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Khattak M, Kierkegaard P, McGregor A, Perry DC. Bridging innovation to implementation in artificial intelligence fracture detection : a commentary piece. Bone Joint J 2025; 107-B:582-586. [PMID: 40449898 DOI: 10.1302/0301-620x.107b6.bjj-2024-1567.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2025]
Abstract
The deployment of AI in medical imaging, particularly in areas such as fracture detection, represents a transformative advancement in orthopaedic care. AI-driven systems, leveraging deep-learning algorithms, promise to enhance diagnostic accuracy, reduce variability, and streamline workflows by analyzing radiograph images swiftly and accurately. Despite these potential benefits, the integration of AI into clinical settings faces substantial barriers, including slow adoption across health systems, technical challenges, and a major lag between technology development and clinical implementation. This commentary explores the role of AI in healthcare, highlighting its potential to enhance patient outcomes through more accurate and timely diagnoses. It addresses the necessity of bridging the gap between AI innovation and practical application. It also emphasizes the importance of implementation science in effectively integrating AI technologies into healthcare systems, using frameworks such as the Consolidated Framework for Implementation Research and the Knowledge-to-Action Cycle to guide this process. We call for a structured approach to address the challenges of deploying AI in clinical settings, ensuring that AI's benefits translate into improved healthcare delivery and patient care.
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Affiliation(s)
- Mohammed Khattak
- Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
| | - Patrick Kierkegaard
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Alison McGregor
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Daniel C Perry
- Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
- Trauma & Orthopaedics Department, Alder Hey Children's Hospital, Liverpool, UK
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Jensen NM, Hansen AØ, Thonsgaard S, Simony A, Cavallius C, Østergaard RS, Rottwitt LB, Abrahamsen C. Assessment of ankle fracture surgical wounds: the development and testing of the Wound after Osteosynthesis Kolding (WOK) score. Injury 2025; 56:112345. [PMID: 40267859 DOI: 10.1016/j.injury.2025.112345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 04/10/2025] [Accepted: 04/13/2025] [Indexed: 04/25/2025]
Abstract
INTRODUCTION Describing surgical wounds accurately poses challenges due to the diverse terminology used for complications. Existing evaluation methods do not cater specifically to surgical wounds from post-ankle fracture surgery with osteosynthesis. Given the unique anatomical challenges and treatment considerations (limited tissue coverage and blood supply as well as the surgical treatment with osteosynthesis), a targeted wound score is essential for ensuring consistent evaluation and high-quality care and thereby optimizing patient outcomes and satisfaction. The study aimed to develop a wound score specifically for evaluating surgical wounds following ankle fracture surgery. METHOD Development of the Wound after Osteosynthesis Kolding score (WOK) proceeded through three phases: 1) identifying WOK domains, 2) developing item and response options, and 3) pilot testing the WOK score. RESULTS Five domains were identified: erythema, swelling, dehiscence, exudate and warmth. Response options were derived from literature and clinical insights. Content validity was assessed with an S-CVI/Ave of 0.93 for nurses and 0.82 for orthopedic surgeons. Orthopedic surgeons perceived erythema and warmth as less relevant, while nurses considered all five domains to be fairly or very relevant. High agreement between scores was found, but varying kappa scores were observed when assessing intra-rater reliability. Inter-rater reliability was acceptable across all domains (κ = 0.44 to 1.00). Warmth was omitted from the final WOK score due to low content validity among orthopedic surgeons and poor inter-rater reliability. Additionally, assessing warmth in a clinical setting was challenging because ankle brace stabilization affects overall skin humidity and warmth. CONCLUSIONS The Wound after Osteosynthesis Kolding score (WOK) has proven to be a content-valid and reliable tool for assessing minor complications in surgical wounds following ankle fracture surgery.
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Affiliation(s)
- Niels Martin Jensen
- Department of Orthopaedic Surgery & Traumatology, Hospital Lillebaelt Kolding, Denmark; Department of Orthopedic Surgery, Lillebaelt Hospital, Vejle, Denmark.
| | - Alice Ørts Hansen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Simon Thonsgaard
- Department of Orthopaedic Surgery & Traumatology, Hospital Lillebaelt Kolding, Denmark.
| | - Ane Simony
- Department of Orthopaedic Surgery & Traumatology, Hospital Lillebaelt Kolding, Denmark; Department of Region Health Research, University of Southern Denmark, Odense Denmark.
| | - Christian Cavallius
- Department of Orthopaedic Surgery & Traumatology, Hospital Lillebaelt Kolding, Denmark.
| | | | - Lars Bo Rottwitt
- Department of Orthopaedic Surgery & Traumatology, Hospital Lillebaelt Kolding, Denmark.
| | - Charlotte Abrahamsen
- Department of Orthopaedic Surgery & Traumatology, Hospital Lillebaelt Kolding, Denmark; Department of Region Health Research, University of Southern Denmark, Odense Denmark.
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van Veelen NM, Horvat M, Link BC, van de Wall BJM, Beeres FJP. Locking pegs versus locking screws in volar plating of distal radius fractures. Eur J Trauma Emerg Surg 2025; 51:217. [PMID: 40404837 PMCID: PMC12098432 DOI: 10.1007/s00068-025-02876-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2025] [Accepted: 04/27/2025] [Indexed: 05/24/2025]
Abstract
PURPOSE The aim of this study was to compare the radiological outcome of patients with distal radius fractures stabilized with a volar plate using either locking screws or pegs. MATERIAL & METHODS For this retrospective study all adult patients that received volar plating of a distal radius fracture at a trauma center between 06/2019 and 06/2022 were eligible for inclusion. Only patients who received an implant allowing both locking pegs and screws were included. Primary outcome was radiological loss of reduction at the 6-week and at the 12-month follow-up. Secondary outcomes were duration of surgery, implant removal, fracture union and complications. RESULTS Fourty-nine patients treated with pegs and 39 with screws were included. Patient demographics were comparable, however there were more complex fractures in the peg group. There was no significant difference in the occurrence of radiological loss of reduction between the groups at 6 weeks or 12 months (p = 1). Patients treated with pegs were more frequently operated upon by experienced surgeons while screws were more often used by more junior staff. The duration of surgery was longer for patients who received screws (p = 0.003). Union was achieved in all fractures for which a 12-month x-ray was available. There was no significant difference in implant removal rate or other complications. CONCLUSIONS Regarding secondary loss of reduction both locking pegs and screws show similar results. Considering the potential benefits of pegs, such as the smooth surface which may reduce the risk of joint penetration, pegs are a viable alternative to screws.
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Affiliation(s)
- Nicole M van Veelen
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse 166000, Lucerne, Switzerland.
| | - Matija Horvat
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse 166000, Lucerne, Switzerland
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse 166000, Lucerne, Switzerland
| | - Bryan J M van de Wall
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse 166000, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, 6005, Lucerne, Switzerland
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse 166000, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, 6005, Lucerne, Switzerland
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Jia Z, Xu C, Gao W, Yang C, Tang P, Li J. Evaluation of internal fixation stability of distal humerus C-type fractures based on musculoskeletal dynamics: finite element analysis under dynamic loading. J Orthop Surg Res 2025; 20:475. [PMID: 40380213 PMCID: PMC12084957 DOI: 10.1186/s13018-025-05876-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2025] [Accepted: 04/30/2025] [Indexed: 05/19/2025] Open
Abstract
PURPOSE This study establishes a quantitative anatomical-mechanical-clinical decision-making mapping relationship using the Digital Intelligence Orthopaedic Technology, systematically analyses the dynamic biomechanical characteristics of distal humerus fracture in the postoperative period, and establishes the quantitative correlation between optimal strategies of plate configuration and safety thresholds for joint activities, to provide the scientific basis for optimizing internal fixation schemes and quantifying postoperative rehabilitation strategies. METHODS Upper limb muscle modeling was carried out in AnyBody software, muscle force, and other data were exported for finite distance solving and dynamic mechanical conditions were exported as the database for dynamic loading. Coupling the musculoskeletal dynamics simulation with finite element calculation, the elbow flexion-extension angle-muscle force-inner fixation stress transfer chain was established by AnyBody-Abaqus joint modeling technique to quantify the dynamic thresholds of the interface fracture micromovement (IFM) under different activity angles. The effects of different plate configurations (parallel plate, posterior medial plate, posterior lateral plate) on fracture stability and early healing were analyzed. RESULTS In this study, we systematically evaluated the biomechanical pattern of internal fixation of distal humerus fracture as well as the postoperative safe activity window and elucidated the enhancement path of functional recovery of distal humerus fracture utilizing AnyBody musculoskeletal dynamics analysis. By means of AnyBody musculoskeletal dynamics analysis, the humerus stress migration path showed anatomical-dependent characteristics, with gradient transfer from the hawks' fossa to the distal lateral condyle in flexion. Parallel plates stabilized the IFM in the bone healing window (0.06-0.20 mm) at 0-80° of flexion, whereas vertical plates breached the critical threshold (0.48 mm) in the IFM at > 30° of flexion. This reveals the law of mechanical matching between plate configuration and rehabilitation. There was a clear angle-dependent relationship between flexion angle and inter-fracture gap fragment motion (IFM). The IFM values tended to increase with increasing flexion and extension angles. When using parallel plates, allowing 0-80° of elbow flexion ensures better conditions for fracture healing. When using vertical plates, especially posterior medial plates active elbow flexion should be limited to about 30°. CONCLUSIONS In this study, we quantified the mechanical effect of muscle contraction force on the stability of internal fixation of distal humerus C-type fracture and revealed the biomechanical law in the postoperative period; we established a simulation model of dynamic and static loading and proposed a 'safe activity window' for postoperative exercise, which confirms the high stiffness of the parallel steel plate and the control of the angle of early active activity (≤ 80° of flexion). Flexion of more than 30° in the case of vertical plates leads to shear micromotion overruns (> 0.48 mm).
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Affiliation(s)
- Zhengfeng Jia
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
- Graduate School of Medical School of Chinese PLA Hospital, Beijing, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Weilu Gao
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
- Graduate School of Medical School of Chinese PLA Hospital, Beijing, China
| | - Changsen Yang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
- Graduate School of Medical School of Chinese PLA Hospital, Beijing, China
| | - Peifu Tang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
| | - Jiantao Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
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Hoffmann S, Müller A, Illg C, Daigeler A, Held M, Thiel JT. Subcutaneous vs. transcutaneous K-wires for proximal phalanx fractures: a prospective randomized trial on infection rates. Arch Orthop Trauma Surg 2025; 145:280. [PMID: 40317324 DOI: 10.1007/s00402-025-05900-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2025] [Accepted: 04/21/2025] [Indexed: 05/07/2025]
Abstract
In this randomized prospective trial, we compared K-wire osteosynthesis techniques for fractures of the proximal phalanx. Between April 2021 and February 2024, 28 patients treated at the BG Trauma Center Tuebingen were divided into two groups. Both groups underwent osteosynthesis with two K-wires: in Group A, the wire ends were left transcutaneous, while in Group B, they were buried subcutaneously. Follow-up revealed a significantly lower infection rate with subcutaneous wires (5.89%) compared to transcutaneous wires (45.46%). The postoperative infection occurred within the first 6 weeks after surgery. Two patients had to undergo surgical revision changing or removing the K-wires unexpectedly. Additionally, the total active range of motion of the PIP joint in Group A was 21.85° less than in Group B. Patients also expressed a preference for subcutaneous placement of wire ends. These findings strongly support burying K-wire ends after osteosynthesis of proximal phalanx fractures.
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Park JW, Kim HY, Kim KM, Kim J, Jang H, Kim J, Chung H. Epidemiology of osteoporotic ankle fractures in South Korea: a nationwide retrospective cohort study (2006-2022). Osteoporos Int 2025; 36:801-809. [PMID: 40047882 DOI: 10.1007/s00198-025-07429-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 02/08/2025] [Indexed: 05/20/2025]
Abstract
PURPOSE Ankle fractures, ranking as one of the very common osteoporotic fractures, pose a substantial socioeconomic burden. We aimed to investigate the incidence of elderly ankle fractures, refracture risks, and mortality rates in South Korea. METHODS Utilizing the Korean National Health Insurance Service (NHIS) registry from January 2006 to December 2022, individuals over 50 years with ankle fractures were identified. Osteoporotic ankle fractures were defined using admission diagnoses, procedural codes, and cast-related codes. Incidence rates, refracture rates, and one-year mortality rates were analyzed with standardization adjusted for gender and age distribution. RESULTS From 2006 to 2022, annual ankle fracture incidence rose from 193.90 to 278.83 per 100,000 person-years. Women exhibited 1.93 times higher incidence than men, with a notable increase in women. Most common in ages 60 to 69, ankle fracture rates increased until 2019 and after 2020 but decreased between 2019 and 2020. The one-year ankle refracture rates and osteoporotic refracture rates increased from 3.55% and 4.56% in 2007 to 9.32% and 10.37% in 2021, respectively. The one-year mortality rate after ankle fractures decreased from 2.10% in 2007 to 1.49% in 2021. CONCLUSION This study offers insights into the epidemiology of osteoporotic ankle fractures in South Korea, revealing increasing incidence, gender differences, age-related patterns, and trends in refracture and mortality rates over the study period. This study examines the incidence, refracture risk, and mortality of osteoporotic ankle fractures in South Korea using a nationwide dataset (2006-2022). The incidence of ankle fractures increased significantly, especially in women, and refracture rates also rose, highlighting an unmet need for better osteoporosis management.
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Affiliation(s)
- Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ha-Young Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Kyoung Min Kim
- Division of Endocrinology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Jaiyong Kim
- Department of Big Data Research and Development, National Health Insurance Service, Wonju, South Korea
| | - Hoyeon Jang
- Department of Big Data Research and Development, National Health Insurance Service, Wonju, South Korea
| | - Jihye Kim
- Department of Big Data Research and Development, National Health Insurance Service, Wonju, South Korea.
| | - HoeJeong Chung
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Ilsanro, Wonju, 26426, South Korea.
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Edelstein A, McDonald J, Lee W. The impact of surgical timing in ankle fracture on postoperative wound complications: a critical 24-hour cutoff point through systematic review and meta-analysis. Arch Orthop Trauma Surg 2025; 145:269. [PMID: 40285875 DOI: 10.1007/s00402-025-05896-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2025] [Accepted: 04/19/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND Ankle fractures are among the most prevalent injuries in the general population, and the timing of surgical fixation may influence postoperative wound complications. This systematic review and meta-analysis investigated the impact of surgical timing on postoperative wound complications, specifically investigating the significance of a 24-hour cutoff point. MATERIALS AND METHODS The comprehensive literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed, Embase, Web of Science, and Cochrane databases. Research evaluating and comparing clinical outcomes following ankle fracture treatment between early versus delayed surgical fixation groups, specifically using a 24-hour cutoff point, were reviewed. Evaluated data for the meta-analysis included total wound complications: divided into major and minor wound complications, length of stay, and other complications such as fixation failure. RESULTS A total of eight studies were included in this systematic review and meta-analysis. In total, 1,183 patients were analyzed, with 572 in the early fixation group and 611 in the delayed fixation group. Compared to the delayed fixation group, the early fixation group significantly reduced total wound complications and length of stay, with a relative ratio of 0.37 (95% CI, 0.22 to 0.60) and - 0.88 (95% CI, -1.07 to -0.70), respectively. When analyzed as separate groups of major and minor wound complications, there was a trend showing lower rate of major and minor wound complication in the early fixation group than the delayed fixation group, but without reaching statistically significant differences. CONCLUSIONS Based on our review, early surgical intervention within the first 24 h may be considered to minimize the risk of postoperative wound complications and reduce the length of stay in ankle fractures. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
| | - John McDonald
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Wonyong Lee
- University of Chicago, Chicago, USA.
- Guthrie Robert Packer Hospital, Sayre, USA.
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Rota S, Sicard L, Perarnaud J, Agniel R, Bardonnet R, Chaussain C, Boissière M, Pauthe E, Gorin C. Purified bone xenografts: A novel and efficient animal bone substitute derived from an optimized supercritical CO 2 treatment. Mater Today Bio 2025; 31:101619. [PMID: 40124337 PMCID: PMC11930176 DOI: 10.1016/j.mtbio.2025.101619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2024] [Revised: 02/25/2025] [Accepted: 02/26/2025] [Indexed: 03/25/2025] Open
Abstract
Bone xenografts represent a promising alternative to autologous or allograft transplants, yet antigenicity in animal-derived tissues remains a major limitation to their clinical use. To provide any risk of contamination or allogenic rejection, the Supercrit® process was developed to treat allogeneic human bone combining a supercritical CO2 treatment followed by a chemical treatment using high quantities of different solvents. The aim of this study was to produce a xenogeneic bone substitute thanks to the development of a new one-step supercritical process, 'Goxcrit', and to test it in vivo. This new process reduces the use of solvents by injecting them under pressure into the supercritical CO2 flow, while maintaining the cleaning quality of the bone matrix and better preserving its inner structure, essential for its future bone integration. Porcine derived bone samples were treated using Goxcrit or Supercrit®, and compared with human bone treated with Supercrit®, the commercialized bone allograft. In vitro analyses demonstrated the absence of cytotoxicity and of the alpha-gal epitope mainly responsible for cross-species immunogenicity. Additionally, in vivo experiments revealed improved bone formation in rats critical calvarial defects (BV/TV and von Kossa analyses) implanted with Goxcrit samples, with bone remodeling (TRAP/ALP stains), compared to those treated with Supercrit®. These results can be attributed to the less aggressive chemical process of the Goxcrit, which preserves the bone's inner structure critical for remodeling. Our study highlighted the interest of using a porcine bone source treated with the Goxcrit process to meet the growing demand for reliable and effective bone substitutes.
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Affiliation(s)
- Solène Rota
- ERRMECe, Equipe de Recherche sur Les Relations Matrice Extracellulaire-Cellules (EA1391), Biomaterials for Health Research Group, Institut des Matériaux I-MAT (FD4122), CY Tech, CY Cergy Paris Université, Maison Internationale de la Recherche (MIR), rue Descartes, Neuville sur Oise cedex, France
- BIOBank, Bone Tissue Bank, Lieusaint, France
| | - Ludovic Sicard
- Université Paris Cité, URM1333 Oral Health Inserm, Dental School, Montrouge, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Service de médecine-buccodentaire, Hôpitaux Universitaires PNVS, Paris, France
| | - Justine Perarnaud
- ERRMECe, Equipe de Recherche sur Les Relations Matrice Extracellulaire-Cellules (EA1391), Biomaterials for Health Research Group, Institut des Matériaux I-MAT (FD4122), CY Tech, CY Cergy Paris Université, Maison Internationale de la Recherche (MIR), rue Descartes, Neuville sur Oise cedex, France
- BIOBank, Bone Tissue Bank, Lieusaint, France
- Université Paris Cité, URM1333 Oral Health Inserm, Dental School, Montrouge, France
| | - Rémy Agniel
- ERRMECe, Equipe de Recherche sur Les Relations Matrice Extracellulaire-Cellules (EA1391), Biomaterials for Health Research Group, Institut des Matériaux I-MAT (FD4122), CY Tech, CY Cergy Paris Université, Maison Internationale de la Recherche (MIR), rue Descartes, Neuville sur Oise cedex, France
| | | | - Catherine Chaussain
- Université Paris Cité, URM1333 Oral Health Inserm, Dental School, Montrouge, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Service de médecine-buccodentaire, Hôpitaux Universitaires PNVS, Paris, France
| | - Michel Boissière
- ERRMECe, Equipe de Recherche sur Les Relations Matrice Extracellulaire-Cellules (EA1391), Biomaterials for Health Research Group, Institut des Matériaux I-MAT (FD4122), CY Tech, CY Cergy Paris Université, Maison Internationale de la Recherche (MIR), rue Descartes, Neuville sur Oise cedex, France
| | - Emmanuel Pauthe
- ERRMECe, Equipe de Recherche sur Les Relations Matrice Extracellulaire-Cellules (EA1391), Biomaterials for Health Research Group, Institut des Matériaux I-MAT (FD4122), CY Tech, CY Cergy Paris Université, Maison Internationale de la Recherche (MIR), rue Descartes, Neuville sur Oise cedex, France
| | - Caroline Gorin
- Université Paris Cité, URM1333 Oral Health Inserm, Dental School, Montrouge, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Service de médecine-buccodentaire, Hôpitaux Universitaires PNVS, Paris, France
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Knauer OA, Smith JT, McGorty Droll J, Chappell TM. The Evolution of Geriatric Ankle Fracture Management to Promote Mobility. Clin Podiatr Med Surg 2025; 42:293-307. [PMID: 39988393 DOI: 10.1016/j.cpm.2024.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2025]
Abstract
Geriatric ankle fracture management requires a comprehensive approach that balances appropriate patient optimization, fracture reduction, stability, and early mobilization. Surgical and nonsurgical options should be cautiously considered based on patient and fracture characteristics. Early weight-bearing treatment options should be pursued when possible. There are a myriad of treatment options including fibular intramedullary devices or minimally invasive joint prep tibiotalocalcaneal nailing that minimize soft tissue disruption and can provide robust stability sufficient to allow early weight-bearing postoperatively when appropriate. It is essential for geriatric patient treatment teams to optimize outcomes and minimize complications in this often-challenging patient population.
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Affiliation(s)
- Oliver A Knauer
- Department of Podiatric Medicine and Surgery, Virginia Mason Franciscan Health, PMSR/RRA Foot and Ankle Surgery, 34509 9th Avenue South, Suite 306, Federal Way, WA 98003, USA.
| | - Joshua T Smith
- Department of Podiatric Medicine and Surgery, Virginia Mason Franciscan Health, PMSR/RRA Foot and Ankle Surgery, 34509 9th Avenue South, Suite 306, Federal Way, WA 98003, USA
| | - Jenniferlyn McGorty Droll
- Department of Podiatric Medicine and Surgery, Virginia Mason Franciscan Health, PMSR/RRA Foot and Ankle Surgery, 34509 9th Avenue South, Suite 306, Federal Way, WA 98003, USA
| | - Todd M Chappell
- Department of Podiatric Medicine and Surgery, Franciscan Foot and Ankle Associates, Tacoma, WA, USA
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Ivdal H, Bergenholtz L, Bergdahl C, Wolf O, Rydberg EM. Fractures sustained by slipping on ice or snow: an epidemiological study of 50,500 fractures from the Swedish Fracture Register. Acta Orthop 2025; 96:272-277. [PMID: 40134286 PMCID: PMC11933825 DOI: 10.2340/17453674.2025.43186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Accepted: 02/07/2025] [Indexed: 03/27/2025] Open
Abstract
BACKGROUND AND PURPOSE Despite numerous patients sustaining fractures annually due to slipping on ice or snow, descriptive studies are scarce, which may result in less systematic management and prevention. We aimed to analyze fractures in adults sustained by slipping on ice and snow in Sweden using data from the Swedish Fracture Register (SFR). METHODS Data on all patients ≥ 18 years registered in the SFR between January 1, 2015 and December 31, 2022, with a fracture sustained by slipping on ice or snow was extracted. Descriptive statistical analyses were performed. RESULTS During the study period, 50,500 fractures were registered as sustained by slipping on ice or snow, representing 9% of all registered fractures in the SFR during the same period. 60% of the fractures affected the upper extremity. The mean age at the time of fracture was 61 years (18-105) and almost 70% of fractures were seen in women. The most common fractures were to the wrist (34%), ankle (18%), proximal humerus (11%), and hip (10%). CONCLUSION Almost 1 in 10 fractures is sustained by slipping on ice or snow. The most common fractures are related to the wrist and the ankle. The majority of fractures affect the upper extremity, and two-thirds are sustained by women. Protective shoe wear, and better snow and ice clearance, could potentially have a large effect on injury prevention.
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Affiliation(s)
- Henrik Ivdal
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden.
| | - Linnea Bergenholtz
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Bergdahl
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Olof Wolf
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala; Department of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
| | - Emilia Möller Rydberg
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
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Hackl CM, Moore BP, Samai IM, Wong BR. Age-Related Cataract Extraction Is Associated With Decreased Falls, Fractures, and Intracranial Hemorrhages in Older Adults. J Am Geriatr Soc 2025. [PMID: 40099858 DOI: 10.1111/jgs.19441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 02/18/2025] [Accepted: 02/23/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND Cataract extraction with intraocular lens insertion (CEIOL) is among the most frequently performed surgeries in the United States and is indicated for individuals with age-related cataracts causing visual impairment. The association between CEIOL and falls and hip fractures has been described, but there is a paucity of literature describing the association between CEIOL and various other common morbidity and mortality-increasing age-related traumatic injuries. METHODS This retrospective cohort study utilized TriNetX, a health database, to access de-identified electronic medical records. Cohorts of patients aged 60 years and older were identified using diagnostic and procedural codes. Cohort 1 was defined as patients with age-related cataracts who underwent CEIOL within 10 years of documented diagnosis of cataracts. Cohort 2 was defined as patients with age-related cataracts who did not undergo CEIOL within 10 years of documented diagnosis of cataracts. Propensity score matching for demographics and other relevant comorbidities was completed. Chi-square analysis was performed, and data were reported as odds ratios with 95% confidence intervals. Outcomes analyzed included proximal humerus fracture, distal radius fracture, hip fracture, ankle fracture, fall, subdural hemorrhage, and epidural hemorrhage. RESULTS Patients who underwent CEIOL demonstrated significantly lower odds of falls (p < 0.0001), proximal humerus fracture (p = 0.016), distal radius fracture (p = 0.0004), hip fracture (p < 0.0001), ankle fracture (p = 0.0002), subdural hemorrhage (p < 0.0001), and epidural hemorrhage (p = 0.006) as compared to patients with a documented diagnosis of age-related cataract without CEIOL. CONCLUSIONS CEIOL was significantly associated with decreased falls and reductions in major fall-related injuries among patients with age-related cataracts. These findings strongly support improved screening protocols to detect vision loss secondary to age-related cataracts, as this may decrease the incidence of common major fall-related injuries among patients with age-related cataracts.
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Affiliation(s)
- Caitlin M Hackl
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Brady P Moore
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Imanouel M Samai
- Department of Ophthalmology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Brian R Wong
- Department of Ophthalmology, The University of Texas Medical Branch, Galveston, Texas, USA
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12
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Gundtoft PH, Pedersen AB, Viberg B. Incidence, treatment, and mortality of ankle fractures: a Danish population-based cohort study. Acta Orthop 2025; 96:203-208. [PMID: 40029096 PMCID: PMC11868812 DOI: 10.2340/17453674.2025.43006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 01/21/2025] [Indexed: 03/05/2025] Open
Abstract
BACKGROUND AND PURPOSE Previous studies have shown large variation in the incidence of ankle fractures. Nationwide data covering longer periods is necessary to gain knowledge of the current trends. The aim of this study was to describe the trends in incidence, treatment, and mortality of ankle fracture during a 20-year period. METHODS Ankle fractures in patients ≥ 18 years old were identified in the Danish National Patient Register using the validated diagnosis and surgical procedure codes for ankle fractures. Incidence rates per 100,000 and incidence rate ratio (IRR) are reported with 95% confidence intervals (CI). RESULTS We identified 155,740 ankle fractures. The overall mean incidence rate during the period 1997-2018 was 164 (CI 163-165) per 100,000 person-years, being 154 (CI 152-155) for men and 203 (CI 202-205) for women. The incidence rate increased from 155 (CI 131-179) during 1997-2006 to 173 (CI 147-199) during 2007-2018, corresponding to an IRR of 1.12 (CI 1.10-1.12). This increase was primarily driven by an increase in women, with an IRR of 1.21 (CI 1.20-1.23) and for patients above 50 years, with an IRR of 1.22 (CI 1.08-1.10). The proportion of patients surgically treated increased from 21% in 1997-2006 to 25% in 2007-2018. The 1-year mortality risk was higher for patients above 65 years with an ankle fracture compared with the general population of the same age, with an IRR of 1.47 (CI 1.42-1.53). CONCLUSION The incidence of ankle fracture increased from 1997 to 2018, primarily due to an increased incidence in women and in the elderly population. The proportion of surgically treated patients increased from 21% to 26%. Excess mortality after ankle fracture in patients above 65 years was observed.
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Affiliation(s)
- Per H Gundtoft
- Orthopedic Department, Aarhus University Hospital; Department of Orthopedic Surgery, Kolding Hospital, Denmark.
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital; Department of Clinical Medicine, Aarhus University, Denmark
| | - Bjarke Viberg
- Department of Orthopedic Surgery, Kolding Hospital; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Clinical Research, University of Southern Denmark, Denmark
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Hodkinson T, Groom W, Souroullas P, Moulder E, Muir R, Sharma H. Bigger is not necessarily better - 2-ring circular frames associated with shorter duration of treatment in the management of complex tibial fractures - a retrospective cohort study. Injury 2025; 56:112045. [PMID: 39870047 DOI: 10.1016/j.injury.2024.112045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 10/24/2024] [Accepted: 11/18/2024] [Indexed: 01/29/2025]
Abstract
Frame configuration for the management of complex tibial fractures is highly variable and is dependent upon both fracture pattern and surgeon preference. The optimal number of rings to use when designing a frame remains uncertain. Traditionally larger, multi-ring-per-segment constructs have been assumed to offer optimal stability and therefore favourable conditions for fracture healing but there is little in-vivo evidence for this and the recent concept of reverse dynamisation challenges this approach. We compared the clinical outcomes in 302 consecutive patients with tibial fractures treated in our unit with either a stable two-ring circular frame or a three-or-more-ring (3+) frame. The primary outcome measure was time spent in frame. Secondary outcomes were the incidence of malunion and the need for further surgical procedures to achieve bone union. The mean time in frame was 168 days for the 2-ring group and 202 days for the 3+ rings group (p = 0.003). No significant differences were found in the rate of malunion or the requirement for secondary surgical intervention to achieve union. The groups were evenly matched for age, co-morbidities, energy of injury mechanism, post-treatment alignment and presence of an open fracture. This study finds that 2-ring frame constructs are a reliable option associated with shorter duration of treatment and no increase in rates of adverse outcomes compared with larger, more complex frame configurations.
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Affiliation(s)
- Thomas Hodkinson
- Hull Royal Infirmary, Anlaby Road, Kingston upon Hull HU3 2JZ, UK
| | - William Groom
- Hull Royal Infirmary, Anlaby Road, Kingston upon Hull HU3 2JZ, UK
| | - Panos Souroullas
- York and Scarborough Teaching Hospitals, Wigginton Road, York YO31 8HE. UK
| | | | - Ross Muir
- Hull Royal Infirmary, Anlaby Road, Kingston upon Hull HU3 2JZ, UK
| | - Hemant Sharma
- Hull Royal Infirmary, Anlaby Road, Kingston upon Hull HU3 2JZ, UK.
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14
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Piétu G. Does internal fixation of shaft fracture show specificities in over-80 year-olds? Orthop Traumatol Surg Res 2025; 111:104054. [PMID: 39579967 DOI: 10.1016/j.otsr.2024.104054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 11/25/2024]
Abstract
Osteoporotic fractures in the elderly are increasingly numerous, but diaphyseal locations on native bone are quite rare. Pathological and periprosthetic fractures are not included in this review, as they are specific in terms of context and treatment. Cortical thinning and widening of the medullary canal alter local mechanical properties, necessitating adaptation of internal fixation. Thus, for nailing, the diameter of the implant has to be greater, and fixed-angle or multidirectional locking screws are used; for plate fixation, locking screws are required. To avoid secondary periprosthetic fracture, fixation must protect the entire bone segment. Long plates should be used, with several divergent epiphyseal end-screws; in the femur, cervicocephalic proximal fixation is recommended. In practice, nailing is mostly used in femoral and tibial isthmic locations. In case of metaphyseal extension, nail and locking plate fixation, ideally percutaneous, show comparable results in terms of function, consolidation and complications. In the tibia, it is mandatory to be soft-tissue friendly given the fragility of pretibial skin in the elderly. In the humerus, the choice is wider. For nailing, passage through the rotator cuff seems acceptable in elderly patients. LEVEL OF EVIDENCE: V; expert opinion.
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Affiliation(s)
- Guy Piétu
- Hôtel Dieu, service d'orthopédie-traumatologie, 1, place Alexis-Ricordeau, 44093 Nantes Cedex 1, France.
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van Luit RJ, Rijntjes J, Hekman E, Govaert L, Hollman F, Schröder FF, Veen EJ. Development of a virtual surgical plan for reverse shoulder arthroplasty as a treatment for complex proximal humerus fracture in an elderly patient. JSES REVIEWS, REPORTS, AND TECHNIQUES 2025; 5:92-96. [PMID: 39872343 PMCID: PMC11764555 DOI: 10.1016/j.xrrt.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2025]
Affiliation(s)
- Roelof J. van Luit
- Department of Orthopaedic Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Jessie Rijntjes
- Department of Orthopaedic Surgery, Medical Spectrum Twente, Enschede, The Netherlands
- Medical 3D Lab, Medical Spectrum Twente, Enschede, The Netherlands
- Technical Medicine, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Edsko Hekman
- Faculty of Engineering Technology, Department of Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Lonneke Govaert
- Department of Orthopaedic Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Freek Hollman
- Department of Orthopaedic Surgery, Viecuri Medical Centre, Venlo, The Netherlands
| | - Femke F. Schröder
- Department of Orthopaedic Surgery, Medical Spectrum Twente, Enschede, The Netherlands
- Medical 3D Lab, Medical Spectrum Twente, Enschede, The Netherlands
- Faculty of Engineering Technology, Department of Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Egbert J.D. Veen
- Department of Orthopaedic Surgery, Medical Spectrum Twente, Enschede, The Netherlands
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Müller D, Klotsche J, Kosik MB, Perka C, Buttgereit F, Hoff P, Gaber T. Fracture Fusion on Fast-Forward: Locally Administered Deferoxamine Significantly Enhances Fracture Healing in Animal Models: A Systematic Review and Meta-Analysis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2025; 12:e2413290. [PMID: 39840407 PMCID: PMC11848589 DOI: 10.1002/advs.202413290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Revised: 12/08/2024] [Indexed: 01/23/2025]
Abstract
Fractures, with a yearly incidence of 1.2%, can lead to healing complications in up to 10% of cases. The angiogenic stimulant deferoxamine (DFO) is recognized for enhancing bone healing when administered into the fracture gap. This systematic review with meta-analysis investigates the effect of local DFO application on bone healing in rat and mouse models. EMBASE, MEDLINE (PubMed), and Web of Science are systematically searched in January 2024. The study is prospectively registered in PROSPERO (CRD42024492533), and the SYRCLE tool is used to assess study quality and risk of bias. Outcome values contain the primary endpoint bone volume fraction (BV/TV) as well as the secondary endpoints bone volume, tissue volume, bone mineral density, trabecular separation, trabecular thickness, vessel formation and the mechanical properties, assessed by µCT, angiography and mechanical strength tests. Out of 21 included studies, 18 qualify for meta-analysis, involving 539 animals. DFO-treated groups exhibit significantly higher BV/TV values (p < 0.0001) compared to controls, with similarly significant improvements in secondary outcomes. These findings highlight the substantial benefit of DFO in promoting bone healing, especially after radiotherapy. Rapid clinical implementation is recommended to help patients at high risk of fracture healing complications.
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Affiliation(s)
- Daniel Müller
- Department of Rheumatology and Clinical ImmunologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin10117BerlinGermany
| | - Jens Klotsche
- Deutsches Rheumaforschungszentrum Berlin (DRFZ)a Leibniz Institute10117BerlinGermany
| | - Magdalena B. Kosik
- Department of Rheumatology and Clinical ImmunologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin10117BerlinGermany
| | - Carsten Perka
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinCharitéCenter for Orthopedics und Traumatology10117BerlinGermany
| | - Frank Buttgereit
- Department of Rheumatology and Clinical ImmunologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin10117BerlinGermany
- Deutsches Rheumaforschungszentrum Berlin (DRFZ)a Leibniz Institute10117BerlinGermany
| | - Paula Hoff
- Department of Rheumatology and Clinical ImmunologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin10117BerlinGermany
- MVZ Endokrinologikum Berlin am Gendarmenmarkt10117BerlinGermany
| | - Timo Gaber
- Department of Rheumatology and Clinical ImmunologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin10117BerlinGermany
- Deutsches Rheumaforschungszentrum Berlin (DRFZ)a Leibniz Institute10117BerlinGermany
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Aranguren S, Cole H, Dargan LJ, Sarlo M, Choi S, Satapathy I, de Vasconcellos JF. Recent advances in the regulatory and non-coding RNA biology of osteogenic differentiation: biological functions and significance for bone healing. Front Cell Dev Biol 2025; 12:1483843. [PMID: 39834390 PMCID: PMC11743950 DOI: 10.3389/fcell.2024.1483843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 12/04/2024] [Indexed: 01/22/2025] Open
Abstract
Injuries associated with contemporary life, such as automobile crashes and sports injuries, can lead to large numbers of traumatic neuromuscular injuries that are intimately associated with bone fractures. Regulatory and non-coding RNAs play essential roles in multiple cellular processes, including osteogenic differentiation and bone healing. In this review, we discuss the most recent advances in our understanding of the regulatory and non-coding RNA biology of osteogenic differentiation in stem, stromal and progenitor cells. We focused on circular RNAs, small nucleolar RNAs and PIWI-interacting RNAs and comprehensively summarized their biological functions as well as discussed their significance for bone healing and tissue regeneration.
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18
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Sarigiannis CN, Ullman M, Andreasson I, Oldfors A, Björkman A. Inflammatory and degenerative changes in the extensor pollicis longus muscle and tendon following ruptures caused by distal radius fractures. BMC Musculoskelet Disord 2025; 26:10. [PMID: 39754134 PMCID: PMC11697914 DOI: 10.1186/s12891-024-08212-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 12/18/2024] [Indexed: 01/07/2025] Open
Abstract
BACKGROUND Rupture of extensor pollicis longus tendon (EPL) is a known complication following a distal radius fracture (DRF). Although the precise mechanisms behind these ruptures remain unclear, vascular impairment is thought to play a significant role. Additionally, the impact of an EPL rupture on microstructure of the tendon and muscle is not well understood, but such information could be important in guiding treatment strategies. This study aims to explore the histopathological changes in the EPL tendon and muscle in patients who have experienced an EPL rupture following a DRF. METHODS Consecutive patients with an EPL rupture following a DRF were included and treated with an Extensor Indicis Proprius to EPL tendon transfer. Samples were taken from the distal part of EPL muscle and the proximal tendon from the musculotendinous junction to the rupture site as well as from the tendon distal to the rupture. The tendon specimens were analysed by standard histopathological techniques including immunohistochemistry. In cases of sufficient amount of muscle, fresh frozen specimens were analysed by enzyme- and immuno-histochemistry on cryostat sections. RESULTS Thirteen patients (12 females, 1 male; median age 61, range 18-72 years) were included in the study. The EPL muscle in all participants showed extensive inflammatory changes, muscle fiber necrosis and regeneration, structural changes in the muscle fibers and slight interstitial fibrosis. The EPL tendon showed profound degenerative changes mainly in the central part of the tendon whereas there were regenerative changes in the periphery of the tendon. The pathological changes were present in all samples regardless of time between the DRF and the EPL rupture or the time between the diagnosis of the rupture and surgery. CONCLUSIONS The extensive inflammatory changes in the EPL muscle indicate that immune mediated mechanisms are involved in muscle degeneration following tendon rupture. The EPL tendon showed characteristic degenerative changes at the myotendinous junction, as well as proximally and distally to the rupture site. The reversibility and the clinical significance of the severe pathological changes seen in the EPL muscle alongside the healing potential of the tendon need further investigation. TRIAL REGISTRATION Retrospectively registered the 2024-03-15 at Clinicaltrials.gov, ID: NCT06313489.
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Affiliation(s)
- Christos Ni Sarigiannis
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Michael Ullman
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingrid Andreasson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Oldfors
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Björkman
- Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Taylor-Williams O, Keen H, Preen DB, Nossent J, Inderjeeth CA. First fracture in rheumatoid arthritis: analysis by fracture site, gender, age, and comorbidities. Osteoporos Int 2025; 36:113-121. [PMID: 39532717 DOI: 10.1007/s00198-024-07311-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 11/03/2024] [Indexed: 11/16/2024]
Abstract
Rheumatoid arthritis (RA) is a potentially devastating disorder associated with increased risk of fractures, but current studies do not completely evaluate the RA fracture risk profile. This study estimates fracture incidence by site of fracture and makes comparisons between RA and controls using the key variables gender, age, and comorbidities. BACKGROUND Rheumatoid arthritis RA is a potentially devastating osteoimmunological disorder, predisposing to osteoporosis (OP), fragility fracture (FF), and major osteoporotic fractures (MOF). As few studies incorporate statistical matching, comorbidity and non-MOF sites, we compared the incidence of first FF, MOF, and non-MOF in RA patients with a matched control cohort adjusting for comorbidities. METHODS This longitudinal cohort study uses routinely collected administrative data from the West Australian Rheumatic Disease Epidemiological Registry (WARDER) between 1980 and 2015. RA patients, as defined using International Classification of Disease (ICD) codes, were compared to hospitalised patients free of rheumatic disease. Case-control matching adjusted for age, gender, and comorbidities (Charlson Comorbidity Index). Incidence rates (IR) per 1000 person years (PY) with 95% confidence intervals (CI) were compared by incidence rate ratios (IRR). FINDINGS In RA patients from 2000 to 2010, the first fracture IR was 18.3 (15.7-21.2) for an IRR of 1.32 (1.10-1.60). Upper limb, lower limb, and axial IR were 5.56 (95% CI 4.18-7.26), 10.60 (95% CI 8.66-12.87), and 2.47 (95% CI 2.58-3.68) with IRR of 1.18 (95% CI 0.84-1.65), 1.44 (95% CI 1.19-1.86), and 1.01 (95% CI 0.61-1.63) respectively. The first fracture IR increased 6 years before first RA hospital record (RR 1.58, CI 1.05-2.39). CONCLUSIONS After age, gender, and comorbidity adjustment, RA is associated with a 32% higher incidence of first fracture, increased MOF, and a fracture incidence that is already increased before a first recorded RA diagnosis. This suggests a need for early attention to prevention of all fractures in RA patients.
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Affiliation(s)
- Owen Taylor-Williams
- Rheumatology Group, Medical School, University of Western Australia, Perth, Australia.
- Royal Perth Hospital, Perth, Australia.
| | - Helen Keen
- Department Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia
- Department Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Johannes Nossent
- Rheumatology Group, Medical School, University of Western Australia, Perth, Australia
- Department Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Charles A Inderjeeth
- Rheumatology Group, Medical School, University of Western Australia, Perth, Australia
- Department Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia
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Mascio A, Greco T, Comisi C, Cinelli V, De Gasperis N, Candelli M, Franceschi F, Covino M, Maccauro G, Perisano C. Foot and Ankle Trauma: Epidemiology Before, During, and Post COVID-19 Pandemic in a Level I Trauma Center: A 5-Year Experience and Data Analysis. J Clin Med 2024; 13:7585. [PMID: 39768506 PMCID: PMC11677254 DOI: 10.3390/jcm13247585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Revised: 12/02/2024] [Accepted: 12/08/2024] [Indexed: 01/10/2025] Open
Abstract
Background: Foot and ankle injuries are one of the leading orthopedic causes of emergency department (ED) admissions. The purpose of this study was to analyze, through 5 years of data collection, differences in number and type of admissions, as well as the severity of foot and ankle trauma to the ED in the pre-pandemic period, during the COVID-19 emergency, and in the post-pandemic period. This study aims to assess epidemiological and clinical data. Methods: Five years of data were collected on admissions to the ED at the Fondazione Policlinico Universitario A. Gemelli using an electronic database. The system allowed the use of a numeric code assessed at triage ranging from 1 to 5, where 1 indicated a patient with compromised vital functions, and it continued in decreasing criticality. Data were extensively analyzed and extrapolated to obtain epidemiological and clinical evaluation. Results: Data from 3787 patients, including 1945 males with a mean age of 41.4 years, were collected. Data were evaluated in the three different periods. In the pre-pandemic period, 2228 ED admissions were recorded, including 1138 males with a mean age of 37.4 years and a mean of 2.79 admissions per day. Codes 3 and 4 reported in the ED triage were 4.8% and 90.1%, respectively; the average surgical treatment was 5.6%. During the COVID period, the total number of admissions was 981, with 501 males with an average age of 43.8 years and a mean of 1.30 admissions per day. Codes 3 and 4 were 22.5% and 72.7%, respectively; the average surgical treatment was 10.4%. In the post-COVID period, 578 admissions were, including 306 males with a mean age of 43.2 years, and a daily access rate of 1.58 patients. Codes 3 and 4 reported in the ED triage were 25.4% and 70.8%, respectively; the average surgical treatment was 8.6%. Conclusions: During the pandemic period due to COVID-19 a substantial decrease in total admissions per day in the ED was noted, but an increase in more complex codes occurred, as evidenced by the percentage increase in surgical admissions compared to total admissions during the pandemic; the mean age of users gradually increased. Total hospitalization data remained stable in the post-pandemic period, likely due to the global impact of the pandemic. COVID-19 radically and concretely changed people's living habits and priorities for accessing the ED.
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Affiliation(s)
- Antonio Mascio
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00136 Rome, Italy; (A.M.); (V.C.); (G.M.); (C.P.)
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy;
| | - Tommaso Greco
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy;
- Department of Life Sciences, Health, and Healthcare Professions, Link Campus University, 00165 Rome, Italy;
| | - Chiara Comisi
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00136 Rome, Italy; (A.M.); (V.C.); (G.M.); (C.P.)
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy;
| | - Virginia Cinelli
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00136 Rome, Italy; (A.M.); (V.C.); (G.M.); (C.P.)
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy;
| | - Nicola De Gasperis
- Department of Life Sciences, Health, and Healthcare Professions, Link Campus University, 00165 Rome, Italy;
- Concordia Hospital, Via delle Sette Chiese, 90, 00145 Rome, Italy
| | - Marcello Candelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Catholic University of the Sacred Hearth, 00168 Rome, Italy; (M.C.); (F.F.); (M.C.)
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Catholic University of the Sacred Hearth, 00168 Rome, Italy; (M.C.); (F.F.); (M.C.)
| | - Marcello Covino
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Catholic University of the Sacred Hearth, 00168 Rome, Italy; (M.C.); (F.F.); (M.C.)
| | - Giulio Maccauro
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00136 Rome, Italy; (A.M.); (V.C.); (G.M.); (C.P.)
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy;
| | - Carlo Perisano
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00136 Rome, Italy; (A.M.); (V.C.); (G.M.); (C.P.)
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy;
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Gupta T, Shamim S, Ahmed A, Gupta V, Mazumdar G, Vaish A. A Study on Outcome of Conservative Management of Shaft Humerus Fracture: A Case Report. J Orthop Case Rep 2024; 14:252-256. [PMID: 39669033 PMCID: PMC11632492 DOI: 10.13107/jocr.2024.v14.i12.5088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 10/19/2024] [Indexed: 12/14/2024] Open
Abstract
Introduction Conservative or surgical treatment options are available for humeral shaft fractures. To pinpoint individuals who would benefit from early surgical fixation, fracture characteristics were examined. In conservative treatment, the "U" slab prevents displacement, and overriding is corrected by gravity while the patient continues to move about. Rotation is prohibited for 14 days by holding the arm immobile to the chest with the elbow flexed. The preferred course of treatment for fractures of the humeral shaft at all levels is the hanging cast. Materials and Methods This study was conducted at Eras Lucknow Medical College and Hospital. Forty patients with Humerus shaft fractures (HSF) who met the inclusion criteria and presented in casualty or outpatient department participated in the study. This prospective cross-sectional study was of 24 months duration. Statistical analysis Descriptive statistical analysis was performed to calculate the mean with corresponding standard deviations (s.d.). Test of proportion was used to find the standard normal deviate (Z) to compare the difference. Results The ratio of male and female (Male: Female) was 3:1. Test of proportion showed that the proportion of males (75.0%) was significantly higher than that of females (25.0%) (Z = 7.07; P < 0.001). Thus, in this study, the males were at higher risk of having fracture shaft of humerus than females. Right-sided fractures (57.5%) were significantly higher than left-sided fractures (42.5%) (Z = 2.12; P = 0.034). About 72.5% of the patients were with disabilities of the arm, shoulder, and hand (DASH) score between 14 and 16 which was significantly higher than other DASH scores (Z = 3.30; P < 0.0001). Conclusion Our observation regarding this study is that conservative management of HSF can be opted as the most effective way of treatment, and any complications due to any untoward event during the operative treatment should be limited.
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Affiliation(s)
- Tushar Gupta
- Department of Medicine, Apollo Hospital. New Delhi, India
| | - Sharib Shamim
- Department of Medicine, Apollo Hospital. New Delhi, India
| | - Afroz Ahmed
- Department of Orthopedics, Era Lucknow Medical College and Hospital, Lucknow, India
| | - Vipin Gupta
- Department of Medicine, Apollo Hospital. New Delhi, India
| | - Gourav Mazumdar
- Department of Orthopaedic, Deen Dayal Upadhyay Hospital, New Delhi, India
| | - Akansha Vaish
- Department of Medicine, Apollo Hospital. New Delhi, India
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Schweser K, Leary E, Levack AE, Marmor MT. Clinical relevance of current patient-reported outcome measures for ankle fracture: surgeons' perspective. OTA Int 2024; 7:e349. [PMID: 39479553 PMCID: PMC11524735 DOI: 10.1097/oi9.0000000000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 08/26/2024] [Accepted: 09/22/2024] [Indexed: 11/02/2024]
Abstract
Objectives Determine the relevance of the most frequently used patient-reported outcome measures (PROMs) for monitoring patient recovery after ankle fracture, from the clinical perspective of orthopaedic trauma surgeons, given lack of validated PROMs. Design Prospective cohort. Setting Orthopaedic Trauma Association committee meetings, electronic correspondence. Patients/Participants Orthopaedic trauma surgeons. Intervention Delphi method for consensus activities. Level of Evidence IV. Main Outcome Measurements Most clinically relevant PROMs for ankle fracture recovery. Results Several English-language PROMs were identified based on use in literature and relevance to ankle fractures. 7 were selected by expert consensus. These are the Ankle Fracture Outcome of Rehabilitation Measure (A-FORM), Foot and Ankle Ability Measure (FAAM), American Academy of Orthopaedic Surgeons (AAOS), Foot and Ankle Disability Index (FADI) Score, Lower Extremity Functional Scale (LEFS), Olerud-Molander Ankle Score (OMAS), and Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF). The most clinically relevant PROM is the A-FORM, followed by the AAOS, LEFS, PROMIS PF, FADI, and OMAS, and the least clinically relevant overall, the FAAM. Conclusions Understanding which PROM best matches physician expectations for tracking recovery is an important step toward a robust, evidence-based approach to patient care. The A-FORM was identified as the most clinically relevant among the most used PROMs. These results will aid surgeons, clinicians, and scientists to identify a uniformly, clinically relevant PROM for the treatment and study of outcomes and recovery after isolated ankle fracture.
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Affiliation(s)
- Kyle Schweser
- Missouri Orthopaedic Institute and Department of Orthopaedic Surgery, School of Medicine, University of Missouri, Columbia, MO
| | - Emily Leary
- Missouri Orthopaedic Institute and Department of Orthopaedic Surgery, School of Medicine, University of Missouri, Columbia, MO
- Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO
| | - Ashley E. Levack
- Loyola University Stritch School of Medicine, Loyola University Medical Center, Maywood, IL
| | - Meir T. Marmor
- Zuckerberg San Francisco General Hospital, Orthopaedic Trauma Institute, University of California San Francisco, San Francisco, CA
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Truter P, Pelletier I, Coates S, Giglia-Smith L, Richards K, Mountain D, Bulsara C, Spilsbury K, Edgar DW. Is clinician reported practice in Western Australian emergency departments aligned with direct discharge pathway protocols for minor self-limiting fractures? A multi-centre professional survey. Emerg Med Australas 2024; 36:920-928. [PMID: 39090806 DOI: 10.1111/1742-6723.14474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE To determine ED clinician's current management for five common minor self-limiting fractures (MSLF) and evaluate practice against evidence-informed direct discharge pathway (DD) protocols. METHODS A survey was provided to doctors, nurse practitioners and advanced scope physiotherapists working in seven metropolitan, public health EDs in Perth, Australia. The relative odds of ED location (e.g. which facility) and clinician level factors (e.g. country of initial training, years of ED experience, profession) on recommending care completely consistent with evidence informed direct discharge pathway protocols were estimated. RESULTS Two hundred sixty-two clinicians completed the survey. There was variability in practice across all sites, with most reported care assessed at 60%-76% consistency with individual elements of DD care provision. Highest consistency was seen in lower limb immobilisation and DVT prophylaxis. Lowest consistency was seen in weight bearing advice, pain management and (boxer's) fracture reduction and immobilisation. There were very low levels of complete consistency, ranging from 9% (boxer's fracture) to 25% (radial head fracture). Two factors were associated with increased odds of completely consistent care: (i) clinician experience working in ED, with greater duration of practice associated with increased odds ratios (OR range, 1.6-3.3); and (ii) profession, where advanced scope physiotherapy was associated with increased odds ratios (OR range, 3.2-25.0). CONCLUSIONS Survey results suggested system wide variation in ED fracture management practice and target areas for service improvement. Avenues for service improvement could include hospital wide agreed management plans for specific fractures and support for less experienced clinicians.
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Affiliation(s)
- Piers Truter
- School of Health Sciences, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Physiotherapy Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Physiotherapy Department, Rockingham Hospital, Perth, Western Australia, Australia
| | - Irene Pelletier
- Emergency Department, Joondalup Health Campus, Perth, Western Australia, Australia
| | - Sophie Coates
- Physiotherapy Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Louise Giglia-Smith
- Physiotherapy Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Karen Richards
- Physiotherapy Department, SJOG Midland Public and Private Hospital, Perth, Western Australia, Australia
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - David Mountain
- Emergency Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Curtin University Medical School, Perth, Western Australia, Australia
| | - Caroline Bulsara
- School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Katrina Spilsbury
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Dale W Edgar
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Discipline of Surgery, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
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Gräschke E, Jarvers JS, Heyde CE, Spiegl UAJ. Characteristics and outcomes of inpatients aged 85 and older with thoracolumbar vertebral fractures: impact on hospital stay and mortality. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:4504-4512. [PMID: 39436426 DOI: 10.1007/s00586-024-08520-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 09/23/2024] [Accepted: 10/03/2024] [Indexed: 10/23/2024]
Abstract
BACKGROUND There is a gap in evidence about medical outcomes in oldest-old patients (aged 85 and older) with vertebral fractures (VFs). The aim of this study was to evaluate the impact of patient and fracture characteristics on "short-term" hospital outcomes. METHODS All patients aged ≥ 85 presenting an acute or subsequent VF at our single level I spine center between 2019 and 2021 requiring hospital treatment were included. The data collection was conducted retrospectively. The primary parameters of interest were length of stay (LOS) and in-hospital mortality. Further outcome parameters were the occurrence of general (non-operative) complications and Intensive Care Unit (ICU) admission. For statistical analysis, linear and binary logistic regression modeling were performed. RESULTS A total of 153 patients with an average age of 88.5 (range 85 to 99) met the inclusion criteria. Our patients were mostly female (68.6%) and moderately comorbid according to a Charlson Comorbidity Index (CCI) of 2.9. 58.8% had diagnosed osteoporosis. Fracture morphologies represented as "Osteoporotic Fracture" (OF) classification types were of central importance for undergoing operative treatment (OP) (p < 0.001), necessity for intensive care (p = 0.023), LOS (p = 0.014), and mortality (p = 0.018). 38.6% had OP. We recorded a complication rate of 59.5%, which highly influenced (p < 0.001) both primary outcome parameters. Overall, patients stayed 14.6 days with a mortality of 11.1%. CONCLUSION VFs are a severe event in oldest-old patients with a crucial risk of poor medical outcomes during hospitalization. The fracture morphologies are of central importance. However, little is known about the hospital stay of oldest-old inpatients with VFs. Considering an aging population, further investigations would be recommended.
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Affiliation(s)
- Erik Gräschke
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Jan-Sven Jarvers
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Christoph-Eckhard Heyde
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
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Chidda A, Soares S, Nogueira P, Schwab JM, Tannast M, Seidel A. Osteosynthesis with anatomic reduction after malleolar fractures improves ten years outcome: a single center trial. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 35:28. [PMID: 39589566 PMCID: PMC11599394 DOI: 10.1007/s00590-024-04153-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Accepted: 11/10/2024] [Indexed: 11/27/2024]
Abstract
INTRODUCTION Malleolar fractures are the most common ankle fractures and a major risk factor for ankle osteoarthritis in the long-term. Little is known about modifiable risk factors for a satisfactory outcome. This study aimed to assess the long-term clinical, functional and radiological outcomes in patients after osteosynthesis. METHODS In this retrospective single center study, we assessed the difference in patients who underwent surgical intervention for malleolar fractures sustained between 2007 and 2014. The reduction was assessed on the first postoperative radiograph. At follow-up patients completed a questionnaire, including the European Foot and Ankle Society (EFAS) and Short Form-12 (SF-12) scores to evaluate patient-reported outcomes and quality of life. Ankle osteoarthritis was assessed using the Kellgren and Lawrence classification. RESULTS One hundred seventeen patients, 102 with anatomic reduction and 15 with malreduction, were reached at mean follow-up at 11.4 years and 10.9 years. The mean EFAS score was 18,0 for anatomic and 16,1 for nonanatomic reduction and 6.1 and 4.5 for the sport component. The rate of satisfaction with the result was 8.2 in anatomic reduction and 7.5 in the malreduction. There was no significant difference in the SF-12 group between the two groups. Anatomic reduction is a protective facture for a satisfactory outcome in the univariate model with the hazard ratio of 5.94. CONCLUSION Anatomic reduction is one of the strongest protective factors for satisfactory outcome after malleolar fractures in a follow-up of more than 10 years.
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Affiliation(s)
- Amal Chidda
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Chemin Des Pensionnats 2-6, 1708, Fribourg, Switzerland
| | - Sérgio Soares
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Chemin Des Pensionnats 2-6, 1708, Fribourg, Switzerland
| | - Pedro Nogueira
- Department of Orthopaedic Surgery and Traumatology, Valais Hospital, Martiny, Switzerland
| | - Joseph M Schwab
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Chemin Des Pensionnats 2-6, 1708, Fribourg, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland
| | - Angela Seidel
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Chemin Des Pensionnats 2-6, 1708, Fribourg, Switzerland.
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Bingol I, Kamaci S, Yilmaz ET, Oral M, Yasar NE, Dumlupinar E, Ata N, Ulgu MM, Birinci S, Bayram S, Tokgozoglu AM, Demirors H. The epidemiology of geriatric fractures: A nationwide analysis of 1 million fractures. Injury 2024; 55:111900. [PMID: 39332226 DOI: 10.1016/j.injury.2024.111900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 08/23/2024] [Accepted: 09/15/2024] [Indexed: 09/29/2024]
Abstract
OBJECTIVE Fractures among the geriatric population impose a substantial burden on healthcare systems. This study aims to investigate the incidence and distribution of fractures among geriatric individuals over seven years, analyzing changes by age and sex. The findings will inform national healthcare strategies for addressing the growing impact of geriatric fractures. MATERIALS AND METHODS Electronic health records from a nationwide personal health records system were analyzed, focusing on ICD-10 codes for fractures. Recurrent codes for the same patients within three months were excluded. Patients were categorized into three age groups (65-74, 75-84, and 85+ years), and fractures were grouped anatomically. Incidence rates for specific fracture locations were calculated based on the actual population at risk annually. Incidence rates were further stratified by sex and age groups using Turkey's age- and sex-specific populations. RESULTS A total of 1,004,663 geriatric fractures (66.9 % female, 33.1 % male) were identified over seven years. The overall fracture incidence among the geriatric population was 1.9 % (1910/100,000). Hip fractures were the most common (25.2 %), followed by wrist (15 %) and lumbar-pelvic fractures (11.9 %). Femur fractures were predominant in the 75-84 and 85+ age groups, while wrist fractures were more common in the 65-74 age group. Fracture incidences generally increased with age, except for ankle, foot, and toe fractures, which decreased with age for both sexes (p < 0.05). The male/female ratio was lowest for wrist, elbow, and humeral shaft fractures (1:3.2, 1:2.7, and 1:2.7, respectively). The lowest overall fracture incidence was observed in 2020 (1568/100,000), while the highest was in 2017 (2523/100,000). CONCLUSION With Turkey's aging population, the socioeconomic impact of geriatric fractures is anticipated to rise. Fracture patterns and incidence vary by age and sex among geriatric individuals. These findings provide valuable insights for healthcare planning and the development of community-based preventive measures tailored to specific fracture locations and demographics.
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Affiliation(s)
- Izzet Bingol
- Department of Orthopaedics and Traumatology, Ankara Yildirim Beyazit University, Ankara, Türkiye.
| | - Saygin Kamaci
- Department of Orthopaedics and Traumatology, Hacettepe University, Ankara, Türkiye
| | - Engin Turkay Yilmaz
- Department of Orthopaedics and Traumatology, Hacettepe University, Ankara, Türkiye
| | - Melih Oral
- Department of Orthopaedics and Traumatology, Hacettepe University, Ankara, Türkiye
| | - Niyazi Erdem Yasar
- Department of Orthopaedics and Traumatology, Health Sciences University, Ankara Bilkent City Hospital, Ankara, Türkiye
| | - Ebru Dumlupinar
- Faculty of Medicine, Department of Biostatistics, Ankara University, Ankara, Türkiye
| | - Naim Ata
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Türkiye
| | - M Mahir Ulgu
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Türkiye
| | | | - Sinem Bayram
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Türkiye
| | | | - Huseyin Demirors
- Department of Orthopaedics and Traumatology, Bayındır Hospital, Ankara, Türkiye
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Li B, Liu C, Alt V, Rupp M, Zhang N, Cheung WH, Jantsch J, Wong RMY. Multidisciplinary approach and host optimization for fracture-related infection management. Injury 2024; 55 Suppl 6:111899. [PMID: 39482032 DOI: 10.1016/j.injury.2024.111899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 08/29/2024] [Accepted: 09/15/2024] [Indexed: 11/03/2024]
Abstract
In orthopaedic trauma, fracture-related infections (FRI) are still dreadful challenges that can cause non-union, amputation and even death. Standardization of general treatment strategies for FRI is still lacking. Due to the complexity of FRI, a multidisciplinary approach addressing host status, state of the fracture and causative microorganism has been applied in the management of FRI. Surgical treatment, antibiotic therapy and host optimization for FRI were summarized and discussed. The goal of this review is to provide an overview and summary of current approaches of FRI management and to make suggestions on FRI prevention and treatment based on multidisciplinary principles.
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Affiliation(s)
- Baoqi Li
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chaoran Liu
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Germany
| | - Ning Zhang
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wing-Hoi Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jonathan Jantsch
- Institute for Medical Microbiology, Immunology, and Hygiene, and Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Ronald Man Yeung Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
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Wentzel D, Root C, Dallman J, Mar D, Templeton K. Fractures in the Transgender Population: A Descriptive Study. Kans J Med 2024; 17:142-145. [PMID: 39758537 PMCID: PMC11698576 DOI: 10.17161/kjm.vol17.22384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/26/2024] [Indexed: 01/07/2025] Open
Abstract
Introduction While there is some data on the bone health of transgender individuals, less is known about their fracture patterns. The authors of this study aimed to describe the anatomic locations of fractures and the prevalence of select comorbidities among transgender patients who presented with fractures at a single institution. Methods The authors conducted a retrospective chart review of patients with fractures at a single institution between January 2020 and January 2021. The study examined demographics, fracture locations, and comorbidities for all transgender individuals who sustained fractures. Results The average age of patients was 35.7 ± 13.2 years. The shoulder and upper arm were the most common fracture sites, accounting for 38% of injuries. Twenty-seven percent of transgender patients presented with multiple fractures. Notably, no lumbar spine fractures were observed in this group. The prevalence of depression was 54%, and hypertension was 19% among transgender patients. Although 85% of fractures were not due to high-energy trauma, none of the patients had a documented history of bone health disorders. Conclusions This study provides insights into the fracture patterns among transgender individuals at a single institution, highlighting a tendency toward low-energy fractures in a relatively young population. Further research, including age-matched comparative studies, is needed to better understand bone health and fracture risk in transgender patients.
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Affiliation(s)
- Dylan Wentzel
- The University of Kansas School of Medicine-Kansas City, Kansas City, Kansas
| | - Cooper Root
- The University of Kansas School of Medicine-Wichita, Wichita, Kansas
| | - Johnathan Dallman
- The University of Kansas School of Medicine-Kansas City, Kansas City, Kansas
- Department of Orthopedic Surgery and Sport Medicine
| | - Damon Mar
- The University of Kansas School of Medicine-Kansas City, Kansas City, Kansas
- Department of Orthopedic Surgery and Sport Medicine
| | - Kimberly Templeton
- The University of Kansas School of Medicine-Kansas City, Kansas City, Kansas
- Department of Orthopedic Surgery and Sport Medicine
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Shi V, Morgan EF. Estrogen and estrogen receptors mediate the mechanobiology of bone disease and repair. Bone 2024; 188:117220. [PMID: 39106937 PMCID: PMC11392539 DOI: 10.1016/j.bone.2024.117220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/28/2024] [Accepted: 07/30/2024] [Indexed: 08/09/2024]
Abstract
It is well understood that the balance of bone formation and resorption is dependent on both mechanical and biochemical factors. In addition to cell-secreted cytokines and growth factors, sex hormones like estrogen are critical to maintaining bone health. Although the direct osteoprotective function of estrogen and estrogen receptors (ERs) has been reported extensively, evidence that estrogen signaling also has a role in mediating the effects of mechanical loading on maintenance of bone mass and healing of bone injuries has more recently emerged. Recent studies have underscored the role of estrogen and ERs in many pathways of bone mechanosensation and mechanotransduction. Estrogen and ERs have been shown to augment integrin-based mechanotransduction as well as canonical Wnt/b-catenin, RhoA/ROCK, and YAP/TAZ pathways. Estrogen and ERs also influence the mechanosensitivity of not only osteocytes but also osteoblasts, osteoclasts, and marrow stromal cells. The current review will highlight these roles of estrogen and ERs in cellular mechanisms underlying bone mechanobiology and discuss their implications for management of osteoporosis and bone fractures. A greater understanding of the mechanisms behind interactions between estrogen and mechanical loading may be crucial to addressing the shortcomings of current hormonal and pharmaceutical therapies. A combined therapy approach including high-impact exercise therapy may mitigate adverse side effects and allow an effective long-term solution for the prevention, treatment, and management of bone fragility in at-risk populations. Furthermore, future implications to novel local delivery mechanisms of hormonal therapy for osteoporosis treatment, as well as the effects on bone health of applications of sex hormone therapy outside of bone disease, will be discussed.
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Affiliation(s)
- Vivian Shi
- Boston University, Department of Biomedical Engineering, 44 Cummington St, Boston 02215, MA, USA; Center for Multiscale and Translational Mechanobiology, Boston University, 44 Cummington St, Boston 02215, MA, USA
| | - Elise F Morgan
- Boston University, Department of Biomedical Engineering, 44 Cummington St, Boston 02215, MA, USA; Center for Multiscale and Translational Mechanobiology, Boston University, 44 Cummington St, Boston 02215, MA, USA.
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Börjesson E, Johannesson K, Ekelund J, Rydberg EM. Non-surgical treatment of lateral malleolar fractures is safe: long-term follow-up of a comprehensive treatment algorithm. BMC Musculoskelet Disord 2024; 25:818. [PMID: 39415180 PMCID: PMC11481417 DOI: 10.1186/s12891-024-07924-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 10/07/2024] [Indexed: 10/18/2024] Open
Abstract
INTRODUCTION A study at Sahlgrenska University Hospital (SU) found significant variation in the treatment of ankle fractures, leading to the development of a structured treatment algorithm (TA). The TA aimed to standardise treatment and reduce the number of unnecessary surgical procedures. A follow-up study concluded that the number of surgeries had significantly decreased since the TA was introduced. However, the long-term effects of the TA and the reduced number of surgical procedures remain unclear. The aim of the study was to analyse the long-term effects of a structured TA for ankle fractures, focusing on complications and reoperation rates. METHOD The present study is a long-term follow-up of the same two cohorts of patients with lateral malleolar fractures of type AO/OTA44-B1, as studied in the previous studies on the TA for ankle fractures at SU. The current study compares a group of AO/OTA 44B1 fractures treated before introducing the TA, the pre-TA cohort (n = 410), with a group treated after introducing the TA, the post-TA cohort (n = 333). Both cohorts were followed for at least four years, and the outcomes were reoperation or complication. Reoperation was defined as any surgical procedure performed ≥ 30 days after the injury. RESULTS The results highlight a statistically significant reduction in the reoperation rate for lateral malleolar ankle fractures from 7.1 to 2.4% (p = 0.006) after introducing a TA that reduced the number of primary surgical procedures. Hardware-related issues were identified as the dominant cause of reoperation in both cohorts. Three major reoperations were observed in the pre-TA cohort compared to none in the post-TA cohort. The present study revealed no increase in the frequency of reoperations (late surgeries) due to non-union. CONCLUSION The non-surgical treatment of stable ankle fractures does not lead to an increase in reoperations caused by non-union. A TA that reduces the need for primary surgical procedures for lateral malleolar fractures of type AO/OTA44-B1 has resulted in a significant decrease in reoperation rates and no increase in failure rates. This long-term follow-up demonstrates that a non-surgical approach to isolated lateral malleolar fractures is safe.
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Affiliation(s)
- Erik Börjesson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Orthopaedics, Sahlgrenska University Hospital, Göteborgsvägen 31, Gothenburg, Mölndal, SE-431 80, Sweden.
| | - Karolina Johannesson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Ekelund
- Centre of Registers Gothenburg, Gothenburg, Sweden
| | - Emilia Möller Rydberg
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Göteborgsvägen 31, Gothenburg, Mölndal, SE-431 80, Sweden
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Sicard L, Maillard S, Mbita Akoa D, Torrens C, Collignon AM, Coradin T, Chaussain C. Sclerostin Antibody-Loaded Dense Collagen Hydrogels Promote Critical-Size Bone Defect Repair. ACS Biomater Sci Eng 2024; 10:6451-6464. [PMID: 39269225 DOI: 10.1021/acsbiomaterials.4c00883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
The management of extensive bone loss remains a clinical challenge. Numerous studies are underway to develop a combination of biomaterials, biomolecules, and stem cells to address this challenge. In particular, the systemic administration of antibodies against sclerostin, a regulator of bone formation, was recently shown to enhance the bone repair efficiency of dense collagen hydrogels (DCHs) hosting murine dental pulp stem cells (mDPSCs). The aim of the present study was to assess whether these antibodies, encapsulated and released from DCHs, could promote craniofacial bone repair by the local inhibition of sclerostin. In vitro studies showed that antibody loading modified neither the hydrogel structure nor the viability of seeded mDPSCs. When implanted in a mouse calvaria critical-size bone defect, antibody-loaded DCHs showed repair capabilities similar to those of acellular unloaded DCHs combined with antibody injections. Importantly, the addition of mDPSCs provided no further benefit. Altogether, the local delivery of antisclerostin antibodies from acellular dense collagen scaffolds is highly effective for bone repair. The drastic reduction in the required amount of antibody compared to systemic injection should reduce the cost of the procedure, making the strategy proposed here a promising therapeutic approach for large bone defect repair.
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Affiliation(s)
- Ludovic Sicard
- Université Paris Cité, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), 92120 Montrouge, France
- AP-HP, Dental Medicine Departments, Bretonneau and Louis Mourier Hospitals, GHN-Université Paris Cité, 75018 Paris, France
| | - Sophie Maillard
- Université Paris Cité, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), 92120 Montrouge, France
| | - Daline Mbita Akoa
- Sorbonne Université, CNRS, Laboratoire de Chimie de la Matière Condensée de Paris (LCMCP), UMR 7574, 4 Place Jussieu, 75005 Paris, France
| | - Coralie Torrens
- Université Paris Cité, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), 92120 Montrouge, France
| | - Anne-Margaux Collignon
- Université Paris Cité, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), 92120 Montrouge, France
- AP-HP, Dental Medicine Departments, Bretonneau and Louis Mourier Hospitals, GHN-Université Paris Cité, 75018 Paris, France
| | - Thibaud Coradin
- Sorbonne Université, CNRS, Laboratoire de Chimie de la Matière Condensée de Paris (LCMCP), UMR 7574, 4 Place Jussieu, 75005 Paris, France
| | - Catherine Chaussain
- Université Paris Cité, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), 92120 Montrouge, France
- AP-HP, Dental Medicine Departments, Bretonneau and Louis Mourier Hospitals, GHN-Université Paris Cité, 75018 Paris, France
- AP-HP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Dental Medicine Department, Bretonneau Hospital, GHN-Université Paris Cité, 75018 Paris, France
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Husarek J, Hess S, Razaeian S, Ruder TD, Sehmisch S, Müller M, Liodakis E. Artificial intelligence in commercial fracture detection products: a systematic review and meta-analysis of diagnostic test accuracy. Sci Rep 2024; 14:23053. [PMID: 39367147 PMCID: PMC11452402 DOI: 10.1038/s41598-024-73058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 09/12/2024] [Indexed: 10/06/2024] Open
Abstract
Conventional radiography (CR) is primarily utilized for fracture diagnosis. Artificial intelligence (AI) for CR is a rapidly growing field aimed at enhancing efficiency and increasing diagnostic accuracy. However, the diagnostic performance of commercially available AI fracture detection solutions (CAAI-FDS) for CR in various anatomical regions, their synergy with human assessment, as well as the influence of industry funding on reported accuracy are unknown. Peer-reviewed diagnostic test accuracy (DTA) studies were identified through a systematic review on Pubmed and Embase. Diagnostic performance measures were extracted especially for different subgroups such as product, type of rater (stand-alone AI, human unaided, human aided), funding, and anatomical region. Pooled measures were obtained with a bivariate random effects model. The impact of rater was evaluated with comparative meta-analysis. Seventeen DTA studies of seven CAAI-FDS analyzing 38,978 x-rays with 8,150 fractures were included. Stand-alone AI studies (n = 15) evaluated five CAAI-FDS; four with good sensitivities (> 90%) and moderate specificities (80-90%) and one with very poor sensitivity (< 60%) and excellent specificity (> 95%). Pooled sensitivities were good to excellent, and specificities were moderate to good in all anatomical regions (n = 7) apart from ribs (n = 4; poor sensitivity / moderate specificity) and spine (n = 4; excellent sensitivity / poor specificity). Funded studies (n = 4) had higher sensitivity (+ 5%) and lower specificity (-4%) than non-funded studies (n = 11). Sensitivity did not differ significantly between stand-alone AI and human AI aided ratings (p = 0.316) but specificity was significantly higher the latter group (p < 0.001). Sensitivity was significant lower in human unaided compared to human AI aided respectively stand-alone AI ratings (both p ≤ 0.001); specificity was higher in human unaided ratings compared to stand-alone AI (p < 0.001) and showed no significant differences AI aided ratings (p = 0.316). The study demonstrates good diagnostic accuracy across most CAAI-FDS and anatomical regions, with the highest performance achieved when used in conjunction with human assessment. Diagnostic accuracy appears lower for spine and rib fractures. The impact of industry funding on reported performance is small.
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Affiliation(s)
- Julius Husarek
- Department of Orthopaedic Surgery and Traumatology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- University of Bern, Bern, Switzerland
- Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Silvan Hess
- Department of Orthopaedic Surgery and Traumatology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Sam Razaeian
- Department for Trauma, Hand and Reconstructive Surgery, Saarland University, Kirrberger Str. 100, 66421, Homburg, Germany
| | - Thomas D Ruder
- Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University Institute of Diagnostic, University of Bern, Bern, Switzerland
| | - Stephan Sehmisch
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Martin Müller
- Department of Emergency Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Emmanouil Liodakis
- Department for Trauma, Hand and Reconstructive Surgery, Saarland University, Kirrberger Str. 100, 66421, Homburg, Germany.
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Pisljagic S, Temberg JL, Steensbæk MT, Yousef S, Maagaard M, Chafranska L, Lange KHW, Rothe C, Lundstrøm LH, Nørskov AK. Peripheral nerve blocks for closed reduction of distal radius fractures-A systematic review with meta-analysis and trial sequential analysis. Acta Anaesthesiol Scand 2024; 68:1149-1160. [PMID: 39039732 DOI: 10.1111/aas.14474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/26/2024] [Accepted: 06/04/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Peripheral nerve blocks may provide better conditions for closed reduction of distal radius fractures as compared to other more frequently used modalities. In this systematic review, we evaluate existing evidence on the effect and harm of peripheral nerve blocks for closed reduction of distal radius fractures in adults. METHODS We performed a systematic review with meta-analysis and trial sequential analysis including trials investigating the use of peripheral nerve blocks for closed reduction of distal radius fractures. Co-primary outcomes were (1) the quality of the closed reduction measured as the proportion of participants needing surgery afterwards and (2) pain during closed reduction. RESULTS Six trials (n = 312) met the inclusion criteria. One trial reported on the need for surgery with 4 of 25 participants receiving nerve block compared to 7 of 25 receiving haematoma block needing surgery (RR 0.57, 96.7% CI [0.19; 1.71], p = .50). Four trials reported pain during closed reduction. In a meta-analysis, pain was not statistically significantly reduced with a nerve block (-2.1 Numeric Rating Scale (NRS) points (0-10), 96.7% CI [-4.4; 0.2], p = .07, tau2 = 5.4, I2 = 97%, TSA-adj. 95% CI [-11.5; 7.3]). No trial sequential boundaries were crossed, and the required information size was not met. Pre-planned subgroup analysis on trials evaluating ultrasound guided peripheral nerve blocks (patients = 110) showed a significant decrease in 'pain during reduction' (-4.1 NRS, 96.7% CI [-5.5; -2.6], p < .01, tau2 = 0.9, I2 = 80%). All trial results were at high risk of bias and the certainty of the evidence was very low. CONCLUSION The certainty of evidence on the effect of peripheral nerve blocks for closed reduction of distal radius fractures is currently very low. Peripheral nerve blocks performed with ultrasound guidance may potentially reduce pain during closed reduction. High-quality clinical trials are warranted.
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Affiliation(s)
- Sanja Pisljagic
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Jens L Temberg
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Mathias T Steensbæk
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Sina Yousef
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Mathias Maagaard
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Køge, Denmark
| | - Lana Chafranska
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Kai H W Lange
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Rothe
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
| | - Lars H Lundstrøm
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders K Nørskov
- Department of Anaesthesiology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Baik SH, Baye F, McDonald CJ. Response to letter to editor. Menopause 2024; 31:940-941. [PMID: 39078665 DOI: 10.1097/gme.0000000000002421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Affiliation(s)
- Seo H Baik
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institute of Health, Bethesda, MD
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Herpe G, Nelken H, Vendeuvre T, Guenezan J, Giraud C, Mimoz O, Feydy A, Tasu JP, Guillevin R. Effectiveness of an Artificial Intelligence Software for Limb Radiographic Fracture Recognition in an Emergency Department. J Clin Med 2024; 13:5575. [PMID: 39337062 PMCID: PMC11433213 DOI: 10.3390/jcm13185575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 09/08/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
Objectives: To assess the impact of an Artificial Intelligence (AI) limb bone fracture diagnosis software (AIS) on emergency department (ED) workflow and diagnostic accuracy. Materials and Methods: A retrospective study was conducted in two phases-without AIS (Period 1: 1 January 2020-30 June 2020) and with AIS (Period 2: 1 January 2021-30 June 2021). Results: Among 3720 patients (1780 in Period 1; 1940 in Period 2), the discrepancy rate decreased by 17% (p = 0.04) after AIS implementation. Clinically relevant discrepancies showed no significant change (-1.8%, p = 0.99). The mean length of stay in the ED was reduced by 9 min (p = 0.03), and expert consultation rates decreased by 1% (p = 0.38). Conclusions: AIS implementation reduced the overall discrepancy rate and slightly decreased ED length of stay, although its impact on clinically relevant discrepancies remains inconclusive. Key Point: After AI software deployment, the rate of radiographic discrepancies decreased by 17% (p = 0.04) but this was not clinically relevant (-2%, p = 0.99). Length of patient stay in the emergency department decreased by 5% with AI (p = 0.03). Bone fracture AI software is effective, but its effectiveness remains to be demonstrated.
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Affiliation(s)
- Guillaume Herpe
- Emergency Radiology Unit, University Hospital Center of Poitiers, 86000 Poitiers, France
- Laboratoire de Mathématiques Appliquées LMA, CNRS UMR 7348, 86021 Poitiers, France
| | - Helena Nelken
- Emergency Radiology Unit, University Hospital Center of Poitiers, 86000 Poitiers, France
| | - Tanguy Vendeuvre
- Emergency Department, University Hospital Center of Poitiers, 86000 Poitiers, France
| | - Jeremy Guenezan
- Emergency Department, University Hospital Center of Poitiers, 86000 Poitiers, France
| | - Clement Giraud
- Laboratoire de Mathématiques Appliquées LMA, CNRS UMR 7348, 86021 Poitiers, France
| | - Olivier Mimoz
- Emergency Department, University Hospital Center of Poitiers, 86000 Poitiers, France
| | - Antoine Feydy
- Department of Musculoskeletal Imaging, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Jean-Pierre Tasu
- Department of Diagnostic and Interventional Radiology, Poitiers University Hospital, 86000 Poitiers, France
| | - Rémy Guillevin
- Emergency Department, University Hospital Center of Poitiers, 86000 Poitiers, France
- CHU de Poitiers Service de Radiologie, 86000 Poitiers, France
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Najdaghi S, Azizkhani R, Fatemi NAS, Nasr Isfahani M, Salamati P. The epidemiology of spinal fractures: A nationwide data-based study in Iran. Qatar Med J 2024; 2024:42. [PMID: 39319018 PMCID: PMC11420553 DOI: 10.5339/qmj.2024.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 07/22/2024] [Indexed: 09/26/2024] Open
Abstract
Background Blunt trauma is a physical injury to a part of the body, mainly caused by road accidents, direct blows, attacks, sports injuries, and falls in elderly people. Spinal fractures are observed only in a small percentage of injured patients. Accordingly, the present study was conducted on collected data between 2018 and 2022 to determine the frequency of spinal fractures in blunt trauma in Iran while also considering the mechanism of injury as a secondary outcome of interest. Methods In this retrospective study, blunt trauma patients with spinal fractures, regardless of age were included by the census sampling method. Data were obtained from the National Trauma Registry of Iran. Means and standard deviations were used for continuous variables, and the chi-square test was used to assess the relationship between the variables. Results Among 25,986 cases of all-cause trauma patients, 1,167 cases (4.5%) of blunt trauma and spinal fracture were included in the study. Gender, the severity of injury, and the cause of trauma showed a significant difference among different age groups (p < 0.05). Significant differences were found in the injury mechanisms across various spine regions (p < 0.05). The majority of patients (68.2%) had lumbar spinal fractures. Road traffic collisions were the most common cause of spinal cord injuries, accounting for 58.3% of cases, followed by falls (36.1%). The injury severity score was higher in younger patients (under 18 years old), with a mean of 4.4 ± 3.5, and in patients with cervical injuries. The majority of injuries occurred in the lumbar area (68.2%), followed by the thoracic area. Furthermore, notable variations existed in Emergency Room (ER) stay duration, overall hospitalization, Intensive Care Unit (ICU) stay duration, and injury severity levels, all influenced by the spinal regions (p < 0.05). Distinctively, ICU stay durations and ER stay duration showed significant differences, particularly in relation to injuries in the lumbar and thoracic regions (p < 0.05). Conclusion According to the results of the present study, trauma is more severe, and cervical injuries are more common in young people, which is a critical finding that underscores the need for targeted interventions to mitigate the severity of trauma in this age group. Additionally, the majority of cervical injuries occurred in young people, which is a particularly concerning finding given the potential for long-term disability and impact on quality of life. Our findings suggest that strategies to reduce cervical injuries, such as speed control, seat belt use, and phone-free driving, are crucial interventions for mitigating the severity of trauma and promoting patient outcomes in young people.
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Affiliation(s)
- Soroush Najdaghi
- Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Azizkhani
- Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Neda Al-Sadat Fatemi
- Trauma Data Registration Center, Al-Zahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Health in Disaster and Emergencies, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Nasr Isfahani
- Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Trauma Data Registration Center, Al-Zahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran *
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Nicolas T, Ségolène R, Thierry R, Maeva D, Joelle V, Arnaud P, Ludmila B, Pierre W, Pierre C, Baptiste C. Multiparametric influence of 3D-printed organo-mineral scaffolds on bone regeneration. Sci Rep 2024; 14:20848. [PMID: 39242756 PMCID: PMC11379694 DOI: 10.1038/s41598-024-71698-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 08/30/2024] [Indexed: 09/09/2024] Open
Abstract
The development of synthetic bone substitutes that equal or exceed the efficacy of autologous graft remains challenging. In this study, a rat calvarial defect model was used as a reference to investigate the influence of composition and architecture of 3D-printed cement, with or without bioactives, on tissue regeneration. Printable cement pastes were formulated by combining hyaluronic acid and cement precursors. Cementitious scaffolds were printed with 3 different patterns. After 7 weeks of implantation with or without bone marrow, multiparametric qualitative and quantitative assessments were performed using µCT, SEM, and histology. None of the set-up strategies was as efficient as autologous cancellous bone graft to repair calvarial defects. Nonetheless, the presence of scaffold improved the skull vault closure, particularly when the scaffold was soaked in total bone marrow before implantation. No significant effect of scaffold macro-architecture was observed on tissue mineralization. Magnesium phosphate-based scaffolds (MgP) seemed to induce higher bone formation than their calcium-phosphate-based counterparts. They also displayed a quicker biodegradation and sparse remaining material was found after 7 weeks of implantation. Although further improvements are required to reach clinical settings, this study demonstrated the potential of organo-mineral cements for bone regeneration and highlighted the peculiar properties of MgP-based cements.
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Affiliation(s)
- Touya Nicolas
- Regenerative Medicine and Skeleton, RMeS UMR 1229, Nantes Université, Oniris, CHU Nantes, INSERM, 44000, Nantes, France
| | - Reiss Ségolène
- Regenerative Medicine and Skeleton, RMeS UMR 1229, Nantes Université, Oniris, CHU Nantes, INSERM, 44000, Nantes, France
| | - Rouillon Thierry
- Regenerative Medicine and Skeleton, RMeS UMR 1229, Nantes Université, Oniris, CHU Nantes, INSERM, 44000, Nantes, France
| | - Dutilleul Maeva
- Regenerative Medicine and Skeleton, RMeS UMR 1229, Nantes Université, Oniris, CHU Nantes, INSERM, 44000, Nantes, France
| | - Veziers Joelle
- Regenerative Medicine and Skeleton, RMeS UMR 1229, Nantes Université, Oniris, CHU Nantes, INSERM, 44000, Nantes, France
| | - Pare Arnaud
- Regenerative Medicine and Skeleton, RMeS UMR 1229, Nantes Université, Oniris, CHU Nantes, INSERM, 44000, Nantes, France
| | - Brasset Ludmila
- Regenerative Medicine and Skeleton, RMeS UMR 1229, Nantes Université, Oniris, CHU Nantes, INSERM, 44000, Nantes, France
| | - Weiss Pierre
- Regenerative Medicine and Skeleton, RMeS UMR 1229, Nantes Université, Oniris, CHU Nantes, INSERM, 44000, Nantes, France
| | - Corre Pierre
- Regenerative Medicine and Skeleton, RMeS UMR 1229, Nantes Université, Oniris, CHU Nantes, INSERM, 44000, Nantes, France
| | - Charbonnier Baptiste
- Regenerative Medicine and Skeleton, RMeS UMR 1229, Nantes Université, Oniris, CHU Nantes, INSERM, 44000, Nantes, France.
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Wang F, Pi Y, Zhao Y, Zhang Y, Zhou B, Li Z, Sun J, Yu Y, Tian M, Yang M, Huang L, Song H, Neal B, Kissock KR. Effect of salt substitution on fracture-a secondary analysis of the Salt Substitute and Stroke Study (SSaSS). BMC Med 2024; 22:366. [PMID: 39232779 PMCID: PMC11376003 DOI: 10.1186/s12916-024-03586-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 08/27/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Associations of dietary sodium and potassium intake with fracture risk are inconsistent and the effects of salt substitute on fracture incidence are unknown. We assessed the effect of salt substitute compared to regular salt intake on fracture incidence using data from the Salt Substitute and Stroke Study (SSaSS). METHODS SSaSS was a cluster-randomized controlled trial conducted in 600 villages in northern China. Villages were randomly allocated into intervention and control groups in a 1:1 ratio. Salt substitute was provided to intervention villages and control villages continued regular salt use for 5 years. The primary outcome for this secondary analysis was the incidence of all fractures. Secondary outcomes included incidence of vertebral fracture, non-vertebral fracture, and fracture of unknown or non-specific location. RESULTS 20,995 participants were included in this study, and 821 fractures occurred during follow-up. Intention-to-treat analyses showed no differences between the salt substitute and regular salt groups in the incidence of all fractures (rate ratio (RR) 0.96; 95% CI 0.81 to 1.14), vertebral fracture (RR 0.82; 95% CI 0.53 to 1.26), non-vertebral fracture (RR 1.05; 95% CI 0.86 to 1.29), or fracture of unknown or non-specific location (RR 0.80; 95% CI 0.54 to 1.18). CONCLUSIONS Use of salt substitute compared to regular salt had no detectable effect on the incidence of fracture in a population at high risk of cardiovascular disease and fracture. TRIAL REGISTRATION ClinicalTrials.gov, NCT02092090. Registered on March 12, 2014.
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Affiliation(s)
- Faxuan Wang
- School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yangyang Pi
- School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yi Zhao
- School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China.
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan, Ningxia, China.
| | - Yuhong Zhang
- School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Bo Zhou
- Department of Evidencebased Medicine, First Hospital of China Medical University, Shenyang, China
| | - Zhifang Li
- School of Public Health, Changzhi Medical College, Changzhi, China
| | - Jixin Sun
- Department of Noncommunicable Disease Prevention and Control, Center for Disease Control of Hebei Province, Shijiazhuang, China
| | - Yan Yu
- School of Public Health, Xi'an Jiaotong University School of Medicine, Xi'an, China
| | - Maoyi Tian
- School of Public Health, Harbin Medical University, Harbin, China
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Liping Huang
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Hongyi Song
- The George Institute for Global Health China, Beijing, China
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- School of Public Health, Imperial College London, London, UK
| | - Katrina R Kissock
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Braybrook PJ, Tohira H, Brink D, Finn J, Buzzacott PL. Epidemiology and Severity of Medical Events for Mountain Bikers and Hikers Transported by Ambulance in Western Australia, 2015 to 2020. Wilderness Environ Med 2024; 35:257-265. [PMID: 38634125 DOI: 10.1177/10806032241245966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Outdoor activities offer physical and mental health benefits. However, incidents can occur requiring ambulance transport to hospital. This study aimed to describe the epidemiology and severity of traumatic and medical incidents for mountain bikers and hikers transported by ambulance within Western Australia. METHODS This was a retrospective cohort study of ambulance-transported mountain bikers and hikers within Western Australia from 2015 to 2020. Data were extracted from ambulance electronic patient care records. Multivariable analyses were undertaken to identify variables associated with higher patient severity based on the National Early Warning Score 2 (NEWS2). RESULTS A total of 610 patients required ambulance transport to hospital while mountain biking (n=329; 54%) or hiking (n = 281; 46%). Median age of mountain bikers and hikers was 38 (24-48) y and 49 (32-63) y, respectively. Paramedics reported a fracture in 92 (28%) mountain bikers and 78 (28%) hikers. The predominant injury locations for mountain bikers were upper limbs and for hikers, lower limbs. Cases were trauma related in 92% of mountain bikers and 55% of hikers. A significant association (P<0.001) between the etiology of the ambulance callout and patient severity was found. In trauma etiology cases, the frequency of medium-risk+ NEWS2 severity was 21.4%. In medical cases, the frequency of medium-risk+ severity was 40.8%. CONCLUSION Both mountain bikers and hikers experienced incidents requiring ambulance transport to hospital. Incidents of a medical etiology had a higher clinical risk, as determined by the NEWS2 scores, regardless of activity being undertaken.
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Affiliation(s)
- Paul J Braybrook
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, WA, Australia
- St John Western Australia, Belmont, WA, Australia
| | - Hideo Tohira
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, WA, Australia
- Discipline of Emergency Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - Deon Brink
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, WA, Australia
- St John Western Australia, Belmont, WA, Australia
| | - Judith Finn
- Discipline of Emergency Medicine, Medical School, University of Western Australia, Perth, WA, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter L Buzzacott
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Perth, WA, Australia
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Jehle D, Paul KK, Troung S, Rogers JM, Mireles B, Straub JJ, Golovko G, Talbott MM, Lindsey RW, Mouton CP. Equity in the Early Pain Management of Long Bone Fractures in Black vs White Patients: We Have Closed the Gap. West J Emerg Med 2024; 25:809-816. [PMID: 39319813 PMCID: PMC11418864 DOI: 10.5811/westjem.18531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 04/19/2024] [Accepted: 04/26/2024] [Indexed: 09/26/2024] Open
Abstract
Introduction Patients with long bone fractures often present to the emergency department (ED) with severe pain and are typically treated with opioid and non-opioid analgesics. Historical data reveals racial disparities in analgesic administration, with White patients more likely to receive analgesics. With the diversifying US population, health equity is increasingly crucial. In this study we aimed to evaluate the early administration of opioid and non-opioid analgesia among Black and White patients with long bone and femur fractures in EDs over different time frames using a substantial database. Methods We retrospectively extracted Information from 57 US healthcare organizations within the TriNetX database, encompassing 95 million patients. The ED records from 2003-2023 were subjected to propensity score matching for age and gender. We focused on four cohorts: two comprising Black and White patients diagnosed with long bone fractures, and another two with Black and White patients diagnosed solely with femur fractures. We examined analgesic administration rates over 20 years (2003-2023) at five-year intervals (2003-2008; 2008-2013; 2013-2018; 2018-2023), and further analyzed the rates for the most recent two-year period (2021-2023). Results Disparities in analgesic administration significantly diminished over the study period. For patients with long bone fractures (1,095,052), the opioid administration gap narrowed from 6.3% to 1.1%, while non-opioid administration disparities reduced from 4.4% to 0.3%. Similar trends were noted for femur fractures (265,181). By 2021-2023, no significant differences in analgesic administration were observed between racial groups. Conclusion Over the past 20 years, the gap in early administration of opioid and non-opioid analgesics for Black and White patients presenting with long bone fractures or femur fractures has been disappearing.
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Affiliation(s)
- Dietrich Jehle
- University of Texas Medical Branch, Department of Emergency Medicine, Galveston, Texas
| | - Krishna K. Paul
- University of Texas Medical Branch, Department of Emergency Medicine, Galveston, Texas
| | - Stanley Troung
- University of Texas Medical Branch, Department of Emergency Medicine, Galveston, Texas
| | - Jackson M. Rogers
- University of Texas Medical Branch, Department of Emergency Medicine, Galveston, Texas
| | - Blake Mireles
- University of Texas Medical Branch, Department of Emergency Medicine, Galveston, Texas
| | - John J. Straub
- University of Texas Medical Branch, Department of Emergency Medicine, Galveston, Texas
| | - Georgiy Golovko
- University of Texas Medical Branch, Department of Pharmacology and Toxicology, Galveston, Texas
| | - Matthew M. Talbott
- University of Texas Medical Branch, Department of Emergency Medicine, Galveston, Texas
| | - Ronald W. Lindsey
- University of Texas Medical Branch, Department of Orthopaedic Surgery and Rehabilitation, Galveston, Texas
| | - Charles P. Mouton
- University of Texas Medical Branch, Department of Family Medicine, Galveston, Texas
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Nadeem MD, Ali J, Shah S, Mahmood A, Ahmad U. Association Between Antihypertensive Medications and Fracture Risk in Elderly Patients: A Cross-Sectional Study. Cureus 2024; 16:e69714. [PMID: 39429435 PMCID: PMC11490198 DOI: 10.7759/cureus.69714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2024] [Indexed: 10/22/2024] Open
Abstract
Background The use of antihypertensive medications is common among older adults to manage hypertension and prevent cardiovascular events. However, the potential impact of these medications on bone health and the risk of fractures remains a concern. This study investigates the association between antihypertensive medication use and fracture risk in elderly individuals. Materials and methods A cross-sectional study was conducted from February 2023 to July 2024, including 299 elderly patients (aged ≥65) diagnosed with hypertension and currently using antihypertensive medications. Data were collected from medical records, focusing on demographics, fracture incidence, comorbid conditions, and medication use. Logistic regression models were used to analyze the association between antihypertensive use and fracture risk, adjusting for confounders. Results Among the participants, 110 reported falls, and 88 (29.43%) sustained fractures. Fractures were more prevalent among females (63.6%) and those aged 75-84 years (45.5%). A history of falls, mobility difficulties, osteoporosis, and urinary incontinence were significantly associated with fractures. While most antihypertensive classes did not show a significant association with fracture risk, diuretics were associated with a 2.3-fold increased risk of fractures (OR 2.30, p=0.037). Conclusions This study highlights the need for careful consideration of fracture risk in elderly patients using antihypertensive medications, particularly diuretics. Healthcare providers should balance the benefits of blood pressure control with the potential risk of fractures in this population.
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Affiliation(s)
- Muhammad D Nadeem
- Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR
| | - Junaid Ali
- General Medicine, Khyber Medical University, Peshawar, PAK
| | - Shahin Shah
- General Medicine, Medlife Medical Center, Abu Dhabi, ARE
| | - Abroo Mahmood
- Primary Care, Advocare Northbrunswick Medical Associates, North Brunswick, USA
| | - Umair Ahmad
- Medicine, Khyber Pakhtunkhwa Health Department, Peshawar, PAK
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Breinbauer R, Mäling M, Ehnert S, Blumenstock G, Schwarz T, Jazewitsch J, Erne F, Reumann MK, Rollmann MF, Braun BJ, Histing T, Nüssler AK. B7-1 and PlGF-1 are two possible new biomarkers to identify fracture-associated trauma patients at higher risk of developing complications: a cohort study. BMC Musculoskelet Disord 2024; 25:677. [PMID: 39210389 PMCID: PMC11360573 DOI: 10.1186/s12891-024-07789-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Around 10% of fractures lead to complications. With increasing fracture incidences in recent years, this poses a serious burden on the healthcare system, with increasing costs for treatment. In the present study, we aimed to identify potential 'new' blood markers to predict the development of post-surgical complications in trauma patients following a fracture. METHODS A total of 292 trauma patients with a complete three-month follow-up were included in this cohort study. Blood samples were obtained from 244 of these patients. Two complication groups were distinguished based on the Clavien-Dindo (CD) classification: CD grade I and CD grade III groups were compared to the controls (CD 0). The Mann-Whitney U test was used to compare the complication groups to the control group. RESULTS Analysis of the patients' data revealed that risk factors are dependent on sex. Both, males and females who developed a CD III complication showed elevated blood levels of B7-1 (p = 0.015 and p = 0.018, respectively) and PlGF-1 (p = 0.009 and p = 0.031, respectively), with B7-1 demonstrating greater sensitivity (B7-1: 0.706 (male) and 0.692 (female), PlGF-1: 0.647 (male) and 0.615 (female)). Further analysis of the questionnaires and medical data revealed the importance of additional risk factors. For males (CD 0: 133; CD I: 12; CD III: 18 patients) alcohol consumption was significantly increased for CD I and CD III compared to control with p = 0.009 and p = 0.007, respectively. For females (CD 0: 107; CD I: 10; CD III: 12 patients) a significantly increased average BMI [kg/m2] from 25.5 to 29.7 with CD III was observed, as well as an elevation from one to three comorbidities (p = 0.003). CONCLUSIONS These two potential new blood markers hold promise for predicting complication development in trauma patients. Nevertheless, further studies are necessary to evaluate the diagnostic utility of B7-1 and PlGF-1 in predicting complications in trauma patients and consider sex differences before their possible use as routine clinical screening tools.
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Affiliation(s)
- Regina Breinbauer
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Michelle Mäling
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Sabrina Ehnert
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology and Applied Biometry, Eberhard Karls University Tuebingen, Silcherstrasse 5, 72076, Tuebingen, Germany
| | - Tobias Schwarz
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Johann Jazewitsch
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Felix Erne
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Marie K Reumann
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Mika F Rollmann
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Benedikt J Braun
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Tina Histing
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Andreas K Nüssler
- Siegfried-Weller-Institute, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany.
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Schmid G, Schneeweiss P, Hirtl R, Jhala T, Samaras T. Numerical assessment of induced electric fields in a worker's hand with commonly used metallic implants under exposure to low frequency magnetic fields. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:031507. [PMID: 39047759 DOI: 10.1088/1361-6498/ad66dc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/24/2024] [Indexed: 07/27/2024]
Abstract
The European Union's Workers' Directive 2013/35/EU on the minimum health and safety requirements regarding the exposure of workers to electromagnetic fields specifies action levels (ALs) for external electric and magnetic fields, which should protect against induced tissue-internal electric field strengthEiabove the exposure limit values, the latter being defined in order to prevent tissue stimulation at low frequencies. However, although 2013/35/EU explicitly calls for the protection of 'workers at particular risk' (including workers with metallic implants), the AL specified in the Directive have been derived under the assumption that there are no metallic parts present inside the body. Therefore, in the present work, we analysed the situation of a worker's hand and forearm bearing metallic implants (Herbert screw and volar radius plate) used for osteosynthesis after the most common bone fractures of the hand/forearm, exposed to low frequency magnetic fields. The uniform exposure of the whole hand and forearm as well as the exposure to a specific and widely used device, a deactivator for single-use labels of acousto-magnetic electronic article surveillance systems, were considered based on numerical computations using a high-resolution anatomical hand and forearm model. The results obtained indicated that the maximum induced electric field strength averaged in a volume of 2 mm × 2 mm × 2 mm cube was higher in the presence of the metallic implants by a factor of up to 4.2 for bone tissue and 2.3 for soft tissue compared with the case without an implant. Hence, it is obvious that the local induced electric field strengths may be substantially increased by the implants. The extent of this increase, however, is highly dependent on the implant's position inside the body, the implant's geometry, and the field distribution and orientation with respect to the anatomical structure and the implant.
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Affiliation(s)
- Gernot Schmid
- Seibersdorf Laboratories, EMC & Optics, A-2444 Seibersdorf, Austria
- Department of Physics, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece
| | - Pia Schneeweiss
- Seibersdorf Laboratories, EMC & Optics, A-2444 Seibersdorf, Austria
| | - Rene Hirtl
- Seibersdorf Laboratories, EMC & Optics, A-2444 Seibersdorf, Austria
| | - Tobias Jhala
- Seibersdorf Laboratories, EMC & Optics, A-2444 Seibersdorf, Austria
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, D-72076 Tuebingen, Germany
| | - Theodoros Samaras
- Department of Physics, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece
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J O, S L, S G, B H, S M N. An overview of the performance of AI in fracture detection in lumbar and thoracic spine radiographs on a per vertebra basis. Skeletal Radiol 2024; 53:1563-1571. [PMID: 38413400 PMCID: PMC11194188 DOI: 10.1007/s00256-024-04626-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Subtle spinal compression fractures can easily be missed. AI may help in interpreting these images. We propose to test the performance of an FDA-approved algorithm for fracture detection in radiographs on a per vertebra basis, assessing performance based on grade of compression, presence of foreign material, severity of degenerative changes, and acuity of the fracture. METHODS Thoracic and lumbar spine radiographs with inquiries for fracture were retrospectively collected and analyzed by the AI. The presence or absence of fracture was defined by the written report or cross-sectional imaging where available. Fractures were classified semi-quantitatively by the Genant classification, by acuity, by the presence of foreign material, and overall degree of degenerative change of the spine. The results of the AI were compared to the gold standard. RESULTS A total of 512 exams were included, depicting 4114 vertebra with 495 fractures. Overall sensitivity was 63.2% for the lumbar spine, significantly higher than the thoracic spine with 50.6%. Specificity was 96.7 and 98.3% respectively. Sensitivity increased with fracture grade, without a significant difference between grade 2 and 3 compression fractures (lumbar spine: grade 1, 52.5%; grade 2, 72.3%; grade 3, 75.8%; thoracic spine: grade 1, 42.4%; grade 2, 60.0%; grade 3, 60.0%). The presence of foreign material and a high degree of degenerative changes reduced sensitivity. CONCLUSION Overall performance of the AI on a per vertebra basis was degraded in clinically relevant scenarios such as for low-grade compression fractures.
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Affiliation(s)
- Oppenheimer J
- Charité Universitätsmedizin Berlin, Klinik für Radiologie, Campus Benjamin FranklinHindenburgdamm 30, 12203, Berlin, Germany.
| | - Lüken S
- Charité Universitätsmedizin Berlin, Klinik für Radiologie, Campus Benjamin FranklinHindenburgdamm 30, 12203, Berlin, Germany
| | - Geveshausen S
- Charité Universitätsmedizin Berlin, Klinik für Radiologie, Campus Benjamin FranklinHindenburgdamm 30, 12203, Berlin, Germany
| | - Hamm B
- Charité Universitätsmedizin Berlin, Klinik für Radiologie, Campus Benjamin FranklinHindenburgdamm 30, 12203, Berlin, Germany
| | - Niehues S M
- Charité Universitätsmedizin Berlin, Klinik für Radiologie, Campus Benjamin FranklinHindenburgdamm 30, 12203, Berlin, Germany
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Bergdahl C, Wolf O, Rydberg EM, Möller M, Wennergren D. Low risk of early conversion to surgery in non-surgically treated proximal humeral fractures - An observational cohort study of 31,761 fractures from the Swedish Fracture Register. Injury 2024; 55:111679. [PMID: 38897070 DOI: 10.1016/j.injury.2024.111679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION The majority of all proximal humeral fractures (PHFs) are treated non-surgically. Due to the risk of early secondary fracture displacement patients with non-surgically treated PHFs routinely undergo serial clinical and radiological evaluations. However, the value of these routine follow-up visits is unclear. This study aimed to examine the rate of early conversion to surgery in non-surgically treated PHFs. Moreover, the associations between patient and fracture characteristics and the risk of conversion to surgery were explored in order to assess the need for routine follow-ups. METHODS Data on all patients aged ≥18 years with a non-surgically treated PHF registered between 2013 and 2021 were extracted from the Swedish Fracture Register. Early change of treatment from non-surgical to surgical is an optional treatment modality in the SFR. The rate of early conversion to surgery within 60 days from injury was analyzed in relation to age and sex of the patient, energy level at injury and fracture morphology according to the AO/OTA classification. RESULTS A total of 31,761 primarily non-surgically treated PHFs (mean age 70 years: 76 % female) were included in the study. The overall rate of early conversion to surgery was 3.7 %. Younger age and increasing fracture severity were associated with a higher conversion rate to surgery. Patients ≥80 years and those with the three most common fracture types (A1, A2, and B1) had <2 % early conversion to surgery. In contrast, patients with C-type fractures, unstable/displaced fractures (A3, B2, and C2), or fracture dislocations (A1.3, B3, and C3) had a substantially higher risk (5.0-20 %) of early conversion. CONCLUSION The overall risk of early conversion to surgery in non-surgically treated PHFs is low and can be further predicted based on patient age and fracture morphology. These results could have implications regarding which patients are in need of routine follow-ups. LEVEL OF EVIDENCE Level II; Retrospective design; Prognosis study.
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Affiliation(s)
- Carl Bergdahl
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden.
| | - Olof Wolf
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Emilia Möller Rydberg
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
| | - David Wennergren
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
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Fernandes JB, Fernandes S, Romão A, Domingos J, Ferreira R, Amador C, Pardal N, Malato D, Barroco A, Félix A, Oliveira A, Rito F, Ratão H, Martins R, Silva S, Godinho C. Developing a consensus-based motivational care pathway for individuals with lower limb fractures: a Delphi protocol. Front Public Health 2024; 12:1384498. [PMID: 39081354 PMCID: PMC11286470 DOI: 10.3389/fpubh.2024.1384498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 07/03/2024] [Indexed: 08/02/2024] Open
Abstract
Older adults with lower limb fractures often harbor concerns about losing their mobility, fearing a loss of independence. It is vital to develop strategies that foster their active engagement in the rehabilitation process. The present protocol aims to create a care pathway tailored to motivate individuals with lower limb fractures to adhere to rehabilitation. We will develop an observational, cross-sectional, and descriptive study using the Delphi data-gathering approach. Purposive sampling will recruit a panel of healthcare professionals and experts who care for patients with lower limb fractures. Aligned with the Delphi method, a series of iterative rounds will be developed to gather consensus around the motivational strategies used by health professionals in the rehabilitation of people with lower limb fractures. We will employ the Qualtrics platform for data collection and analysis, and a consensus target of 75% has been predetermined. For quantitative data analysis, we will use descriptive statistics encompassing a range of measures, including count, mean, standard deviation, median, minimum, maximum, and range. An inductive thematic analysis procedure will be employed to extract meaningful themes and patterns from qualitative data. The study results are expected to significantly impact clinical practice by creating a specialized care pathway to motivate individuals with lower limb fractures to adhere to rehabilitation. Adopting these explicit standards by professionals will ensure uniform and high-quality care.
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Affiliation(s)
- Júlio Belo Fernandes
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
- Nurs* Lab, Almada, Portugal
| | - Sónia Fernandes
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
- Nurs* Lab, Almada, Portugal
| | - Ana Romão
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
- Nurs* Lab, Almada, Portugal
| | | | - Rui Ferreira
- Department of Nursing, Hospital Garcia de Orta, Almada, Portugal
| | - Catarina Amador
- Department of Nursing, Hospital Garcia de Orta, Almada, Portugal
| | - Nelson Pardal
- Department of Nursing, Hospital Garcia de Orta, Almada, Portugal
| | - Domingos Malato
- Department of Nursing, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Ana Barroco
- Department of Nursing, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Ana Félix
- Department of Nursing, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - António Oliveira
- Department of Nursing, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Fernanda Rito
- Department of Nursing, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Hélder Ratão
- Department of Nursing, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Rita Martins
- Department of Nursing, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Sandra Silva
- Department of Nursing, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Catarina Godinho
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
- Nurs* Lab, Almada, Portugal
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Zhang D, Litvak A, Lin N, Pirkle S, Strelzow J, Hynes K. Current Trends in the Surgical Treatment of Fibular Fractures: A National Database Study of Intramedullary vs. Plate Fixation Practice Patterns, Complications, and Cost. Adv Orthop 2024; 2024:7506557. [PMID: 39036541 PMCID: PMC11260212 DOI: 10.1155/2024/7506557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/14/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024] Open
Abstract
Existing primary evidence comparing fibular intramedullary fixation (IMF) with traditional plate fixation (PF) for the treatment of distal fibular fractures remains limited by modest sample sizes. Using a large national database, this study aims to compare use rates, fracture patterns, patient characteristics, time to surgery, complication rates, and cost between fibular IMF and PF within the United States. Adults treated with fibular IMF or PF between October 2015 and October 2021 were identified within the PearlDiver Database. The ratio of IMF-treated to PF-treated patients was tracked temporally to compare use rates. Fracture patterns were determined using fracture diagnoses within one-month preceding surgery. Further comparisons of IMF- and PF-treated groups only included patients with at least 12 months of follow-up, and patients with upper tibia or tibia shaft fractures were excluded. An analysis of cohorts matched at a 1 : 4 (IMF: PF) ratio to control for risk factors was performed to compare time to surgery, complication rates (infection, nonunion, malunion, revision, hardware removal, pulmonary embolism, and deep vein thrombosis), and cost. 39329 patients (2294 IMF and 37035 PF) were identified. IMF use trended upwards relative to PF use over time. Tibia and fibula shaft fractures were the most common injuries in IMF patients versus bimalleolar and trimalleolar fractures in PF patients. A higher proportion of IMF patients had open fractures. IMF patients were younger, with higher mean ECI, fewer female patients, and higher rates of CKD. Percutaneous approaches were more common among IMF patients. There were no significant differences in time to surgery or complication rates. IMF was less costly. The popularity of IMF trended upwards across the study period. IMF was used more commonly in injuries involving higher energy trauma and soft tissue disruption. Overall, IMF patients were younger with more comorbidities. When used in similar populations, IMF appears to be a cost-effective alternative to PF.
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Affiliation(s)
- Douglas Zhang
- The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Audrey Litvak
- The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Nicholas Lin
- The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
| | - Sean Pirkle
- Department of Orthopaedics and Sports MedicineUniversity of Washington, Seattle, WA 98195, USA
| | - Jason Strelzow
- Department of Orthopaedic Surgery and Rehabilitation MedicineUniversity of Chicago Medicine, Chicago, IL 60637, USA
| | - Kelly Hynes
- Department of Orthopaedic Surgery and Rehabilitation MedicineUniversity of Chicago Medicine, Chicago, IL 60637, USA
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Seidel A, Chidda A, Perez V, Krause F, Zderic I, Gueorguiev B, Lalonde KA, Meulenkamp B. Biomechanical Effects of Hindfoot Alignment in Supination External Rotation Malleolar Fractures: A Human Cadaveric Model. Foot Ankle Int 2024; 45:764-772. [PMID: 38618682 DOI: 10.1177/10711007241241075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND Pressure distribution in the ankle joint is known to be dependent on various factors, including hindfoot alignment. We seek to evaluate how hindfoot alignment affects contact pressures in the ankle joint in the setting of supination external rotation (SER) type ankle fractures. METHODS SER fractures were created in 10 human cadaver lower extremity specimens, simulating progressive stages of injury: without fracture (step 0), SER fracture and intact deltoid ligament (step 1), superficial deltoid ligament disruption (step 2), and deep deltoid ligament disruption (step 3). At each step, varus and valgus alignment was simulated by displacing the calcaneal tuberosity 7 mm medial or lateral. Each limb was axially loaded following each osteotomy at a static load of 350 N. The center of force (COF), contact area (CA), and peak contact pressure (PP) under load were measured, and radiographs of the ankle mortise were taken to analyze the medial clear space (MCS) and talar tilt (TT). RESULTS The COF (5.3 mm, P = .030) and the CA (-188.4 mm2, P = .015) changed in step 3 in the valgus hindfoot alignment compared to baseline parameters, indicating the importance of deep deltoid ligament integrity in maintaining normal ankle joint contact stress in the valgus hindfoot. These changes were not seen in the setting of varus alignment (COF: 2.3 mm, P = .059; CA -121 mm2, P = .133). PP were found to not change significantly in either varus or valgus (varus: -4.9 N, P = .132; valgus: -4 N, P = .464).The MCS demonstrated widening in step 3 compared to step 2 (0.7 mm, P = .020) in both varus and valgus hindfoot. The TT increased significantly in step 3 in the valgus hindfoot (2.8 degrees, P = .020) compared to step 0. CONCLUSION SER-IV fractures with valgus hindfoot alignment showed significant changes in pressure distribution and radiographic parameters when compared to SER-IV fractures with varus hindfoot alignment. CLINICAL RELEVANCE Based on this cadaver modeling study, patients with SERIV fracture with varus hindfoot alignment and complete deltoid ligament lesion may not need fracture fixation, whereas those with valgus hindfoot alignment likely need fracture fixation.
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Affiliation(s)
- Angela Seidel
- Department of Orthopaedics, Civic Hospital, Ottawa, Canada
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Switzerland
| | - Amal Chidda
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Switzerland
| | - Virginie Perez
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Switzerland
| | - Fabian Krause
- Department of Orthopaedic Surgery and Traumatology, Inselspital and Orthopädie Sonnenhof, University of Berne, Bern, Switzerland
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
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49
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Lee JY, Lee JH, Seo J, Kang M, Jung EH, Kim SA, Suh KJ, Kim JW, Kim SH, Lee JO, Kim JW, Kim YJ, Lee KW, Kim JH, Lee JS, Bang SM. Skeletal-Related Events in Patients With Multiple Myeloma: A Comprehensive Retrospective Cohort Study. J Korean Med Sci 2024; 39:e175. [PMID: 38859738 PMCID: PMC11164652 DOI: 10.3346/jkms.2024.39.e175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Multiple myeloma (MM) patients are at risk of skeletal-related events (SREs) like spinal cord compression, pathologic fractures, bone surgery, and radiation to bone. Real-world data regarding SREs in MM are limited. METHODS We conducted a large, retrospective, nationwide cohort study using the Korean Health Insurance Review and Assessment Service (HIRA) database from 2007 to 2018. RESULTS Over a 12-year study period, we identified 6,717 patients who developed symptomatic MM. After a median follow-up of 35.1 months (interquartile range [IQR], 20.8-58.2 months), 43.6% of these patients experienced SREs, and 39.6% had four or more SREs. One in five patients (20.0%) experienced pathologic fractures within the first year of follow-up. The median time to first SRE was 9.6 months (IQR, 1.2-25.8 months), with 3.0 months in the group with prior SREs and 19.8 months in the group without prior SREs. During follow-up, 78.5% of patients received bisphosphonates. Multiple logistic regression analysis revealed several factors associated with an increased risk of SREs, including being female (odds ratio [OR], 1.44), aged 50 or older (OR, 1.87), having cerebrovascular disease (OR, 1.34), undergoing first-line chemotherapy regimens not containing bortezomib or lenalidomide (OR, 1.49), and being in the group with prior SREs and bisphosphonate use (OR, 5.63), compared to the group without prior SREs and without bisphosphonate use. CONCLUSION This population-based study is the first to report the incidence and risk factors of SREs in Korean MM patients, which can be used to assess their bone health.
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Affiliation(s)
- Ji Yun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ju-Hyun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jeongmin Seo
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Minsu Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun Hee Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-A Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Koung Jin Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji-Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jeong-Ok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong Seok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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50
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Schulz D, Deichsel A, Jordan MC, Windolf J, Raschke MJ, Neubert A. Developing a core outcome set for acetabular fractures: a systematic review protocol. Syst Rev 2024; 13:150. [PMID: 38840193 DOI: 10.1186/s13643-024-02571-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 05/24/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Clinical trials investigating acetabular fractures are heterogeneous in their investigated outcomes and their corresponding measurements. Standardization may facilitate comparability and pooling of research results, which would lead to an increase in knowledge about the optimal treatment of acetabular fractures, resulting in long-term evidence-based treatment decisions and improvements in patient care. The aim of this systematic review is to identify the reported outcomes and their measurements from studies on treatments for acetabular fractures to develop a core outcome set which contains the most relevant outcome measures to be included in future studies. METHODS Studies published in English and German including patients aged 16 years and older, with a surgically treated acetabular fracture, will be included. Studies with nonsurgical treatment, pathologic fractures, polytraumatized patients, and patients younger than 16 years of age will be excluded because other outcomes may be of interest in these cases. Any prospective and retrospective study will be included. Systematic reviews will be excluded, but their included studies will be screened for eligibility. The literature will be searched on MEDLINE, CENTRAL, Web of Science, ClinicalTrials.gov, and WHO ICTRP. Risk of selective reporting of outcomes will be assessed using the Outcome Reporting Bias in Trials classification system. Heterogeneously defined outcomes that measure the same outcome will be grouped and subsequently categorized into outcome domains using the taxonomy of the Core Outcome Measures in Effectiveness Trials Initiative. DISCUSSION It is expected that a high number of studies will be included, and many outcomes will be identified using different definitions and measurement instruments. A limitation of this systematic review is that only previously investigated outcomes will be detected, thus disregarding potentially relevant outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022357644.
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Affiliation(s)
- Denise Schulz
- Department of Orthopaedics and Traumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- TraumaEvidence @ German Society of Traumatology, Berlin, Germany.
| | - Adrian Deichsel
- TraumaEvidence @ German Society of Traumatology, Berlin, Germany
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, University of Münster, Münster, Germany
| | - Martin C Jordan
- TraumaEvidence @ German Society of Traumatology, Berlin, Germany
- Department of Orthopaedic Traumatology, University Hospital Würzburg, Julius-Maximilian-University of Würzburg, Würzburg, Germany
| | - Joachim Windolf
- Department of Orthopaedics and Traumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- TraumaEvidence @ German Society of Traumatology, Berlin, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, University of Münster, Münster, Germany
| | - Anne Neubert
- Department of Orthopaedics and Traumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- TraumaEvidence @ German Society of Traumatology, Berlin, Germany
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