SCREW POSITION FOR CEPHALOMEDULLARY NAIL ON IMPLANT FAILURE AND FUNCTIONAL OUTCOME COMPARED TO THE CENTER-CENTER POSITION IN INTERTROCHANTERIC FRACTURE

Background &#x0D; Intertrochanteric fracture (ITF) is one of the most common injuries in older people and is more prevalent in females. Thus, we aimed to compare two proximal femoral nail screw positions (centre-centre and posteroinferior) in stable ITF types.&#x0D; Objectives &#x0D; To determine better techniques for screw placement, especially in the emergency department.&#x0D; Patients and Methods&#x0D; Prospectively and retrospectively, 76 (33 males and 43 females) patients aged &gt; 55 years were registered; 44 of them were treated with proximal femoral nails with screw positions centre-centre inside the femoral neck (group A), and 32 patients treated with proximal femoral nail with screw positions posteroinferior inside the femoral neck (group B). They were followed up after 3, 6, and 12 months postoperatively to compare screw position effect on implant failure and functional outcome using MHHS. The reduction quality was assessed using neck-shaft angle (NSA), while the quality of Fixation was assessed using tip-apex distance (TAD) and calcar tip-apex distance (CalTAD). Singh index (SI) was used for osteoporosis assessment.&#x0D; Results&#x0D; The mean age of patients was 72.93±8.4 (group A) and 70.13±6.86 (group B). There was no significant correlation in incidences of implant failure among TAD (&lt;25 mm) and CalTAD (&gt;25 mm) in group A. For group B in Cleveland index (CI) areas 8 and 9, TAD and CalTAD were ≥ 25 mm, and there were no correlations with end-result and implant failure. In group A, 2 cases of implant-related complications were recorded; in group B, one patient was recorded. The functional score was higher in group B. Fixation quality between the two groups remained comparable. &#x0D; Conclusion&#x0D; The functional outcome of group B was better with optimal surgical conditions. Both groups had comparable radiological and Fixation failure outcomes.

Multidimensional cultural distance and self-employment of internal migrants in China

This research examines the roles of multidimensional cultural distance including both value and practice on supporting urbanization, focusing on self-employment of internal migrants in China. Prior to examining the effect of cultural distance, we confirm that self-employment is the dominant choice for urban migrants. Building on Hofstede's theory, we calculating the Kogut and Singh Index of cultural values and cultural practices based on survey data set of World Values. After combining these two indices with China Migrants Dynamic Survey data to construct a comprehensive cross-sectional dataset of 521,166 observational samples from 2010 to 2016, we show that both cultural value distance and cultural practice distance have a negative effect on self-employment of internal migrants in China. According to the theory of labor market segmentation, our results reveal that cultural distance is strongly negative associated with the likelihood for internal migrants to engage in self-employment both for opportunity purpose and necessary purpose. From heterogeneity analysis, negative effects of cultural distances exist in the service industry, manufacturing industry, and the Yangtze River Delta. Further discussion shows that cultural value distance also has an indirect influence on individual behavior through cultural practice. Our results suggest that cultural distance prevents migrants from integrating into the local labor market in the form of self-employment.

Characteristics of subsequent contralateral proximal femoral fracture: more convenient access is needed to treat osteoporosis

BackgroundPatients with proximal femoral fracture (PFF) have high mortality and many complications. Osteoporosis increases the risk of subsequent fractures, leading to subsequent contralateral PFF. This study was performed to analyze the features of individuals with subsequent PFF following surgical therapy of first PFF and to ascertain whether such patients received an examination or treatment of osteoporosis. The reasons for lack of examination or treatment were also analyzed.MethodsThis retrospective study involved 181 patients with subsequent contralateral PFF who underwent surgical treatment in Xi'an Honghui hospital from September 2012 to October 2021. The patients’ sex, age, hospital day, mechanism of injury, surgical procedure, fracture interval, fracture type, fracture classification, and Singh index of the contralateral hip at the time of the initial and subsequent fractures were recorded. Whether the patients took calcium and vitamin D supplements, used anti-osteoporosis medication, or underwent a dual X-ray absorptiometry (DXA) scan was recorded, as was the start time of each. Patients who had never undergone a DXA scan or received anti-osteoporosis medication took part in a questionnaire.ResultsThe 181 patients in this study comprised 60 (33.1%) men and 121 (66.9%) women. Patients with initial PFF and subsequent contralateral PFF had a median age of 80 years (range 49–96 years) and 82 years (range 52–96 years), respectively. The median fracture interval was 24 (7–36) months. Contralateral fractures occurred at the highest incidence between 3 months and 1 year (28.7%). The Singh index was not significantly different between the two fractures. In 130 (71.8%) patients, the fracture type was the same. No significant difference was found in the fracture type or fracture stability classification. A total of 144 (79.6%) patients had never received a DXA scan or anti-osteoporosis medication. The main reason for not treating osteoporosis further was concern about the safety of drug interactions (67.4%).ConclusionsPatients with subsequent contralateral PFF were of advanced age, had a higher proportion of intertrochanteric femoral fractures, had more severe osteoporosis, and had longer hospital stays. The difficulty managing such patients requires multidisciplinary involvement. Most of these patients were not screened or formally treated for osteoporosis. Advanced-age patients with osteoporosis need reasonable treatment and management.

Predictors of Failure Following Fixation of Trochanteric Fractures

BACKGROUND: Trochanteric fractures are frequent and mainly affect the elderly causing autonomy loss. Their incidence is increasing, and they are associated with substantial morbidity and high cost. AIM: The aim of our study was to identify epidemiological, radiological, and technical predictors of failure of trochanteric fracture fixation in the elderly. METHODS: We conducted a retrospective study including 188 patients aged over 65 years, who underwent surgery for trochanteric fractures, in the period between 2015 and 2020 at the orthopedics department of the Military Hospital of Tunis. The minimum follow-up was 12 months. RESULTS: Thirty-four patients had a mechanical failure (18.1% of cases), including 12 cases of cephalic screw migration (CSM) (6.4%), 12 cases of disassembly (6.4%), eight cases of malunion (4.3%), and four cases of non-union (2.1%). Bone fragility with a Singh index ≤III was associated with CSM, disassembly of fixation material, and malunion (respectively, p &lt; 0.001; p = 0.01 and p = 0.044). Reduction quality was associated with disassembly (p &lt; 0.001) and CSM (p = 0.004). Eccentric screw positioning on anteroposterior (p &lt; 0.001) and lateral views (p = 0.018), high tip-apex distance (TAD) (p &lt; 0.001), and calcar-referenced TAD (p &lt; 0.001) were predictive of CSM. Logistic regression analysis showed that poor reduction quality was an independent factor associated with the occurrence of mechanical complications. Functional outcomes were assessed using Parker and Postel Merle d’Aubigné scores. CONCLUSION: To minimize the risk of mechanical complications, the surgeon must pay close attention to the fracture reduction and to the correct positioning of the cervical screw.

Zoledronic Acid Does Not Retard Bone Union: A Randomized Controlled Trial in Fragility Intertrochanteric Femur Fractures.

Fragility hip fracture is a leading cause of death in the elderly and is common in postmenopausal women and elderly people. In the treatment of osteoporosis, bisphosphonates (BPs) are often considered first-line medications.Zoledronic acid is the most potent and long-acting BP in clinical use and is administered as an intravenous infusion. In the context of acute fractures, the use of BPs has been controversial due to conflicting reports of their positive and negative effects on fracture healing. The purpose of this study was to determine the effect of zoledronic acid on fracture healing in intertrochanteric (IT) fragility fractures. The study was conducted in a tertiary healthcare center after receiving scientific and ethical approval. The study included 136 patients of either gender over the age of 50 who presented with an IT femur fracture after minor trauma between November 2020 and November 2022. The total number of patients had been classified into two groups, and grouping involved random sampling: Group T (test group, n = 68; zoledronic acid injections were given on postoperative day 3) and Group C (control group, n = 68; interventions were given after fracture healing). Patients were evaluated using the Radiographic Union Score for Hip (RUSH) and SinghIndex for radiological outcomes and the Harris Hip Score (HHS) for functional outcomes. The patients were followed for six months. The overall mean age was 73.25 years; in Group T, it was 72.5± 11.9 years, and in Group C, it was 73.7± 11.8 years. Of 136 patients, 69 (51%) were males and 67 (49%) were females. The average fracture healing time in Group T was 12.2 ± 3.6 weeks, while it was 13.0 ± 2.8 weeks in Group C. Functional outcomes, including HHS, were found to be better in Group T than in Group C (p < 0.005). No significant difference was observed between the two groups with respect to the radiological union, the RUSHscore, or Singh Index, implying no negative effect of zoledronic acid. This study demonstrates that postoperative intravenous zoledronic acid therapy does not retard fracture healing. Osteoporosis management is frequently neglected because of a surgeon's fear of ZOL retarding fracture healing and a lack of awareness among patients, resulting in low compliance.Thus, opportunistic administration of zoledronic acid postoperatively can be beneficial and will increase compliance for osteoporosis management and fracture prevention to 100%.

Is the proximal femoral nail a favourable option for trochanteric femur fractures in osteopenic elderly patients?

Primary aim of this study to evaluate the functional results and complications of the patients aged 70 and over whom are treated with proximal femoral nail (PFN) because of hip fracture. 128 patients out of 223 patients were included in the study, who were aged 70 and over, to whom treated with proximal femoral nail because of hip fracture in our clinic between 2006 and 2014. Since 26 of these 128 patients who were included in this study passed away before the follow up period of 1 year, they were excluded from the study. Fractures were evaluated by AO/OTA classification. Their Singh index and morphological cortical indexes were calculated from the pre-surgery radiographies. The functional situations of the patients were evaluated by Harris hip score. Average age of the evaluated 102 patients was 81.13 (70-98), 44 of them were male, 58 of them were female. According to AO/OTA fracture classification 48 of them were 31-A1, 25 of them were 31-A2, 29 of them were 31-A3. 54 fractures were on the left hip, 48 fractures were on the right hip. Average Singh index was 2.72 (1-5), average morphological cortical index was 2.94 (2.1-3.7), average Harris hip score was 74.3 (49-88). 4 patients have had complications after surgery and revised with other treatment modalities. Since the functional results are on a satisfactory level, in our opinion as well, proximal femoral nail should be considered among the surgical treatments in the elderly patients with hip fracture.

Abstract C091: Deprivation/segregation indices and survival in the AACES ovarian cancer cohort: A mediation analysis

Abstract Deprivation indices (DIs), constructed from area-level socio-economic indicators, attempt to allow for the acknowledged relationship between socio-economic status and health outcomes. Segregation indices (SIs) address the area-level divisions in ethnicity and socio-economic status. In this study we evaluated the effects of deprivation and segregation on ovarian cancer survival among African-American women in a Bayesian hierarchical joint mediation framework. Deprivation and segregation effects considered were the most commonly used: 4 dimensions of Kolak social determinants of health, Yost index, Singh index, the percentage of people below the poverty line, ICE income and race segregation measures, and the concentrated disadvantage index. We analyzed a cohort (n=559) of African-American ovarian cancer patients from the states of Alabama, Georgia, Illinois, Louisiana, New Jersey, North Carolina, Ohio, South Carolina, Tennessee, and Texas and the metropolitan area of Detroit, as part of the African American Cancer Epidemiology Study (AACES). We evaluated the effects of mediation via stage at diagnosis, histology and delayed diagnosis and examined confounding variables: age, current BMI, income, smoking status, and physical activity level, using Bayesian Gibbs variable selection to select the confounders for the final models. Our main result, with the stage as the mediator, showed that increased urbanization, mobility, socio economic status of Kolak dimensions and decreased deprivation measured by Yost index have positive effects on overall survival. 1 unit decrease of deprivation measured by Yost index will lead to 26% decrease of the hazard for ovarian cancer (CI: 0.56,0.91). Similarly, increased urbanization gives positive effect for the overall survival. 1 unit increase of urbanization lead to 27% decrease of hazard (CI: 0.57,0.95). Similar results are found for histology and diagnosis delay: when histology is the mediator, increase of urbanization and socio-economic status, and decreased deprivation measured by Singh, Yost and concentrated disadvantage indices have positive association with overall survival. When delayed diagnosis was our mediator, increased urbanization, socio-economic status and mobility, and decreased deprivation measured by Yost, ICE income and concentrated disadvantage indices have the positive association with overall survival. The results of mediation analyses revealed that Kolak dimensions and decreased deprivation was associated with increased survival from ovarian cancer . In summary, these results indicate that several measures of area-level deprivation, when mediated by intermediate pathway variables, are associated with survival among African-American women diagnosed with ovarian cancer. Their particular direction and level of impact varies with DI or SI chosen. Citation Format: Joanne Kim, Andrew B. Lawson, Joellen Schildkraut, Edward S. Peters, Courtney E. Johnson. Deprivation/segregation indices and survival in the AACES ovarian cancer cohort: A mediation analysis [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C091.

Age-related Comparison of Hip Joint Morphology in Isolated Femur Neck Fractures

Objective: Femoral neck fractures mostly occurs due to high-energy trauma in young population and management differs compared to elderly. Different geometric parameters in the hip joint can play a role in fracture morphology regarding to the age. Present study aims to compare hip morphology between young and elderly population Materials and methods: 45 patients with isolated femoral neck fracture included to the study. Patients were divided into two regarding to the age; group 1 (younger than 60 yr.) and group 2 (older than 60 yr.). Garden and Pauwels classifications, Sharp angle (acetabular index-AI), acetabular depth (AD), Hip-axis length (HLA), Neck-shaft angle (NSA), Center-edge angle (CE), Singh indexes and femur head extrusion indexes were compared between groups. Results: The mean age of group 1 (22 patients) was 48 ± 10.4 while the mean age of group 2 (23 patients) was 77 ± 6.3. Significant differences found in 3 parameters; the mean HLA (13.4 ± 1.4 cm vs 12 ± 1.1 cm) (p: 0,034), the Sharp angle (37.9° ± 5° vs 40.3° ± 3°) (p: 0.047) and the CE (38.1° ± 6.2° vs 34.8° ± 4.5°) (p: 0.48) between group 1 and 2 respectively. No statistically significant difference was found in terms of AD, NSA, Singh index and extrusion index. Conclusions: Our study shows influence of proximal femoral and acetabular morphology on femoral neck fracture in young patients and may help future studies to reveal the relevance between hip morphology and fractures type.

Screening of postmenopausal osteoporosis using Singh’s index

Background and Objectives: Early evaluation of risk factors and menopause symptoms and consequences. Long-term osteoporosis complications prevention. The Singh index is a cheap, straightforward approach that used measure osteoporosis depending on the radiological aspect of the proximal femur's trabecular bone over an AP radiograph. Osteoporosis graded by singh index.Methods: 52 postmenopausal women who were randomly chosen from the Gynecology OPD at the Kamineni Institute of Medical Sciences in Narketpally participated in the current study. Women who were postmenopausal and went to the gynaecology OPD were included. Women having a confirmed case of endometrial cancer, endometriosis, genital cancer, breast cancer, or a history of fractures were not included.Results: Average women's age was 64. Mean menopausal age is 49.71 years. 69% (n=52) of postmenopausal women in the study group had osteoporosis using Singh's index. Of 36 osteoporotic patients, 41.6% are in Singh's grade 2 and 58.33% are in grade 3. None of the osteoporotic patients are in singh’s grade 1.Utilizing singh's index, menopausal years correlate with menopause grades. Menopausal years correlate with symptoms. Symptomatic osteoporosis patients make about 55% of the total. Backache was reported by 60% of study participants. Over 50% of women complain of musculoskeletal issues, suggesting they have bone loss following menopause.Conclusion: An X-ray for Singh's grading together with questionnaires to analyse high-risk cases can be a start toward early screening in those women who stand to benefit from these preventative measures.

Cultural Differences in an Artificial Representation of the Human Emotional Brain System: A Deep Learning Study

Cultural differences between countries are customarily calculated by comparing mean scores on multiple dimensions, which ignores heterogeneity within societies. This article proposes a fundamentally new way of measuring cultural differences by evaluating the functioning of the emotional brain—that is, by comparing how people think, rather than what they think. Deep learning as a supervised machine learning technique is used to mathematically represent the emotional brain of the Volksgeist (“folk spirit”) with a complex system of nonlinear combinations of value priorities, opinions, and other factors with subjective feelings of well-being. Cross-validating how well one Volksgeist's artificial brain fits another country provides a novel measure for emotional cultural differences, which also considers heterogeneity within a society. This measure is conceptually and statistically unrelated to the Kogut–Singh index calculated from mean scores on cultural dimensions. However, it shows good face validity and supports international marketing and business theory as a negative and highly significant predictor for bilateral trade flows within Europe, using a classic gravity model.