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Hip fractures are common and their incidence is likely to rise over the next decade as the elderly population increases. Hip fractures can have a devastating effect on the lives of the elderly who are most at risk of this injury. In many cases hip fracture results in long-term loss of independence. This article focuses on extracapsular hip fracture...
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Objective
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Background
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Objective:
Nowadays, with the increasing proportion of osteoporosis in patients with lumbar degenerative diseases, doctors are facing the choice of intraoperative internal fixation methods. The purpose of this study was to compare and assess the clinical results of posterior bilateral pedicle screw fixation and lateral fixation in the extreme late...
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Citations
... The three different boundary conditions applied to each femur A proximal femoral fracture resulting from a fall on the side is categorized as either a neck or a pertrochanteric fracture, with an almost equal probability to occur. (21,22) Two different load directions induce two different fracture scenarios. These directions were determined by a former clinical study on 32 patients who experienced a hip fracture and were CT scanned immediately after the fracture. ...
Autonomous finite element analyses (AFE) based on CT scans predict the biomechanical response of femurs during stance and sidewise fall positions. We combine AFE with patient data via a machine learning (ML) algorithm to predict the risk of hip fracture. An opportunistic retrospective clinical study of CT scans is presented, aimed at developing a ML algorithm with AFE for hip fracture risk assessment in type 2 diabetic mellitus (T2DM) and non‐T2DM patients.
Abdominal/pelvis CT scans of patients who experienced a hip fracture within 2 years after an index CT scan were retrieved from a tertiary medical center database. A control group of patients without a known hip fracture for at least 5 years after an index CT scan was retrieved. Scans belonging to patients with/without T2DM were identified from coded diagnoses. All femurs underwent an AFE under three physiological loads. AFE results, patient's age, weight, and height were input to the ML algorithm (support vector machine [SVM]), trained by 80% of the known fracture outcomes, with cross‐validation, and verified by the other 20%.
In total, 45% of available abdominal/pelvic CT scans were appropriate for AFE (at least 1/4 of the proximal femur was visible in the scan). The AFE success rate in automatically analyzing CT scans was 91%: 836 femurs we successfully analyzed, and the results were processed by the SVM algorithm. A total of 282 T2DM femurs (118 intact and 164 fractured) and 554 non‐T2DM (314 intact and 240 fractured) were identified. Among T2DM patients, the outcome was: Sensitivity 92%, Specificity 88% (cross‐validation area under the curve [AUC] 0.92) and for the non‐T2DM patients: Sensitivity 83%, Specificity 84% (cross‐validation AUC 0.84).
Combining AFE data with a ML algorithm provides an unprecedented prediction accuracy for the risk of hip fracture in T2DM and non‐T2DM populations. The fully autonomous algorithm can be applied as an opportunistic process for hip fracture risk assessment. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
... In treating patients with fragility femoral neck fracture, especially for displaced fracture, arthroplasty is generally preferred over fixation [20,29,30]. By contrast, fracture fixation with intramedullary nailing is the mainstay in patients with pertrochanteric fractures [31]. During the post-operative period, patients who receive arthroplasty usually experience less pain and are able to ambulate and bear weight early [20]. ...
An inability to bear self-weight is one of the unfavorable results in geriatric hip fracture, which needs to be prevented. This study determines pre-operative, intra-operative, and post-operative prognostic factors of the inability to bear self-weight at discharge in patients with fragility femoral neck fracture. This retrospective study was conducted at Chiang Mai University (CMU) hospital with an observational cohort design. Electronic medical records of patients aged ≥ 50 years old with fragility femoral neck fractures between 1 January 2015 and 31 December 2019 were reviewed. Pre-, intra-, and post-operative factors were collected. Ambulation status at discharge time was classified into either ability or inability to bear self-weight. Analysis of prognostic factors was done using multivariable risk ratio regression. In total, 269 patients were recruited in this study. Significantly prognostic factors of inability to bear self-weight at discharge were end-stage renal disease (ESRD), cirrhosis, cerebrovascular disease, pre-fracture ambulatory status, having associated fractures, increasing intra-operative blood loss, and having pressure sore. These prognostic factors could be used to predict patients’ outcomes at discharge. Proper management could then be offered to the patients by the multidisciplinary care team to enhance surgical outcomes.
... A proximal femoral fracture due to a fall on the side is categorized by either a neck or a pertrochanteric fracture (in this study these will be denoted as FallN and FallP loading configurations respectively), with an almost equal probability to occur. 31,32 Thus the fracture load could be considered as the mean value of the load inducing neck fracture and the load inducing pertrochanteric fracture. This load can be normalized by patient's body weight (BW) to obtain the BW factor (BWF). ...
Aims
Type 2 diabetes mellitus (T2DM) impairs bone strength and is a significant risk factor for hip fracture, yet currently there is no reliable tool to assess this risk. Most risk stratification methods rely on bone mineral density, which is not impaired by diabetes, rendering current tests ineffective. CT-based finite element analysis (CTFEA) calculates the mechanical response of bone to load and uses the yield strain, which is reduced in T2DM patients, to measure bone strength. The purpose of this feasibility study was to examine whether CTFEA could be used to assess the hip fracture risk for T2DM patients.
Methods
A retrospective cohort study was undertaken using autonomous CTFEA performed on existing abdominal or pelvic CT data comparing two groups of T2DM patients: a study group of 27 patients who had sustained a hip fracture within the year following the CT scan and a control group of 24 patients who did not have a hip fracture within one year. The main outcome of the CTFEA is a novel measure of hip bone strength termed the Hip Strength Score (HSS).
Results
The HSS was significantly lower in the study group (1.76 (SD 0.46)) than in the control group (2.31 (SD 0.74); p = 0.002). A multivariate model showed the odds of having a hip fracture were 17 times greater in patients who had an HSS ≤ 2.2. The CTFEA has a sensitivity of 89%, a specificity of 76%, and an area under the curve of 0.90.
Conclusion
This preliminary study demonstrates the feasibility of using a CTFEA-based bone strength parameter to assess hip fracture risk in a population of T2DM patients. Cite this article: Bone Joint J 2021;103-B(9):1497–1504.
... Boyd and Griffin classification[3] ...
... 4,12 These fractures are biomechanically unstable. 2,13,14 Previous similar studies with larger sample sizes suggest that lateral wall fractures consistently have poor prognosis than intact lateral wall fractures. So we decided to study the prognosis of lateral wall fractures following surgical intervention regardless of the type of implant. ...
... Lateral wall act as buttress to the proximal fragment during this process. 2,[13][14][15][16][17][18][19] However, in lateral wall fractures, line of fracture is parallel to the sliding vector of fragments (high shear forces). This disturbs the fracture healing process. ...
p class="abstract"> Background: Intertrochanteric fractures with fracture lateral wall (FLW) are biomechanically unstable fractures.
Methods: 40 patients who met inclusion criteria underwent surgery. Post-operatively patients were followed up for a minimum period of 24 weeks. Radiological and functional assessment was done post-operatively. Endpoints of fracture were studied thoroughly.
Results: Secondary lateral wall fractures were common than primary lateral wall fractures. Functional outcome was found to be poor in FLW than intact lateral wall (ILW) group (p=0.01). HHS of ILW fracture was 70, while in FLW it was 46. Displacement was found to be a better radiological parameter to assess reduction quality (p=0.02) than neck shaft angle. Implant position with Cleveland method was found to be a better predictor of fixation quality than tip apex distance. There were 6 (15%) mechanical failures. Screw cut out (3 cases) found to be most common mechanical complication (7.5%). There were four failures (33%) in FLW. Secondary lateral wall fractures were found to have poor prognosis than primary lateral wall fractures. A2.3 was found to have more chance of conversion to A3 due to thinned out lateral wall. Many of them happened when DHS was the implant of choice (60%).
Conclusions: Functional outcome of FLW is poor than ILW. Secondary lateral wall fractures have worse prognosis than primary lateral wall fractures. Fragment specific fixation is difficult in secondary lateral wall fractures as compare to primary lateral wall fracture, due to higher comminution.</p
... Furthermore, MPC and Contact models predicted more variations than the most commonly used Linear model in terms of both stratification power and the location of the predicted high strains. That is in agreement with what was reported clinically in terms of fracture types resulted from falls Mokawem et al., 2012). Contact model has higher classification power than MPC model and is more computationally expensive. ...
Abstract
Background
Osteoporotic proximal femoral fractures associated to falls are a major health burden in the ageing society. Recently, bone strength estimated by finite element models emerged as a feasible alternative to areal bone mineral density as a predictor of fracture risk. However, previous studies showed that the accuracy of patients' classification under their risk of fracture using finite element strength when simulating posterolateral falls is only marginally better than that of areal bone mineral density. Patients tend to fall in various directions: since the predicted strength is sensitive to the fall direction, a prediction based on certain fall directions might not be fully representative of the physical event. Hence, side fall boundary conditions may not be completely representing the physical event.
Methods
The effect of different side fall boundary and loading conditions on a retrospective cohort of 98 postmenopausal women was evaluated to test models' ability to discriminate fracture and control cases. Three different boundary conditions (Linear, Multi-point constraints and Contact model) were investigated under various anterolateral and posterolateral falls.
Findings
The stratification power estimated by the area under the receiver operating characteristic curve was highest for Contact model (0.82), followed by Multi-point constraints and Linear models with 0.80. Both Contact and MPC models predicted high strains in various locations of the proximal femur including the greater trochanter, which has rarely reported previously.
Interpretation
A full range of fall directions and less restrictive displacement constraints can improve the finite element strength ability to classify patients under their risk of fracture.
Tumoral calcinosis, also referred to as Teutschländer disease is a rare familial disorder characterized by painless, periarticular lumps or masses. Large amorphous calcific concentrations that surround the joints are the defining feature. These lesions have fibrous septa that divide them into lobules and may often show fluid/calcium levels (milk of calcium/suspended hydroxyapatite crystals).
In our case report, a 24-year-old male came to the outpatient department (OPD) with complaints of pain over the right hip for two days and swelling over both hips for six years. He was apparently well two days prior to the hospital visit, when he met with a road traffic accident, falling off his bike. A plain radiograph of the pelvis and bilateral hip joints along with cross-table lateral views were done, which depicted a typical appearance of amorphous and multilobulated ("cloud-like") calcifications located in a periarticular distribution in both hips along with an intertrochanteric fracture in the right hip. A CT scan, done for better delineation of the calcific masses and fracture pattern, showed no obvious erosion or osseous destruction by the adjacent soft-tissue masses. Laboratory investigations revealed a serum calcium level of 8.8 mg/dl and a serum phosphorous level of 6.0 mg/dl.
The patient was taken up for surgery after routine pre-operative investigations and a pre-anaesthesia check-up. Closed reduction internal fixation (CRIF) was done using a proximal femoral nail (PFN). A biopsy of the soft-tissue masses was sent for histopathology, which was suggestive of lobules of calcific material surrounded by histiocytic giant cells. The patient responded well to the treatment with no residual discharge from the incision site, and his treatment was continued with phosphate binders as prescribed by the endocrinologist.
As elderly populations rise worldwide, the amount of hip fractures have continued to increase and result in substantial medical burdens in many countries. This increase goes hand-in-hand with an increase in surgical procedures to correct hip fractures. The medical burden imparted by hip fractures and their corrective surgeries necessitate a clinically relevant understanding of the hip joint including the vascular, neural and musculoskeletal structures directly associated with and neighboring the joint. It is critical to appreciate how the normal hip anatomy is disrupted by a fracture and how this disruption is heavily influenced by the fracture's location. The effects of advancing age on the integrity of the hip joint and the risk of hip fractures further complicate hip anatomy. Consequentially, normal hip anatomy, aging and the pathology introduced by fractures play major roles in how hip fractures are approached surgically. This article aims to review the clinically relevant anatomy of the healthy hip joint, age-related changes that influence the joint, hip fractures, and corrective surgeries for hip fractures. This article is protected by copyright. All rights reserved.
