Fracture Type Research Articles

AFFnet - a deep convolutional neural network for the detection of atypical femur fractures from anteriorposterior radiographs

Despite well-defined criteria for radiographic diagnosis of atypical femur fractures (AFFs), missed and delayed diagnosis is common. An AFF diagnostic software could provide timely AFF detection to prevent progression of incomplete or development of contralateral AFFs. In this study, we investigated the ability for an artificial intelligence (AI)-based application, using deep learning models (DLMs), particularly convolutional neural networks (CNNs), to detect AFFs from femoral radiographs. A labelled Australian dataset of pre-operative complete AFF (cAFF), incomplete AFF (iAFF), typical femoral shaft fracture (TFF), and non-fractured femoral (NFF) X-ray images in anterior-posterior view were used for training (N = 213, 49, 394, 1359, respectively). An AFFnet model was developed using a pretrained (ImageNet dataset) ResNet-50 backbone, and a novel Box Attention Guide (BAG) module to guide the model's scanning patterns to enhance its learning. All images were used to train and internally test the model using a 5-fold cross validation approach, and further validated by an external dataset. External validation of the model's performance was conducted on a Sweden dataset comprising 733 TFF and 290 AFF images. Precision, sensitivity, specificity, F1-score and AUC were measured and compared between AFFnet and a global approach with ResNet-50. Excellent diagnostic performance was recorded in both models (all AUC >0.97), however AFFnet recorded lower number of prediction errors, and improved sensitivity, F1-score and precision compared to ResNet-50 in both internal and external testing. Sensitivity in the detection of iAFF was higher for AFFnet than ResNet-50 (82 % vs 56 %). In conclusion, AFFnet achieved excellent diagnostic performance on internal and external validation, which was superior to a pre-existing model. Accurate AI-based AFF diagnostic software has the potential to improve AFF diagnosis, reduce radiologist error, and allow urgent intervention, thus improving patient outcomes.

Is the occurrence of extra-articular calcaneal fractures of the joint depression type related to osteoporosis and aging?

The authors experienced several cases of extra-articular calcaneal fracture accompanied by joint depression involving the entire posterior facet without joint involvement. This type of fracture and its characteristics and treatment outcomes have not been previously reported. The study was performed to analyze the characteristics of extra-articular calcaneal fractures of the joint depression type and their postoperative clinical and radiographic results and complications. Between February 2013 and March 2021, 23 extra-articular calcaneal fractures of the joint depression type were consecutively treated by a single surgeon. Relationships between fracture characteristics and patient demographics were assessed. Clinical results were quantified using visual analog scale, American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, and Foot Function Index, radiographic results were evaluated using Böhler's angles, and calcaneal widths were determined using calcaneal axial and lateral radiographs obtained preoperatively and at last follow-up. Twenty (87%) of the 23 cases occurred in women, and the mean age of all patients was 65.8 years (43-90). The three men were older than 65. Five (21.7%) patients had osteopenia, and 12 (52.2%) had osteoporosis. Bone mineral density testing could not be performed in the other six patients. Clinical and radiographic results were significantly improved after surgery. Extra-articular calcaneal fractures of the joint depression type are much more common in women and occur at an older age than calcaneal fractures commonly occur. These fractures are also more common in patients with a low bone mineral density. Level IV.

Radiological characteristics and injury mechanism of Logsplitter injury: a descriptive and retrospective study

BackgroundLogsplitter Injury is a type of high-energy ankle fracture dislocation. The mechanism of injury has not been described in detail. A detailed understanding of the radiological features and pathological changes can further guide treatment.MethodsBetween April 2009 and December 2018, a retrospective analysis was conducted on 62 patients with Logsplitter injury. The study analysed the characteristics of fibular injury, tibial injury, syndesmosis injury, medial injury and lateral ligament injury on preoperative X-ray and CT scans. The incidence of the different injury types was summarised. The correlation between Logsplitter injuries and the mechanisms causing them were analysed using the Lauge-Hansen classification of ankle fractures.ResultsThe study provides data on the types of fractures observed. Of the total fractures, 98.4% were open fractures. The fibula injuries were classified as no fracture (1.6%), transverse or short oblique fractures (61.3%), butterfly fragments (25.8%), and comminuted fractures (11.3%). The tibial injuries included compression of lateral articular surfaces (38.7%) and posterior compressions (6.5%). Medial injuries, including medial malleolar fractures, accounted for 87.1%, and deltoid ligament rupture accounted for 12.9%. The study found that injuries to the syndesmosis consisted of simple ligament ruptures (11.3%), Tillaux fractures (8.1%), Volkmann fractures (43.5%), and Tillaux and Volkmann fractures (37.1%). In 12.9% of cases, there was a complete rupture of the lateral collateral ligament. Based on the Lauge-Hansen classification, 87.1% of injuries were pronation-abduction injuries, while 8.1% were pronation and external rotation injuries, and 1.6% were supination external rotation injuries. Furthermore, 3.2% of cases could not be classified.ConclusionThe pathoanatomic characteristics of Logsplitter injury are diverse, with some cases accompanied by collateral ligament injury. It is important to note that these evaluations are objective and based on current results. The most common injury mechanism is vertical violence combined with abduction, although in some cases, it may be a vertical combined external-rotation injury.Level of evidence(4) case series.Trial registrationThis study has been approved by the ethical research committee of the Honghui Hospital of Xi’an Jiaotong University, under the code: 202,003,002.

The cost of care in maxillofacial fractures treatment in relation to the type of fixation and length of stay at a tertiary care hospital of Karachi, Pakistan: A retrospective chart review.

In addition to the clinical burden of trauma, the financial burden is an important aspect of care globally, especially for patients in low- and middle-income countries. The current retrospective review was done of data from January 2015 to December 2020 related to patients of oral maxillofacial trauma management in a tertiary care setting. Analysis of variance was used to determine the mean difference in the cost incurred depending upon the type of trauma and the number of bone plates used in fracture management. Pearson correlation was applied to explore any correlation involving patient age, aetiology and type of fracture, number of bone plates employed and the length of stay in the hospital. No statistically significant differences were noted in the cost among the different groups. The cost of care was significantly (p<0.001) correlated to the length of stay. Other variables, such as the type of fractures and the number of plates, had no significant impact (p>0.05).

Clavicle nonunion

After conservative treatment nonunion (pseudarthrosis) of the clavicle can be observed approximately 10times more frequently (15-24%) than after surgical treatment (1.4%). Risk factors include the fracture location, displacement, fracture type, sex, the severity of the accident and refractures. The diagnosis of pseudarthrosis of the clavicle can be made by athorough medical history, clinical examination and imaging procedures. The main symptom is pain, often accompanied by malalignment, instability, neurological symptoms and restricted mobility of the affected shoulder. The diagnosis is confirmed by X‑ray images and, if necessary, acomputed tomography (CT) scan. Pseudoarthrosis is classified according to the morphological appearance in X‑ray images and the cause. A differentiation is made between vital and nonvital pseudarthroses. Only symptomatic pseudarthrosis requires treatment. Nonoperative methods, such as magnetic field therapy or ultrasound are minimally effective. Surgical interventions are indicated for pain, movement restrictions or neurovascular problems. The goals of surgical treatment are to restore the vitality, bone length and stability through angular stable osteosynthesis. In cases of surgical pretreatment the anteroinferior plate position offers agood alternative to the superior plate position. In some cases double plating osteosynthesis can be indicated. Autogenous bone material, allogeneic substitute material and vascularized grafts are used for bony defects. Surgical treatment shows high rates of healing but also carries an increased risk of infection.

Hybrid Layer, Shear Bond Strength, and Fracture Patterns of Titanium Dioxide–Doped Phosphate Glass–Filled Universal Dental Adhesives

Abstract Objectives The aim of the study was to explore the potential effects of incorporating 5 and 10 wt% of TiO2-doped phosphate glass powder as fillers into the universal adhesive system. Materials and Methods Human permanent premolars and molars were used in the study. Five and 10 wt% of TiO2-doped phosphate glass powder as fillers were added into the universal adhesive system. Unmodified universal adhesive was used as control. The effects of the added filler in the universal adhesive were examined on hybrid layer formation at the resin composite and dentine interface (mesio-occlusal-distal [MOD] cavities) under scanning electron microscope (SEM), shear bond strength (SBS) of resin composite to dentine using shear bond testing machine, and the patterns of fracture at the resin composite–dentin interface, which were examined under stereomicroscope. The SBS analyses were performed with (8 samples per group, n = 24) and without (8 samples per group, n = 24) 5,000 cycles of thermocycling. Statistical Analysis One-way analysis of variance (ANOVA) was used to analyze the data of the SBS. For bond strength, the effects of adding fillers into the universal adhesive were analyzed. Results The SEM images showed that the hybrid layers were similar in all the groups of unmodified and modified adhesives. An ANOVA test revealed that the SBSs of control and modified adhesives were not significantly different before (p = 0.15) or after (p = 0.39) thermocycling for all the groups. The patterns of fracture revealed various types of fracture in all adhesive groups including composite resin, adhesive, and dentine failure. Composite resin fractures are the most encountered pattern of fracture. Conclusion Adding 5 and 10 wt% of TiO2 into universal adhesive did not adversely affect the hybrid layer, SBS, or mode of failure of composite resin to dentine. The pattern of fracture at the resin composite and dentine interface showed a favorable bonding with more cohesive than adhesive failure, particularly with the 5 wt% glass-modified adhesive group.

Finite element simulations of smart fracture plates capable of cyclic shortening and lengthening: which stroke for which fracture?

Introduction: Bone healing can be improved by axial micromovement, as has been shown in animals and human patients with external fixators. In the development of smart fracture plates, the ideal amount of stroke for different fracture types in the different healing stages is currently unknown. It was hypothesized that the resulting strain in the fracture gap of a simple tibial shaft fracture does not vary with the amount of axial stroke in the plate, the fracture gap size, and the fracture angle. Methods: With finite element simulations based on body donation computed tomography data, the second invariant of the deviatoric strain tensor (J2), strain energy density, hydrostatic strain, octahedral shear strain, and percentage of the fracture gap in the "perfect healing window" were computed for different gap sizes (1-3mm), angles (5°-60°), and plate stroke levels (0.05-0.60mm) in three healing stages. Multiple linear regression analyses were performed. Results: Findings showed that an active fracture plate should deliver an axial stroke in the range of 0.10-0.45mm. Different optimal stroke values were found for each healing phase, namely, 0.10-0.25mm for the first, 0.10mm for the second, and 0.35-0.45mm for the third healing phase, depending on the fracture gap size and less on the fracture angle. J2, hydrostatic strain, octahedral shear strain and the strain energy density correlated with the fracture gap size and angle (all p < 0.001). The influence of the fracture gap size and angle on the variability (adjusted R2) in several outcome measures in the fracture gap was shown to vary throughout healing. The contribution to the variability of the percentage of the fracture gap in the perfect healing window was greatest during the second healing phase. For J2, strain energy density, hydrostatic strain, and octahedral shear strain, the fracture gap size showed the greatest contribution in the third fracture healing phase, while the influence of fracture angle was independent of the healing phase. Discussion: The present findings are relevant for implant development and to design clinical studies that aim to accelerate fracture healing using axial micromovement.

Fracture modeling of CNT/epoxy nanocomposites based on phase-field method using multiscale strategy

The computational modeling of fracture, particularly in structures with complex crack topologies, remains challenging due to significant computational costs, especially in simulating two- and three-dimensional brittle fracture. This study presents an efficient phase-field model to address these challenges. By leveraging the user (UMAT) subroutine in ABAQUS and establishing an analogy between the phase-field evolution law and the heat transfer equation, the method efficiently tackles complex fracture problems. The model is verified through analysis of typical 2D and 3D fracture benchmarks with different failure modes, demonstrating accuracy and efficiency compared to experimental and numerical data. Additionally, the model is applied to explore brittle fracture in carbon nanotubes (CNTs)/epoxy nanocomposites, revealing insights into the impact of CNT weight fraction on fracture phenomena prediction. The incorporated CNTs in the matrix are considered uniformly dispersed and randomly oriented. Overall, the developed model and computational implementation show promise for meeting the requirements of structural-level engineering practices.

Outcomes of surgical management of ankle fractures in patients with diabetes

ObjectiveAnkle fracture surgeries among diabetic are common and can have fatal consequences and serious adverse outcomes. A target hemoglobin A1c (HbA1c) level <8% in all elective surgeries for patients with diabetes is suggested to minimize poor outcomes. We investigated the postoperative outcomes and complications among patients who underwent ankle fracture surgery using HbA1c level as a predictor value. MethodsThis retrospective cohort study was conducted at King Abdulaziz Medical City between January 2016 and December 2022 on all patients with diabetes who underwent open reduction and internal fixation and who had a documented HbA1c level. Radiological outcomes and complications were noted along with the levels of HbA1c and analyzed statistically. ResultsA total of 44 patients were included in the study: 29 women (65.9%) and 15 (34.1%) men. The most frequent ankle fracture type was bimalleolar (54.5%). HbA1c was elevated (54.5%) in patients. A significantly higher proportion of patients who had <8% HbA1c level had radiological union compared to patients who had ≥8% HbA1c level (p = 0.036). Patients who had elevated HbA1c level had more complications although it did not reach statistical significance (p > 0.05). Multivariate regression analysis showed that age and HbA1c level were the significant factors for an uncomplicated and successful ankle surgery. ConclusionPoor postoperative outcomes and complications are more common among patients with elevated HbA1c. This suggests that an elevated HbA1c level is associated with a poor treatment outcome. Determination of HbA1c levels may predict potential problems post ankle fracture surgery and improve management outcomes.

Retrospectİve Comparison Of Talon Or Conventional Locking Nailing For Tibial Shaft Fractures

Objective: Tibial shaft fractures are common orthopedic injuries that present challenges in treatment selection. The primary aim of this retrospective study was to compare the clinical outcomes of tibial shaft fractures treated with Talon and conventional locking nails. Methods: Ninety-four patients who underwent tibial intramedullary nailing between 2019-2021 were included in the study. The patients were divided into two groups based on the type of distal locking used: Group 1 received conventional screw locking, and Group 2 received Talon locking. Patient age, gender, trauma mechanism, fracture type, and surgery data were analyzed. The complications and bone union processes during follow-up were evaluated and compared between the two nail designs. Results: The age and gender of the patients included in the study were statistically similar in both groups. Furthermore, the Talon group demonstrated significantly shorter union times (p &lt; 0.001*). According to the OTA classification, there was a preference for screw-locking systems in more complex fractures (p = 0.017). Conclusion: The results of this retrospective study suggest that Talon locking nails may offer advantages over conventional screw locking, especially in younger patients, resulting in earlier bone union. Further research is needed to investigate Talon nails' biomechanical stability and suitability for specific fracture types.

Obese adolescents have higher risk for femur fracture after motor vehicle collision

BackgroundPrevious reports identified an association between obese adolescents (OAs) and lower extremity (LE) fractures after blunt trauma. However, the type of LE fracture remains unclear. We hypothesized that OAs presenting after motor vehicle collision (MVC) have a higher risk of severe LE fracture and will require a longer length of stay (LOS) and more support services upon discharge, compared to non-OAs. MethodsThe 2017–2019 Trauma Quality Improvement Program database was queried for adolescents (12–17-years-old) presenting after MVC. The primary outcome was LE fracture. A severe fracture was defined by abbreviated injury scale ≥3. OAs were defined by a body mass index (BMI) ≥30. ResultsFrom 22,610 MVCs, 3325 (14.7 %) included OAs. The rate of any LE fracture was higher for OAs (21.6 % vs. 18.8 %, p < 0.001). On subset analysis the only LE fracture at higher risk in OAs was a femur fracture (13 % vs. 9.1 %, p < 0.001). After adjusting for sex and age, the risk for severe LE fracture (OR 1.34, CI 1.18–1.53, p < 0.001) was higher for OAs. OAs with a femur fracture had a longer median LOS (5 vs. 4 days, p = 0.003) and were more likely discharged with additional support services including home-health or inpatient rehabilitation (30.6 % vs. 21.4 %, p < 0.001). ConclusionOAs sustaining MVCs have increased associated risk of femur fractures. OAs are more likely to have a higher-grade LE injury, experience a longer LOS, and require additional support services upon discharge. Future research is needed to determine if early disposition planning with social work assistance can help shorten LOS.

Epidemiological and etiological factors of various fractures and its pharamacological treatment options in a tertiary care teaching hospital - a prospective cohort study

A fracture is a broken bone that can range from a thin crack to a complete break bone. A fracture can occur crosswise, length wise in several parts and in too many pieces. Causes of fracture include physical trauma, accidental fall, sports injuries, stress, and osteoporosis. Fractures can be treated with Medications and lifestyle changes. The objective of the study was to identify common types of fractures mostly affected by people, reduce the incidence rate of fractures and to provide patient counseling regarding precautionary measures to avoid accidents and assaults. In the study period, 120 fracture cases were collected, of this 64 (53.33%) are males and 56 (46.66%) are females. Higher incidence of fractures 27 (22.5%) occurred in 50-60 years of age group. Major fractures 48 (47.5%) were occurred due to trauma. 21 (17.5%) were diagnosed by X-rays, 15 (14.5%) patients are diagnosed by CT scan. 22 (18.33%) patients are categorized under femur bone fractures. 52(43.3%) patients were treated with NSAIDS, 33 (27.5%) patients were treated with antibiotics. 29.33% were treated with vitamins and mineral supplements. The study concludes that out of 120 study subjects, major fractures were occurred due to trauma. Clinical pharmacists and other health care professionals intervention to create awareness regarding fractures, medications, lifestyle modifications and other safety measures helps them to recover faster from fractures.

Is the Timing of Surgery a Sufficient Predictive Factor for Outcomes in Patients with Proximal Femur Fractures? A Systematic Review.

(1) Background: Hip fractures are currently recognized as major public health problems, raising many issues in terms of both patients' quality of life and the cost associated with caring for this type of fracture. Many authors debate whether to operate as soon as possible or to postpone surgery until the patient is stable. The purpose of this review was to review the literature and obtain additional information about the moment of surgery, the time to surgery, length of hospital stay, and how all of these factors influence patient mortality and complications. (2) Methods: The systematic search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PICO guidelines, using the Google Scholar platform, for articles published between 2015 and 2023. Quality assessment was performed. (3) Results: After applying the inclusion criteria, 20 articles were included in the final list. Those who had surgery within 48 h had lower in-hospital and 30-day mortality rates than those who operated within 24 h. The American Society of Anesthesiologists (ASA) score is an important predictive factor for surgical delay, length of hospital stay (LOS), complications, and mortality. (4) Conclusions: Performing surgery in the first 48 h after admission is beneficial to patients after medical stabilization. Avoidance of delayed surgery will improve postoperative complications, LOS, and mortality.

Employing Williams’ series for the identification of fracture mechanics parameters from phase-field simulations

Fracture mechanics and damage mechanics are two theories that describe the degradation of the bearing capacity of structures. Fracture mechanics is based on a discontinuous description of cracking, while damage mechanics proposes a continuous description of material degradation. These two approaches are often opposed in the literature, from both theoretical and numerical points of view. This work suggests correlating the two approaches by applying Williams’ series, usually dedicated to experimental results, to phase-field computations. Williams’ series are employed to extract equivalent fracture mechanics parameters as a post-processing step. The proposed analysis based on a fracture mechanics description excludes the fracture process zone. Typical fracture mechanics parameters such as energy release rate, stress intensity factors, fracture process zone size, and crack tip position are determined from the phase-field computations. The approach is illustrated on a two-dimensional structure representing a beam whose notch opening displacement is controlled. The dependence on the choice of the internal length of the phase-field model is studied. Similarities and differences between both modeling routes are discussed.

Experimental analysis of failure behaviour of PA12 specimens manufactured by SLS as a function of wall thickness and build direction

PurposeThis paper aims to investigate and explain the dual fracture behaviour of PA12 specimens sintered by selective laser sintering (SLS) as a function of wall thickness and build direction with a powder mixture 30:70. To achieve this objective, research related to chemical, thermal and structural behaviours as a function of the input variables was carried out to describe and explain why ductile-fragile behaviour occurs during fractures under uniaxial tension manufactured via a methodology of material analysis and manufacturing processes.Design/methodology/approachThe factorial design 32 relates the fracture of PA12 tensile specimens to the horizontal, transverse and vertical build directions at 2.0, 2.5 and 3.0 mm thicknesses, respectively. Fractographic images revealed the fracture surfaces and their dual ductile-fragile behaviour related to the specimens’ measured crystalline, thermal, surface and chemical properties.FindingsThe study showed that thermal property variables differ depending on the input variables. The wall thickness variable affected this morphology the most, showing the highest percentage of the ductile area, followed by the transverse and vertical directions. It was determined that the failure in the vertical direction is due to crystalline gradients associated with the layer-by-layer construction process. The pore density may be closely related to generating ductile and brittle areas.Originality/valueIn this paper, fracture characterisation is performed based on the mechanical, chemical, structural, thermal and morphological properties of PA12 manufactured by SLS. In addition, a heatmap of porosities in cross-sections is constructed using a machine learning model (k-means) related to dual fracture behaviour. This research revealed significant differences in the fracture type according to the build direction. In addition, thin-section fractography provides a more detailed explanation of the fragile behaviour of the vertical direction associated with crystalline changes due to the direction of the sintering layers.

Proton pump inhibitor use and bone fractures in patients with chronic kidney disease.

Patients with chronic kidney disease (CKD) are at high risk for bone fractures, which are associated with high morbidity and mortality. Proton pump inhibitors (PPI) have been linked to an increased risk for fractures in the general population as well as in patients with need for hemodialysis, but studies in patients with CKD are currently missing. We performed a population-based observational case-control study exploring a sample of patients with CKD derived from the IQVIATM Disease Analyzer database. Patients with and without fractures were matched using the 1:1 nearest neighbor propensity score matching method. To investigate the association between PPI use and fractures, multivariable logistic regression analyses were performed adjusting for confounding factors. In total, 6076 patients with and 6076 patients without fractures were matched and subsequently available for analyses. In the total cohort, PPI use was associated with an increased risk for fractures (OR 1.68; 95% CI 1.55-1.83). This association was noted for nearly all types of fractures. The strongest association between PPI use and fractures was found in patients below the age of 60 with a PPI prescription for longer than two years (OR 6.85, 95% CI 1.85-25.38). The same was true, when analyzing cumulative PPI doses. Here, patients below the age of 60 with a cumulative PPI dose above 16000mg (highest quartile) had the highest risk for fractures (OR 4.62, 95% CI 1.87-11.44). There was no difference between men or women regarding the association between PPI use and fractures. This study provides evidence that PPI use is associated with fractures in patients with CKD. Deprescription of PPI in patients without an indication for treatment could be a modifiable risk factor to reduce fracture risk in this high-risk group.

Bone consolidation under septic condition and hardware retention: about 69 patients

IntroductionManagement of infection on internal fixation hardware is particularly complex.The main aim of the present study was to assess bone consolidation rates under septic conditions in patients treated for bone and joint infection (BJI) with hardware retention. Secondary objectives were to determine a time limit beyond which it is unreasonable to retain hardware, and to assess risk factors for non-consolidation and functional results. The study hypothesis was that bone consolidation is possible under septic conditions without hardware exchange. Material and methodA single-center retrospective observational study was conducted on 69 patients for the period January 1, 2009 to December 31, 2019. We included all patients aged over 15 years with infection after internal fixation or fusion whose files had been discussed in the multidisciplinary team meeting during the study period. Bone healing was screened for on X-ray or CT. Study data comprised type of fracture, smoking status, time to treatment for open fracture, initial surgery time, type of hardware, interval between fixation and revision, and type of irrigation. Functional results were assessed at follow-up: walking, pain, return to work and SF12 and QuickDASH scores. ResultsThe bone healing rate was 73.5% (50/68 patients) at a mean 24 weeks (range, 6–68 weeks).Time to revision did not significantly impact consolidation: 60% for 2 weeks (6/10 cases), 80% for 2−10 weeks (35/40 cases), and 64% for >10 weeks (9/14 cases) (p = 0.28). Smoking, longer initial surgery time and Gustilo type IIIb or IIIc were significant risks factors for non-consolidation. DiscussionBone consolidation under septic conditions with hardware retention adhering to an established medical and surgical protocol was reliable and straightforward, without extra morbidity. These findings are encouraging, and in line with the literature. We were unable to determine a time limit beyond which hardware prevented healing. Level of evidenceIV; descriptive epidemiological study.

The epidemiology of odontoid fractures: a study from the Swedish fracture register

PurposeThe objective of this study is to characterize the occurrence of odontoid fractures within a Swedish population.MethodsProspective data of adults diagnosed with an odontoid fracture between 2015 and 2021 were retrieved from the Swedish Fracture Register (SFR). Epidemiologic data including age, sex, injury mechanism, injury type, fracture type (Anderson and D’Alonzo classification), neurological status and treatment type were requested from the SFR. Data pertinent to osteoporosis was retrieved from the Swedish National Patient Register.ResultsA total of 1,154 odontoid fractures were identified, of which 30 were type I fractures, 583 type II fractures, and 541 type III fractures. The mean (Standard Deviation [SD]) age was 77.2 (13.8) years. The prevalence of osteoporosis and neurological deficits did not differ between the fracture types. The majority of patients were treated non-surgically (81%). Male sex and patient age 18–30 years were commonly associated with a high-injury mechanism, especially motor vehicle accidents. In the type II fracture group, significantly more patients had fallen from standing height or less than in the type III group (66% vs. 58%, p = 0.01) while in contrast, motor vehicle accidents were more common in the type III fracture group (12% vs. type II: 8%, p = 0.04).ConclusionBased on the SFR, the typical odontoid fracture patient is older and suffers a type II fracture. Most injuries were caused by low-energy trauma although in younger patients and males, they were associated with motor vehicle accidents. Across the patient population, odontoid fractures were usually treated non-surgically.

Fatigue fracture of the second rib in a professional athlete

A fatigue fracture, also known as stress fracture or overuse fracture, is caused by the summation of micro-injuries resulting from a chronic state of bone overload. It affects 1.4 %- 4.4 % of professional athletes. The most common site of fatigue fractures are the lower limbs. This is related to the heavy load caused by body weight and performing dynamic activities like jumping, running. Typical fractures are fractures of the fifth metatarsal bone, fibula and tibia, and less common fractures of the femur. Fractures involving the bones of the upper limbs and thorax are less commonly reported in the literature. It affect athletes in strength sports and athletes who perform dynamic and repetitive movements with their upper limbs, most often boxers, weightlifters, wrestlers, judokas, swimmers, golfers, rowers. Fractures in the thorax most often involve the first rib. Fractures of ribs II through XII are extremely rarely described. We present an unusual case of a second rib fracture in a professional athlete. A 26-year-old athlete training in racewalking reported increasing pain in the left scapula area 7 days before competing in the European Championships. Immediately after the competition, the pain changed location to the anterior thorax area, making movement of the upper limb and breathing much more difficult. A chest tomography was performed and it revealed a fatigue fracture of the second rib on the left side. The case report presents an atypical fracture in a female racewalking athlete and presents the uncharacteristic symptoms accompanying this fracture. Incorrect initial diagnosis and application of physiotherapy procedures without performing basic diagnostic tests, delay the diagnosis and initiation of proper treatment, and thus the athlete's recovery.

Tranexamic acid efficacy in geriatric hip fractures: impact of nutritional status on blood loss, transfusion rates, and safety

BackgroundTranexamic acid (TXA) is a widely employed intervention in orthopedic surgeries to minimize blood loss and the need for postoperative transfusions. This study focuses on assessing the efficacy and safety of TXA specifically in undernourished older adults undergoing hip fracture procedures.MethodsA total of 216 patients were classified into two groups based on the Geriatric Nutritional Risk Index: undernourished and normal. In total, 82 patients received intravenous TXA at a dosage of 15 mg/kg before incision, with an additional 1 g administered intravenously over a 3-hour period postoperatively. Postoperative hemoglobin (Hb) drop, blood transfusion rate, and the incidence of deep venous thrombosis (DVT) were assessed in each group according to the presence or absence of TXA. Additionally, demographic factors including age, sex, body mass index, and serum albumin were investigated.Results51.9% patients were identified as undernourished, experiencing progressive anemia (Hb: 10.9 ± 1.5 g/dL) and hypoalbuminemia (serum albumin: 31.9 ± 8 g/L). In comparison with the normal group, undernourished individuals were more likely to sustain femoral neck fractures (undernutrition vs. normal: 56.2 vs. 42.3%) and less likely to incur trochanteric fractures (undernutrition vs. normal: 43.8 vs. 57.7%) (P = 0.043). TXA administration significantly reduced the transfusion rate (P = 0.014) and Hb drop (P = 0.001) in the normal nutritional group, while its impact on the undernourished group remained less pronounced. There was no significant association between TXA administration and the rate of DVT complications, irrespective of the nutritional status.ConclusionsUndernutrition not only diminishes muscle strength and gait function, leading to various types of hip fractures, but it may also hinder the efficacy of TXA in reducing blood transfusion rates and blood loss.