Global Trends in Intertrochanteric Hip Fracture Research From 2001 to 2020: A Bibliometric and Visualized Study

Effects of different reduction patterns on stress distribution in patients with intertrochanteric fractures with intramedullary nail fixation: a finite element analysis

Objective

Positive medial cortical support is a reliable fracture reduction pattern, but existing research on its use is mainly qualitative. We conducted this finite element analysis study to quantitatively evaluate the usefulness of positive cortical support for intertrochanteric fracture reduction.

Methods

Twenty-five models of intramedullary nail fixation for AO type 31-A1.2 intertrochanteric fractures subjected to different reduction patterns were established. The peak von Mises stress at the femoral fracture surface, proximal intersection of the intramedullary nail, and distal intersection of the intramedullary nail, as well as the maximum fracture displacement, were determined by finite element analysis under the three working conditions of standing, walking, and walking stairs.

Results

As the head-neck fragment moved forward, the von Mises stress at the fracture surface, the proximal intersection point of the intramedullary nail, and the distal intersection point gradually decreased. This resulted in reduced fracture displacement, a significant decrease in trabecular bone volume, and a slight increase in the risk of screw cut-out. As the head-neck fragment moved medially, the fracture gained positive support from the medial cortex, leading to a gradual decrease in von Mises stress at the fracture surface and the proximal intersection point of the intramedullary nail, as well as reduced fracture displacement. However, the von Mises stress at the distal intersection point gradually increased.

Conclusion

The reduction pattern involving positive medial, anteromedial, and anterior cortical support may be an effective alternative to anatomical reduction for the treatment of difficult-to-reduce intertrochanteric fractures.

From disease management to prevention, hip prosthesis joint infections in the past 20 years: a global research trends and top 10 cited articles analysis

Background

There are few literatures comprehensively analyzed the global research in hip prosthesis joint infections (HPJI). We aim to clarify the global research trends and analysis the top 10 cited articles in the HPJI field.

Methods

We identified the core collection of articles/reviews in the HPJI field from 2001 to 2021 through the Web of Science Core Collection (WOSCC). VOSviewer and online bibliometric tool were used to conduct the visualized and knowledge maps. Annual trends of publications, research hotspots and the top 10 cited articles were analyzed.

Results

A total of 5,477 publications were finally included. Generally, an increasing trend was observed in the number of publications from 2001 to 2021. The authors, journals and institutions with largest number of publications all belong to the USA. Co-occurrence analysis of keywords showed that surgical techniques, risk factors, revision surgery strategy, epidemiology, diagnoses and prevention were the 6 major research directions. Total hip arthroplasty, replacement, outcomes, risk factors and diagnosis were the keywords that occurred most frequently. The top 10 cited articles were all published in Journal Citation Reports (JCR) Q1 journals, providing valuable reference value from the perspectives of clinical guidelines, perioperative management, causes and diagnostic methods of infection, epidemiological investigation, risk factors and prognostic analysis.

Conclusions

The number of publications in HPJI field had been on the rise over the past 20 years, from disease management to prevention. An intensive reading of the top 10 cited articles is beneficial to understand the focus of HPJI research comprehensively.

Visual analysis of patient safety research hotspots and trends in the context of telemedicine based on Web of Science

To analyze the research status, hotspots, and trends of patient safety in the context of international telemedicine, and to provide reference for future research in various countries. The literature pertaining to patient safety within the realm of telemedicine was systematically retrieved from the Web of Science core collection database, encompassing the period from January 2010 to December 2023. Visual analysis of publication quantity, primary authorship, and keyword trends was conducted using CiteSpace (6.2R6) software. The geographical distribution of research focus was visualized through VOSviewer software and SCImago Graphica software, while research institutions were depicted using VOSviewer software and Highcharts software. Data organization was facilitated by Excel 2019 software. A total of 5356 related articles were included, and the number of published papers showed an overall upward trend, and the countries and institutions with the largest number of papers were the United States and Harvard University, respectively, and a stable core author research population had not yet been formed in this research field. Through keyword analysis, it can be seen that the research hotspots mainly focus on the research on the influencing factors of patient safety in the context of telemedicine, the research on the application value of telemedicine, and the research on coping strategies that affect patient safety. The research on patient safety in the context of telemedicine in foreign countries has a certain depth and breadth, which has important reference significance for improving the medical quality and patient safety of Internet hospitals in various countries.

A Comparative Study of the Early Postoperative Outcome of Three Intramedullary Fixation Modalities in the Treatment of Intertrochanteric Fractures of the Femur in the Elderly

OBJECTIVES

To compare early outcomes of proximal femoral bionic nail (PFBN), Inter-TAN, proximal femoral nail antirotation (PFNA) for intertrochanteric fractures in elderly patients.

METHODS

Eighty-two elderly patients with intertrochanteric femoral fractures treated at Xiangyang No. 1 People's Hospital affiliated with Hubei University of Medicine from December 2021 to 2022 were retrospectively analyzed. They were categorized into three surgical groups: PFBN (22 cases), Inter-TAN (20 cases), and PFNA (40 cases). Preoperative demographics and fracture characteristics were compared, alongside intraoperative and postoperative metrics like operative time and complication rates.

RESULTS

In the PFBN group, operative time, fluoroscopy use, blood loss, and transfusion were higher, but postoperative weight-bearing, healing, and hospital stay were shorter compared to the Inter-TAN and PFNA groups (P<0.05). Inter-TAN had a significantly shorter postoperative weight-bearing time than PFNA (P<0.001). Other compared factors showed no significant differences between groups (P>0.05), including complication rates and scores at 6-month follow-up.

CONCLUSIONS

PFBN, a novel surgical approach for intertrochanteric fractures in elderly patients, outperforms Inter-TAN and PFNA by accelerating early weight-bearing and hastening fracture recovery.

Complication rates after proximal femoral nailing: does level of training matter?

BACKGROUND

Surgical treatment of pertrochanteric fractures is one of the most performed surgeries in orthogeriatrics. Proximal femoral nailing, the most performed procedure, is often used as a training surgery for young residents. The objective of this study was to evaluate the relevance of the resident's training level to complication rates.

MATERIAL AND METHODS

This study was a retrospective cohort study. Surgeons were divided into four groups according to their training level. Complications included infection, cut-out, and revision surgery. The study was performed at a level 1 trauma center. All patients who were treated with proximal femoral nailing surgery with a radiological follow-up of at least 3 months were included.

RESULTS

Of the 955 patients extracted, a total of 564 patients met the inclusion criteria. Second-year residents had significantly higher cut-out rates (p = 0.012). Further analysis indicated a correlation between level of training and surgery duration (p < 0.001) as well as a correlation between surgery duration and infection rate (p < 0.001). The overall complication rate was 11.2%. Analyzing overall complications, no significant difference was found when comparing surgeon groups (p = 0.3). No statistically significant difference was found concerning infection (p = 0.6), cut-out (p = 0.7), and revision surgery (p = 0.3) either.

CONCLUSION

Complication rates after proximal femoral nailing are not higher in patients who are treated by residents. Therefore, proximal femoral nailing is an excellent procedure for general orthopedic training. However, we must keep in mind that accurate positioning of the femoral neck screw is essential to keep cut-out rates as low as possible.

LEVEL OF EVIDENCE III

Knowledge Mapping of Intracranial Aneurysm Clipping: A Bibliometric and Visualized Study (2001-2021)

BACKGROUND

Intracranial aneurysms (IAs) are common cerebrovascular diseases with high rates of mortality and disability. With the development of endovascular treatment technologies, the treatment of IAs has gradually turned to endovascular methods. However, because of the complex disease characteristics and technical challenges of IA treatment, surgical clipping still plays an important role. However, no summary has been performed of the research status and future trends in IA clipping.

METHODS

Publications related to IA clipping from 2001 to 2021 were retrieved from the Web of Science Core Collection database. We conducted a bibliometric analysis and visualization study with the help of VOSviewer software and R program.

RESULTS

We included 4104 articles from 90 countries. The volume of publications on IA clipping, in general, has increased. The United States, Japan, and China were the countries with the most contributions. The University of California, San Francisco, Mayo Clinic, and the Barrow Neurological Institute are the main research institutions. World Neurosurgery and the Journal of Neurosurgery were the most popular journal and most co-cited journal, respectively. These publications came from 12,506 authors, of whom Lawton, Spetzler, and Hernesniemi had reported the most studies. The reports from the past 21 years on IA clipping can generally be divided into 5 parts: (1) characteristics and technical difficulties of IA clipping; (2) perioperative management and imaging evaluation of IA clipping; (3) risk factors for subarachnoid hemorrhage caused by rupture after IA clipping; (4) outcomes, prognosis, and related clinical trials of IA clipping; and (5) endovascular management for IA clipping. "Occlusion," "experience," "internal carotid artery," "intracranial aneurysms," "management," and "subarachnoid hemorrhage" were the major keywords for future research hotspots.

CONCLUSIONS

The results from our bibliometric study have clarified the global research status of IA clipping between 2001 and 2021. The United States contributed the most publications and citations, and World Neurosurgery and Journal of Neurosurgery can be considered landmark journals in this field. Studies regarding occlusion, experience, management, and subarachnoid hemorrhage will be the research hotspots related to IA clipping in the future.

The association between hemoglobin at admission and mortality of older patients with hip fracture: a mean 3-year follow-up cohort study

BACKGROUND

Hip fracture patients often have a large drop in hemoglobin (Hgb) concentration that is associated with the initial trauma. However, there is no study of a correlation between Hgb concentration at admission and short-term mortality. Thus, we evaluated a possible linear and nonlinear association between Hgb and mortalityfor older patients with hip fracture.

METHODS

Consecutive older patients who had hip fractures were screened between January 2015 and September 2019. Demographic and clinical characteristics were collected. Linear and nonlinear multivariate Cox regression models were used to identify association between Hgb at admission and mortality. All analyses were performed with EmpowerStats and R software.

RESULTS

Two thousand five hundred eighty-nine patients were included in the study. There were 849 men and 1740 women. The mean age was 79.6 ± 6.8 years. The mean follow-up was 39.0 months. Nine hundred seven (35.0%) patients died for all-cause reasons. The mean Hgb at admission was 11.07 ± 1.95 g/dL. Linear multivariate Cox regression models showed Hgb at admission was associated with mortality ([Hazard Ratio] HR 0.91, 95% CI 0.87-0.95, P < 0.0001) after adjusting for confounding factors. However, the linear association was unstable, and nonlinearity was found between Hgb at admission and mortality. The Hgb concentration of 9.8 g/dL was an inflection point. A Hgb at admission < 9.8 g/dL was associated with mortality (HR 0.81, 95% CI 0.74-0.89, P < 0.0001), whereas > 9.8 g/dL was not a risk factor for mortality (HR 0.98, 95% CI 0.92-1.04, P = 0.4730).

CONCLUSIONS

The Hgb concentration at admission was nonlinearly associated with mortality of older patients with hip fracture, and Hgb at admission < 9.8 g/dL was a risk predictor of 3-year mortality.

RESEARCH REGISTRATION

ChiCTR2200057323.

Study of platelet-rich plasma application for skin and plastic surgery in recent 20 years: A bibliometric analysis

BACKGROUND

In recent years, platelet-rich plasma (PRP) has been used in plastic surgery, dermatology, and other treatment procedures worldwide. Since the number of scientific writings has been significantly increasing, it is challenging to generate a manual compilation and systematic review of PRP's therapeutic applications in dermatology and plastic surgeries. This study aimed to make a bibliometric analysis of the literature in the field and evaluate research hotspots and frontiers in this field in the past 20 years.

METHODS

Using the Academic Search Premier and ScienceDirect defined search terms, we searched the Web of Science Core Collection (WoSCC) and Scopus databases. All data were analyzed using CiteSpace 5.8.R3 and VOSviewer, including countries, institutions, authors, keywords, cited authors, cited journals, cited references, discovered research hotspots, and frontiers.

RESULTS

A total of 1931 studies were retrieved. The number of publications on PRP application in dermatology and plastic surgeries showed a yearly increase. The United States was the most significant contributor to this field, while Italy's contribution was noteworthy. The journal with the highest number of relevant articles in dermatology and plastic surgery included the Journal of Cosmetic Dermatology. However, the Wound Repair and Regeneration and International Journal of Molecular Sciences were the leading journals that should be paid attention to in the future. Author Anitua E from the Tor Vergata University of Rome published the most publications in this field. In the keyword co-occurrence analysis, all keywords were divided into six clusters, and the most common one in recent years was "PRP for facial beauty." Facial rejuvenation, scar, and alopecia were the main hotspots and research trends in this field.

CONCLUSIONS

Based on the current global trends, the use of PRP in cosmetics and skin care is receiving increasing attention from researchers and clinicians. Recently, an increasing number of articles on PRP's application in skin tissue repair have been published in the United States and Italy. The number of studies on hair loss, facial rejuvenation, and scar management is increasing, suggesting that these subjects may become research hotspots for PRP in dermatology and cosmetic surgeries in recent years.

Navigated intramedullary nailing for patients with intertrochanteric hip fractures is cost-effective at high-volume hospitals in mainland China: A markov decision analysis

Objective

Previous studies have reported that navigation systems can improve clinical outcomes of intramedullary nailing (IMN) for patients with intertrochanteric fractures. However, information is lacking regarding the relationship between the costs of navigated systems and clinical outcomes. The present research aimed to evaluate the cost-effectiveness of navigated IMN as compared with traditional freehand IMN for patients with intertrochanteric fractures.

Methods

A Markov decision model with a 5-year time horizon was constructed to investigate the costs, clinical outcomes and incremental cost-effectiveness ratio (ICER) of navigated IMN for a 70-year-old patient with an intertrochanteric fracture in mainland China. The costs [Chinese Yuan (¥)], health utilities (quality-adjusted life-years, QALYs) and transition probabilities were obtained from published studies. The willingness-to-pay threshold for ICER was set at ¥1,40,000/QALY following the Chinese gross domestic product in 2020. Three institutional surgical volumes were used to determine the average navigation-related costs per patient: low volume (100 cases), medium volume (200 cases) and high volume (300 cases).

Results

Institutes at which 300, 200 and 100 cases of navigated IMN were performed per year showed an ICER of ¥43,149/QALY, ¥76,132.5/QALY and ¥1,75,083/QALY, respectively. Navigated IMN would achieve cost-effectiveness at institutes with an annual volume of more than 125 cases.

Conclusions

Our analysis demonstrated that the navigated IMN could be cost-effective for patients with inter-trochanteric fracture as compared to traditional freehand IMN. However, the cost-effectiveness was more likely to be achieved at institutes with a higher surgical volume.

A sophisticated fracture classification system of the proximal femur trochanteric region (AO/OTA-31A) based on 3D-CT images

OBJECTIVE

Fracture classification evolves dynamically with new and enhanced imaging modalities. This paper aims to introduce a novel hypothesis of a sophisticated fracture classification system for the proximal femur trochanteric region (AO/OTA-31A) based on 3D-CT images and accommodate the clinical requirement of the worldwide outbreak of geriatric hip fractures with large amounts of surgical operations.

METHODS

In the current practice of widely preoperative 3D-CT application and cephalomedullary nailing, we attempt to propose a new comprehensive classification system to describe the fracture characteristics in a more detailed and sophisticated architecture, and pay the most important concern to the parameters that contribute to fracture stability reconstruction in osteosynthesis.

RESULTS

The new four-by-four comprehensive classification system, followed the structure of the AO/OTA system, incorporates many fracture characteristics as dividing indexes into multiple grade levels, such as fracture line direction, the number of fragments, the lesser trochanter fragment and its distal extension (>2 cm), the posterior coronal fragment and its anterior expansion (to the entry portal of head-neck implant at the lateral cortex), the lateral wall and anterior cortex fracture, and the anteromedial inferior corner comminution. From a panoramic perspective, there are four types and each type has four subtypes. A1 is simple two-part fractures (20%), A2 is characterized by lesser trochanter fragment and posterior coronal fractures (62.5%), A3 is reverse obliquity and transverse fractures with complete lateral wall broken (15.5%), and A4 is medial wall comminution which further lacks anteromedial cortex transmission of compression force (2%). For subtypes, A2.2 is with a banana-like posterior coronal fragment, A2.4 is with distal cortex extension >2 cm of the lesser trochanter and anterior expansion of the posterior coronal fragment(s) to the entry portal of head-neck implants, A3.4 is a primary pantrochanteric fracture, and A4.4 is a concomitant ipsilateral segmental fracture of the neck and trochanter region.

CONCLUSION

Classification represents diversity under consistency. The four-by-four sophisticated classification system delineates fracture characteristics in more detail. It is applicable in the time of rapid outbreak of trochanteric fractures in the older population, the large amounts of surgical operations, and incorporates various rare and/or more complicated subtypes which is unclassifiable before.

Global Research Status and Trends of Femoral Neck Fracture Over the Past 27 Years: A Historical Review and Bibliometric Analysis

Background

Femoral neck fracture (FNF) is a commonly encountered injury in orthopedic practice, and many studies have been conducted in this field. However, no bibliometric studies regarding the global research trend concerning FNF have been performed. This study aims to analyze the knowledge framework, research hotspots, and theme trends in the field of FNF research.

Methods

The scientific outputs related to FNF from 1994 to 2021 were retrieved from the Web of Science Core Collection. Three bibliometric tools were used for this study. The main analyses include publication and citation counts, contributions of countries, institutions, authors, funding agencies and journals, and clustering of keywords.

Results

In total, 3,553 articles were identified. The annual publication counts of FNF showed an ascending tendency as a whole. The United States has the most prominent contributions, with the most number of publications and the highest H-index. Karolinska Institutet devoted the most in this domain. Professors Bhandari M, Schemitsch EH, Frihagen F, Parker MJ, and Rogmark C were the core authors in this field. The most productive journal was Injury International Journal of the Care of the Injured. Keywords were divided into four clusters: epidemiology and mortality, fracture prevention, internal-fixation and risk factors, and hip replacement. A trend of balanced and diversified development existed in these clusters. Keywords with the ongoing bursts, including “outcome,” “reoperation,” “complication,” “revision,” “displaced intracapsular,” “fracture,” and “adult,” are considered as the research hotspots in the future and deserve more attention.

Conclusions

The management of FNF in young patients is drawing more attention from orthopedic surgeons, and it is expected that these research topics may continue to be the research hotspots and focus in the near future.

The Global Status of Research in Ankle Fracture: A Bibliometric and Visualized Study

Background

Ankle fractures are common lower extremity fractures that pose a significant economic and social burden. This study analyzed the ankle fracture research literature between 2000 and 2021 to clarify the current status of ankle fracture research and predict future research trends.

Methods

Publications related to ankle fractures published between 2000 and 2021 were retrieved from the Web of Science Core Collection. Then Bibliometric analysis and Visualized Study were performed by VOSviewer software.

Results

A total of 2656 publications were retrieved. The number of publications related to ankle fractures is increasing every year. The top countries and journals in terms of the total number of publications, number of citations, and H-index ranking were USA and foot and ankle int. Lorich DG had the most publications in this field. University of Amsterdam's research group had the biggest number of publications in this field. Co-occurrence analysis clustered the keywords into seven clusters: survival analysis and prognosis study, internal fixation treatment study, treatment study of combined deltoid ligament rupture, treatment study of combined inferior tibiofibular ligament injury, treatment study of posterior ankle fracture, treatment study of postoperative traumatic arthritis of ankle fracture, and treatment study of ankle injury in children.

Conclusions

The importance of ankle fractures is increasing year by year with the aging process, and the number of publications related to ankle fractures will not continue to increase in the future. Survival and prognosis studies, internal fixation studies, combined deltoid ligament rupture studies, and combined inferior tibiofibular ligament injury studies may become the future research hotspots in the field of ankle fractures.