1,720,999 research outputs found
Comparison of clinical and radiographic outcomes of bilateral versus unilateral ramus fixation in straddle fractures with posterior pelvic ring injury
No full textIntroduction: : Superior and inferior ramus fractures, termed straddle fractures, are high-energy fractures often accompanied by unstable pelvic ring injuries. However, consensus is lacking regarding indications for surgical treatment or fixation methods. We aimed to compare clinical and radiological outcomes of unilateral ramus fixation (URF) and bilateral ramus fixation (BRF) for straddle fractures with unilateral posterior pelvic ring injuries. Materials and methods: We enrolled 118 patients (73 males, 45 females; mean age, 47 years) diagnosed with straddle fractures between March 2015 and December 2021 with > 1 year of follow-up. Patients were divided into URF (n = 60) and BRF (n = 58) groups based on the anterior pelvic ring fixation method. Preoperative factors including body mass index, diabetes, smoking, injury mechanism, injury severity score, American Society of Anesthesiologists classification system, Tile classification, and Young and Burgess classification were compared. Intraoperative blood loss, operation time, postoperative bone union rate, complications, and the need for additional surgeries were analyzed. Results: There were no statistically significant preoperative differences between the two groups. However, the URF group showed a significantly lower mean operative time and blood transfusion requirement (63 min and 2 units, respectively) than the BRF group (104 min and 3 units, respectively) (both p < 0.001). Postoperatively, bone union was achieved in 57 (95.0%) and 56 (96.6%) patients in the URF and BRF groups, respectively. Complications occurred in 17 (28.3%) and 14 (24.1%) patients in the URF and BRF groups, respectively, with additional surgeries needed in 3 (5.0%) patients in the URF group and 2 (3.4%) patients in the BRF group. Conclusions: Unilateral anterior fixation can provide sufficient stability and clinical effectiveness in the surgical treatment of straddle fractures in areas with posterior pelvic ring injuries. Compared with bilateral anterior fixation, unilateral fixation significantly reduces operation time and blood loss, making it a viable fixation method for straddle fractures
Does Serum Vitamin D Influence the Prognosis of Critically Ill Patients with Trauma? A Prospective, Observational Study in a Trauma Center
Full text linkBackground: Vitamin D concentrations are associated with sepsis, pneumonia, and mortality in critically ill patients. However, the role of vitamin D in critically injured patients with trauma remains unknown. This study investigated the effects of vitamin D concentrations on outcomes in critically injured patients with trauma. Methods: A prospective observational study was conducted by randomly selecting 100 patients among those who visited our trauma center. The serum vitamin D concentration was measured upon arrival at the hospital, and the length of stay in a trauma intensive care unit after admission, duration of mechanical ventilation, number of days spent in the hospital, development of com-plications, and death were investigated. The association between the surveyed variables and vitamin D concentrations was investigated using regression analysis. Results: Of the 100 patients, 69 were men and 31 were women with an average age of 51.7 years. The average intensive care unit stay length was 18.4 days, and 6 patients (5.9%) died. Univariate regression analysis showed that the factors affecting patient mortality were age (p = 0.02), volume of blood transfused within 24 hours of arrival (p = 0.009), systolic blood pressure measured upon hospital arrival (p = 0.01), and serum lactate concentration measured upon hospital arrival (p = 0.03). Multivariate regression analysis showed that the factors affecting patient mortality were age (p = 0.01), volume of blood transfusion (p = 0.04), and systolic blood pressure measured upon hospital arrival (p = 0.01). Conclusions: There were no statistically significant effects of serum vitamin D concentrations in critically ill patients with trauma on death during hospitalization
Bone-Graft Resorption Reduced by the Induced Membrane Technique and Factors Affecting Volumetric Changes: An Analysis of 120 Serial Computed Tomographic Scans in 40 Patients
No full textBACKGROUND: Little is known about the volumetric changes of grafted bone over time when using the induced membrane technique. This study investigates the volumetric changes of bone graft using serial computed tomographic (CT) scans following the induced membrane technique.
METHODS: Patients with critical-sized bone defects had serial CT scans after undergoing bone-grafting using the induced membrane technique. CT scans to evaluate the volume of bone graft were obtained immediately postoperatively and at 6 and 12 months. The change in the volume of bone graft was determined at 6 and 12 months postoperatively. Patient demographic characteristics, the location and composition of the bone graft, and the type of fixation construct were analyzed.
RESULTS: Forty patients met inclusion criteria. There were 27 tibiae and 13 femora with a mean size defect of 8.6 cm (range, 2.5 to 20.6 cm). Of these patients, 21 received autograft with cancellous bone graft and 19 received mixed autogenous bone with demineralized bone matrix (DBM) at a mean time of 17 weeks after the membrane formation. For the first 6 months, there was an overall osseous resorption of -9.9%. The overall graft volume from 6 to 12 months demonstrated an increase of osseous volume by +1.6%. For the entire 12-month period, there was a mean graft volume resorption of -8.3%. A correlation was found between the early volumetric changes of grafted bone and the percentage of DBM in the graft mixture. A correlation was also found between the late volumetric changes and the location of defect or the type of fixation.
CONCLUSIONS: At 1 year after use of the induced membrane technique for the treatment of a critical-sized bone defect, resorption of the grafted bone averaged -8.3%. The volumetric changes were influenced by the property of the grafted bone, the fixation construct, and the location of the defect.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence
Clinical outcome of AO/OTA type C fracture of the distal humerus using the expanded paratricipital approach and cadaveric comparison of the exposure of the paratricipital and expanded paratricipital approaches to the distal humerus
No full textBACKGROUND: We investigated the overall clinical outcome of the expanded paratricipital approach in complex articular fractures of the distal humerus and the effect of lack of visualization in the surgical field. In addition, we performed a cadaveric study to investigate the expansion or limitation of articular access in the expanded paratricipital approach. METHODS: Forty-one AO/OTA type 13C fracture cases treated using the expanded paratricipital approach at a single trauma center from 2013 to 2017 were enrolled in this study. We evaluated the overall clinical outcome and analyzed the effect of lack of visualization in the surgical field with the expanded paratricipital approach by comparing outcomes between 2 groups classified by the location of the main articular fracture (group 1, limited visualization; group 2, without limited visualization). The length of inaccessible and accessible articular segments were analyzed using 40 matched-pair elbows. RESULTS: The average duration of follow-up was 15.1 months. All fractures (type C1 in 11 cases, type C2 in 21, and type C3 in 9) were radiologically healed at 3.2 months after surgery. No cases required additional surgery because of implant irritation. The average Mayo Elbow Performance Score was 90.5. The mean Disabilities of the Arm, Shoulder and Hand score was 18.5. Among the 41 cases, the limited visualization group (group 1, n = 21) had a longer surgical time and higher percentage of nonanatomic reduction than group 2. Although the expanded paratricipital approach allowed more articular exposure than the conventional approach, there was still a 20mm inaccessible articular segment (30% of transepicondylar width) in cadaveric dissection. CONCLUSIONS: The expanded paratricipital approach can be used in type C1, type C2, and selective type C3 articular fractures of the distal humerus with favorable results. Relative to surgical times and achieving anatomic reduction, it is more successful in a fracture with a main articular fragment and with good visualization
Mapping of acetabular posterior wall fractures using a three-dimensional virtual reconstruction software
No full textIntroduction: The aim of this study was to analyze and describe the fracture patterns of the acetabular posterior wall based on quantitative measurements of the fracture characteristics. Materials and methods: Computed tomography images of 51 patients with acetabular posterior wall fractures from an initial cohort of 216 acetabular fractures were imported into a three-dimensional (3D) virtual software. The reconstructed 3D images were utilized to evaluate the following: (i) fracture line mapping on the inner articular and retro-acetabular surfaces, (ii) common zones of fracture and marginal impaction, and (iii) categorization by location and pattern of comminution. The clock-face position was applied for description: the midpoint of the transverse acetabular ligament served as the +180° reference point, and the 0° reference point was set perpendicular to the ligament. The fracture angle on the articular surface was defined as the intersection between the start and end points. The fracture span on the retro-acetabular surface was defined as the ratio of the perpendicular distance, which is between the fracture beak and acetabular rim, to the entire length, which is from the edge to the rim. Quantitative measurements were performed, and the fracture patterns were analyzed. A color scale bar was used to visualize the common and marginal impaction zones. Results: The articular surface mapping of all the cases demonstrated that the average starting point of the fracture line was +6.2° (±12.8°) and the endpoint was 96.7° (±13.3°), and the average fracture angle was 119.6° (±7.6°) with 80.6% of the fragments having angles within 18.7–117°. The retro-acetabular surface mapping demonstrated that the average fracture span was 0.65 ±0.20, and 61.7 % of the fracture lines were located within 0.6 to 0.9. Marginal impaction was found in 21 cases (21/51, 41.2%; range: between +7° and +105°). Conclusion: The fracture maps showed fracture patterns and recurrent fracture zones on the articular and retro-acetabular surfaces. However, there was no remarkable pattern of marginal impaction. Level of evidence: Retrospective cohort study
Radiographic outcomes and non-union factor analysis in fragmentary segmental femoral shaft fractures (AO/OTA 32C3) treated with reamed antegrade nailing
Full text linkAbstract This study retrospectively assessed radiographic outcomes and risk factors associated with non-union in femoral shaft fragmentary segmental fractures (AO/OTA 32C3) treated with reamed antegrade intra-medullary nailing. Radiological outcomes, including union and alignment, were evaluated. The risk factors for non-union were investigated, including demographics and treatment-related characteristics, such as the number of interlocking screws, segmentation length, main third fragment length, distance of the main third fragment, width ratio and exposed nail length in one cortex from immediate post-operative radiographs. Multivariate logistic regression was used for statistical analysis. Among 2295 femoral shaft fracture patients from three level-1 trauma centers, 51 met the inclusion criteria. The radiological union was achieved in 37 patients (73%) with a mean union time of 10.7 ± 4.8 months. The acceptable axial alignment was observed in 30 patients (59%). Multiple logistic regression analysis identified only exposed nail length as a significant risk factor for non-union (odds ratio: 1.599, p = 0.003) and the cut-off value was 19.1 mm (sensitivity, 0.786; specificity, 0.811). The study revealed high rates of non-union (27%) and malalignment (41%). Therefore, patients who underwent intramedullary nailing with an exposed nail length greater than 19.1 mm or about twice the nail diameter should be cautioned of the potential non-union
Learning curve of a novice foot and ankle surgeon in minimally invasive calcaneal fracture surgery via the sinus tarsi approach
No full textThe sinus tarsi approach has gained popularity for treating calcaneal fractures; however, limited research exists on the learning curve among novice orthopedic surgeons. This study aimed to assess the learning curve of junior orthopedic surgeons who have recently completed their fellowship, focusing on surgical efficiency and clinical outcomes. From October 2022 to January 2024, 50 cases of calcaneal fractures (12 Sanders type 2, 23 type 3, and 15 type 4) were treated using the sinus tarsi approach at a single Level 1 trauma center. The cumulative sum test was employed to identify case cutoffs for key surgical parameters. Pre- and postoperative X-rays and computed tomography (CT) were analyzed to measure the Bohler angle, hindfoot varus angle, and posterior facet step-off. Operative time, intraoperative C-arm fluoroscopy use, and postoperative complications, including infections and revision surgeries, were also evaluated. Significant postoperative improvements were observed: the Bohler angle increased from 12.2 degrees to 26.3 degrees , hindfoot varus angle decreased from 15.2 degrees to 5.3 degrees , and posterior facet step-off was reduced from 14.1 mm to 0.56 mm. Consistent correction of the Bohler angle and hindfoot varus angle was achieved after 21 cases, while posterior facet step-off correction reached proficiency after 26 cases. Reduction quality was classified as Excellent (n = 24), Good (n = 13), Fair (n = 8), and Poor (n = 5), with Excellent or Good outcomes achieved consistently after 21 cases. The mean operative time was 104 min, decreasing from 124.2 min to 85.2 min after 24 cases. The average number of fluoroscopy shots was 141, decreasing from 206.4 in the first 19 cases to 95.1 thereafter. Complications included six revision surgeries, one infection, four cases of insufficient posterior facet correction, and one case of screw penetration. Novice foot and ankle surgeons can achieve surgical proficiency in the sinus tarsi approach for calcaneal fracture fixation after approximately 20 to 26 cases. This learning curve was reflected by improved operative efficiency, reduced fluoroscopy use, and consistent radiographic correction of the Bohler angle, hindfoot varus angle, and posterior facet step-off
Improving Outcomes with Sequential Fixation Using Long-Threaded Screws for Valgus-Impacted Femoral Neck Fractures
No full textBackground and Objectives: Valgus-impacted femoral neck fractures (OTA 31B1.1 and 31B1.2) are considered stable fractures with favorable outcomes compared to displaced fractures. However, complications such as femoral neck shortening, screw sliding, and suboptimal recovery can occur, particularly in severe deformities. This study evaluated the outcomes of a sequential fixation technique using short-threaded screws followed by long-threaded screws. Materials and Methods: This prospective study included 135 patients aged 60 years or older with valgus-impacted femoral neck fractures (OTA 31B1.1 and 31B1.2) treated between March 2017 and February 2021. Patients were divided into two groups: those treated solely with short-threaded screws (the control group) and those treated using a sequential fixation technique involving initial compression with short-threaded screws followed by stabilization with long-threaded screws. Exclusion criteria included follow-up < 12 months, pathological fractures, high-energy trauma, or periprosthetic fractures. Clinical outcomes, including the Harris Hip Score (HHS), and radiological parameters, such as screw sliding distance (SDS) and fixation failure, were analyzed. Multivariate regression identified predictors of outcomes to assess the effectiveness of the sequential fixation technique. Results: The mean follow-up was 38.3 months. Multivariate regression revealed that posterior tilt > 15° (β = 2.944, p < 0.001) and the use of long-threaded screws (β = −1.906, p < 0.001) were significant predictors of reduced SDS. Posterior tilt > 15° (OR 15.085, p = 0.002), valgus tilt > 15° (OR 28.616, p = 0.002), and bone mineral density (OR 0.285, p = 0.005) were predictors of fixation failure, while long-threaded screws significantly reduced fixation failure risk (OR 0.062, p = 0.005). Conclusions: The sequential use of short-threaded screws for compression, followed by long-threaded screws for stabilization, effectively reduced screw sliding and fixation failure while improving functional and radiological outcomes. This technique shows promise as an effective treatment for valgus-impacted femoral neck fractures
Efficacy and safety of recombinant human bone morphogenetic protein-2 (rhBMP-2) combined with autologous bone for the treatment of long bone nonunion: A report of a prospective case series
No full textIntroduction: Recombinant human Bone morphogenetic proteins have been used for the treatment of nonunions with promising results. We have been investigating both experimentally and clinically the efficacy of the rhBMP-2 with the macro / micro-porous hydroxyapatite carrier granules on the potency on the reconstruction of long bone defect. The purpose of this study was to prospectively evaluate the efficacy and safety of this specific rhBMP-2 with HA carrier granules mixed with autologous cancellous bone in patients with nonunion and bone defect resulted from the fracture related infection. Materials and Methods: This was a retrospective review of a prospective cohort at a university hospital. Patients diagnosed with nonunion under the definition of the United States Food and Drug Administration with bone defect after long bone fractures were enrolled from January 2020 to February 2021. We included patients with atrophic and oligotrophic nonunion, and hypertrophic nonunion with malalignment that needed to be corrected. The other patient group was consisted of segmental bone defect resulted from FRI. The maximum amount of rhBMP-2 allowed in this clinical study was 6 mg and was added to autologous bone at a 1:1 ratio. Autologous bone was added to the mixture if the volume of mixed graft was insufficient to fill the bone defect. Patients were followed 3, 6, and 12 months post-operatively. Each visit, a radiograph was taken for assessment. Visual analog scale (VAS), questionnaire for quality of life (SF-12 physical component summary [PCS], mental component summary [MCS]), and weight-bearing status were collected for functional outcome assessment. Drug safety was assessed by examining BMP-2 antibodies. Results: Of the 24 enrolled patients (mean age: 57 years), 15 (62.5 %), 2 (8.33 %), and 7 (29.17 %) presented atrophic nonunion, hypertrophic nonunion with deformity, and bone defect after fracture related infection, respectively. Thirteen patients had nonunion in the femur, 9 in the tibia, and 1 in the humerus and radius. The average amount of harvested autologous bone was 9.25 g and 4.96 mg of rhBMP-2. All 24 patients achieved union after 1-year follow up. The union rate was 95.83 % and 100 % at 6 and 12 months postoperatively, respectively. Preoperative SF-12 PCS (mean: 34.71) improved at 6 and 12 months postoperatively, respectively. Preoperative SF-12 MCS (mean: 42.89) improved 12 months postoperatively (49.13, p = 0.0338). Change of VAS was statistically significant 3 months postoperatively (p = 0.0012). No adverse effects or development of BMP-2 antibodies were observed. Conclusion: BMP-2 combined with autogenous bone resulted in excellent radiographical and functional outcomes in a relatively small prospective series of patients with nonunion and bone defect, without adverse effects. Further investigations are necessary to support our finding and optimize treatment strategies in nonunion patients
Model validation for CHO-wt and CHO-AβPP<sub>695</sub> cells and effect of DHA on Aβ<sub>40</sub> release.
No full text<p>(A) Conditioned medium was collected from CHO-wt and CHO-AβPP<sub>695</sub> cells with and without DHA treatment and subjected to ELISA immunoassays for Aβ<sub>40.</sub> There was negligible release of Aβ<sub>40</sub> from CHO-wt cells as compared to CHO-AβPP<sub>695</sub> cells at 24 and 48 h. A significant decrease was observed in the release of Aβ<sub>40</sub> in CHO-AβPP<sub>695</sub> cells after treatment with 25 µM DHA for 24 h and 48 h. <sup>#</sup><i>p</i><0.001 as compared to CHO-wt vehicle treated cells, <sup>φ</sup><i>p</i><0.05 compared to CHO-AβPP<sub>695</sub> 24 h vehicle treatment and <sup>§</sup><i>p</i><0.001 as compared to CHO-AβPP<sub>695</sub> 48 h vehicle treatment. Analysis was done via ANOVA with Bonferroni’s post-hoc analysis. (B) Western blot analysis of the cell lysates confirm AβPP<sub>695</sub> plasmid overexpression in CHO-AβPP<sub>695</sub> cells compared to CHO-wt.</p
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