BACKGROUND Retrograde pubic ramus screw placement is an effective technique but requires substantial surgical expertise and specialized equipment.The management of osteoporotic anterior pelvic ring injuries remains ch...BACKGROUND Retrograde pubic ramus screw placement is an effective technique but requires substantial surgical expertise and specialized equipment.The management of osteoporotic anterior pelvic ring injuries remains challenging due to technical difficulties and a high risk of complications.AIM To introduce a novel and simplified surgical approach that utilizes a custom-designed handheld pelvic alignment guide(HPAG)in combination with a 6.0 mm hollow screw,aiming to enhance the accuracy,efficiency,and safety of retrograde pubic ramus screw fixation in osteoporotic pelvic fragility fractures.METHODS The HPAG and 6.0 mm hollow screw were employed during surgical treatment.A 2.0-3.0 cm incision was made to expose the optimal screw entry point.Intraop-erative pelvic inlet and obturator oblique views were used to monitor fracture reduction and guide screw insertion.Clinical outcomes and fracture reduction quality were evaluated using Matta,visual analog scale,and Majeed scores during follow-ups.A representative case is presented to demonstrate the surgical procedure in detail.RESULTS No perioperative complications were observed.The mean operative time was 35.2±6.97 minutes,with a screw insertion time of 7.25±1.86 minutes,an average incision length of 2.8±0.67 cm,and mean blood loss of 43.25±15.64 mL.At one-year follow-up,seven patients achieved excellent Majeed scores and three achieved good scores.CONCLUSION No perioperative complications were observed.The mean operative time was 35.2±6.97 minutes,with a screw insertion time of 7.25±1.86 minutes,an average incision length of 2.8±0.67 cm,and mean blood loss of 43.25±15.64 mL.At one-year follow-up,seven patients achieved excellent Majeed scores and three achieved good scores.展开更多
Background: Reduced bone density is a major risk factor for fragility fracture. Previous studies reported, that 69% to 100% of patients with fragility fractures had low bone mineral density (BMD). Objective: The objec...Background: Reduced bone density is a major risk factor for fragility fracture. Previous studies reported, that 69% to 100% of patients with fragility fractures had low bone mineral density (BMD). Objective: The objective of the study is to estimate the prevalence of osteoporosis and osteopenia among patients with fragility fractures. Results: The result of the study revealed that the mean age of patients included in the study was 65.11 ± 10.17 and the majority (77.3%) were females. The most common sites of fractures were the femur, radius and vertebra (30.7%, 17.0% and 14.8% respectively). Moreover, more than 95% of patients with fragility fracture who underwent BMD testing had low bone mineral density. In female with fragility fracture the prevalence of osteoporosis was higher in comparison to male (58.8% and 45.0% respectively). Conclusion: Our data showed that low BMD measurement is prevalent in patient with fragility fracture. It also highlighted the importance of implementation of Fracture liaison service, to reduce the gap between fragility fracture and osteoporosis treatment.展开更多
The aim of this study was to identify three-dimensional microstructural changes of trabecular bone with age and gender, using micro-computed tomography. Human trabecular bone from two disease groups, osteoporosis and ...The aim of this study was to identify three-dimensional microstructural changes of trabecular bone with age and gender, using micro-computed tomography. Human trabecular bone from two disease groups, osteoporosis and osteoarthritis was analyzed. A prior analysis of the effects of some procedure variables on the micro-CT results was performed. Preliminary micro-CT scans were performed with three voxel resolutions and two acquisition conditions. On the reconstruction step, the image segmentation was performed with three different threshold values. Samples were collected from patients, with coxarthrosis (osteoarthritis) or fragility fracture (osteoporosis). The specimens of the coxarthrosis group include twenty females and fifteen males, while the fragility fracture group was composed by twenty three females and seven males. The mean age of the population was 69 ± 11 (females) and 67 ± 10 years (males), in the coxarthrosis group, while in the fragility fracture group was 81 ± 6 (females) and 78 ± 6 (males) years. The 30 μm voxel size provided lower percentage difference for the microarchitecture parameters. Acquisition conditions with 160 μA and 60 kV permit the evaluation of all the volume’s sample, with low average values of the coefficients of variation of the microstructural parameters. No statistically significant differences were found between the two diseases groups, neither between genders. However, with aging, there is a decrease of bone volume fraction, trabecular number and fractal dimension, and an increase of structural model index and trabecular separation, for both disease groups and genders. The parameters bone specific surface, trabecular thickness and degree of anisotropy have different behaviors with age, depending on the type of disease. While in coxarthrosis patients, trabecular thickness increases with age, in the fragility fracture group, there is a decrease of trabecular thickness with increasing age. Our findings indicate that disease, age and gender do not provide significant differences in trabecular microstructure. With aging, some parameters exhibit different trends which are possibly related to different mechanisms for different diseases.展开更多
According to World Health Organization,one in six people will be older than 60 by 2030.The rising life expectancy is anticipated to contribute to a subsequent increase of geriatric fractures worldwide.Osteosarcopenia,...According to World Health Organization,one in six people will be older than 60 by 2030.The rising life expectancy is anticipated to contribute to a subsequent increase of geriatric fractures worldwide.Osteosarcopenia,which is the coexistence of osteoporosis and sarcopenia,greatly affects older people.Recent studies have tried to identify the prevalence of osteosarcopenia in older populations as well as its correlation with fragility fractures such as hip fractures.The latter pose a major burden on both health loss and costs worldwide.Increasing amount of evidence suggests that osteosarcopenia in patients with hip fractures contributes to higher rates of mortality and complications.At the same time,research focuses on the molecular basis of the interplay between osteoporosis and sarcopenia by utilizing genomic or proteomic approaches.These promising studies could reveal potential preventive or diagnostic biomarkers to optimize the management of osteosarcopenia in hip fractures patients.The fact that bones and muscle can also function as endocrine organs further highlights the complex relationship between osteoporosis and sarcopenia,underscoring the need for a better understanding of the role of myokines and osteokines in osteosarcopenia.Finally,the impact of osteosarcopenia on pain management and rehabilitation after hip fracture surgery,requires further assessment.展开更多
BACKGROUND Osteoporotic fractures,whether due to postmenopausal or senile causes,impose a significant financial burden on developing countries and diminish quality of life.Recent advancements in artificial intelligenc...BACKGROUND Osteoporotic fractures,whether due to postmenopausal or senile causes,impose a significant financial burden on developing countries and diminish quality of life.Recent advancements in artificial intelligence(AI)algorithms have demonstrated immense potential in predicting osteoporotic fractures.AIM To assess and compare the efficacy of AI models against dual-energy X-ray absorptiometry(DXA)and the Fracture Risk Assessment Tool(FRAX)in predicting fragility fractures.METHODS We conducted a literature search in English using electronic databases,including PubMed,Web of Science,and Scopus,for studies published until May 2024.The keywords employed were fragility fractures,osteoporosis,AI,deep learning,machine learning,and convolutional neural network.The inclusion criteria for selecting publications were based on studies involving patients with proximal femur and vertebral column fractures due to osteoporosis,utilizing AI algorithms,and analyzing the site of fracture and accuracy for predicting fracture risk using SPSS version 29(Chicago,IL,United States).RESULTS We identified 156 publications for analysis.After applying our inclusion criteria,24489 patients were analyzed from 13 studies.The mean area under the receiver operating characteristic curve was 0.925±0.69.The mean sensitivity was 68.3%±15.3%,specificity was 85.5%±13.4%,and positive predictive value was 86.5%±6.3%.DXA showed a sensitivity of 37.0% and 74.0%,while FRAX demonstrated a sensitivity of 45.7%and 84.7%.The P value for sensitivity between DXA and AI was<0.0001,while for FRAX it was<0.0001 and 0.2.CONCLUSION This review found that AI is a valuable tool to analyze and identify patients who will suffer from fragility fractures before they occur,demonstrating superiority over DXA and FRAX.Further studies are necessary to be conducted across various centers with diverse population groups,larger datasets,and a longer duration of follow-up to enhance the predictive performance of the AI models before their universal application.展开更多
Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review ...Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review of the management of OVCFs.The purpose of this study is to review background information,diagnosis,and surgical and non-surgical management of the OVCFs.A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed.Combinations of the following terms were used:compression fractures,vertebral compression fractures,osteoporosis,osteoporotic compression fractures,vertebroplasty,kyphoplasty,bisphosphonates,calcitonin,and osteoporosis treatments.Additional articles were also included by examining the reference list of articles found in the search.OVCFs,especially those that occur over long periods,can be asymptomatic.Symptoms of acute OVCFs include pain localized to the mid-line spine,a loss in height,and decreased mobility.The primary treatment regimens are pain control,medication management,vertebral augmentation,and anterior or posterior decompression and reconstructions.Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain.Bisphosphonates and denosumab are the first-line treatments for osteoporosis.Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief.Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications.Calcium and vitamin D supplementation can have a protective and therapeutic effect.Management of OVCFs must be combined with multiple approaches.Appropriate exercises and activity modification are important in fracture prevention.Medication with different mechanisms of action is a critical long-term causal treatment strategy.The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods.Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present.The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.展开更多
<strong>Background and Objectives:</strong> Osteoporosis causes fragility fractures which increase the morbidity and mortality in the elderly. Our objective was to look at the hospital admissions due to fr...<strong>Background and Objectives:</strong> Osteoporosis causes fragility fractures which increase the morbidity and mortality in the elderly. Our objective was to look at the hospital admissions due to fragility fractures and site of fractures. <strong>Methods: </strong>This is a retrospective study of a 2-year period (2017-2018), in which we evaluated all the admissions of fragility fractures at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. A Fragility Fracture is a fracture which occurs in patients with low bone mass due to a fall from a standing height. The data were gathered from the Quadru Med patient care system for patients over the age of 50 years: sex, site of fracture, previous fractures, and treatment meted out. The hospitalization rate for fragility fractures was calculated by taking into consideration of all the adult admissions to the orthopaedic department. Ethical approval was obtained from the Institutional Review Board of the Hospital and the Imam Abdul Rahman Bin Faisal University, Dammam. <strong>Results:</strong> During the study period 187 patients with fragility fractures were admitted. The mean age was 68.55 ± 12.43 years;fracture femur was the most common with 136 (72.7%), tibia 15 (8%) and spine 14 (7.5%). At the time of discharge based on the T score of spine 50 were osteopenic and 45 were osteoporotic. Overall adult admission for the study period was 1410 patients and 13.26% were patients with fragility fractures. There were 3 (1.6%) deaths within the first 30 days in the hospital. <strong>Conclusions:</strong> Fracture femur was the most common fragility fracture seen in our study. Orthopaedic surgeons should be ready to treat all fragility fractures and treat osteoporosis appropriately so that a second fracture is prevented.展开更多
BACKGROUND The National Institute for Health and Care Excellence(NICE)guidelines have advised further research is required into investigating the added prognostic value of bone mineral density(BMD)in the assessment of...BACKGROUND The National Institute for Health and Care Excellence(NICE)guidelines have advised further research is required into investigating the added prognostic value of bone mineral density(BMD)in the assessment of fracture risk with the Fracture Risk Assessment Tool(FRAX)score.AIM To investigate the significance of BMD in fracture neck of femur patients and compare it to the outcome of the FRAX score.METHODS Inclusion criteria for this study were all patients who underwent dual-energy Xray absorptiometry(DXA)scan following fracture neck of femur between 2015 and 2017.Analysis of BMD,FRAX scores and patient demographic data was undertaken.RESULTS A total of 69 patients were included in the study,mean age 74.1 years.There was no significant difference between mean BMD of the femoral neck in males(0.65)as compared to females(0.61)(P=0.364).Analyses showed no significant correlation between BMD and menopause age(rs=-0.28,P=0.090).A significant difference was seen of the femoral neck BMD between the different fracture pattern types(P=0.026).A stronger correlation was observed between BMD of femoral neck and FRAX major score(rs=-0.64,P<0.001)than with BMD of lumbar spine and FRAX major score(rs=-0.37,P=0.003).CONCLUSION This study demonstrated that BMD of the femoral neck measured by DXA scan is of added prognostic value when assessing patients for risk of fracture neck of femur in combination with the FRAX predictive scoring system.展开更多
BACKGROUND Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality.However,data on the clinical outcomes of open ankle fracture ma...BACKGROUND Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality.However,data on the clinical outcomes of open ankle fracture management in patients older than 70 is minimal.AIM To evaluate the clinical outcomes following open ankle fracture management in patients older than 70.Our secondary aim is to look at predictors of poor outcomes.METHODS Following local research and audit department registration,22 years of prospectively collated data from an electronic database in a district general hospital were assessed.All patients older than 70 years of age with an open ankle fracture requiring surgical intervention were identified.Demographic information,the nature,and the number of surgical interventions were collated.Complications,including surgical site infection(SSI),venous thromboembolic events(VTEs)during hospital stay,and mortality rate,were reviewed.RESULTS A total of 37 patients were identified(median age:84 years,range:70-98);n=30 females median age:84 years,range:70-97);n=7 males median age:74 years,range:71-98))who underwent surgical intervention after an open ankle fracture.Sixteen patients developed SSIs(43%).Superficial SSIs(n=8)were managed without surgical intervention and treated with antibiotics and regular dressing changes.Deep SSIs(n=8;20%)required a median of 3(range:2-9)surgical interventions,with four patients requiring multiple washouts and one patient having metalwork removed.VTE incidence was 5%during the hospital stay.Eight patients died within 30 d,and mortality at one year was 19%.The 10-year mortality rate was 57%.The presence of a history of stroke,cancer,or prolonged inpatient stay was found to be predictive of lower survivorship in this population(log-rank test:cancer P=0.008,stroke P=0.001,length of stay>33 d P=0.015).The presence of a cardiac history was predictive of wound complications(logistic regression,P=0.045).Age,number of operations,and diabetic history were found to be predictive of an increase in the length of stay(general linear model;age P<0.001,number of operations P<0.001,diabetes P=0.041).CONCLUSION An open ankle fracture in a patient older than 70 years has at least a 20%chance of requiring repeated surgical intervention due to deep SSIs.The presence of a cardiac history appears to be the main predictor for wound complications.展开更多
The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of b...The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of bone damage in the patient affected by UC. It is wise to assess vitamin D status in ulcerative colitis patients to recognize who is predisposed to low levels of vitamin D, whose deficiency has to be treated with oral or parenteral vitamin D supplementation. An adequate dietary calcium intake or supplementation and physical activity, if possible, should be guaranteed. Osteoporotic risk factors, such as smoking and excessive alcohol intake, must be avoided. Steroid has to be prescribed at the lowest possible dosage and for the shortest possible time. Moreover, conditions favoring falling have to been minimized, like carpets, low illumination, sedatives assumption, vitamin D deficiency. It is advisable to assess the fracture risk in all UC patient by the fracture assessment risk tool (FRAX<sup>®</sup> tool), that calculates the ten years risk of fracture for the population aged from 40 to 90 years in many countries of the world. A high risk value could indicate the necessity of treatment, whereas a low risk value suggests a follow-up only. An intermediate risk supports the decision to prescribe bone mineral density (BMD) assessment and a subsequent patient revaluation for treatment. Dual energy X-ray absorptiometry bone densitometry can be used not only for BMD measurement, but also to collect data about bone quality by the means of trabecular bone score and hip structural analysis assessment. These two indices could represent a method of interesting perspectives in evaluating bone status in patients affected by diseases like UC, which may present an impairment of bone quality as well as of bone quantity. In literature there is no strong evidence for instituting pharmacological therapy of bone impairment in UC patients for clinical indications other than those that are also applied to the patients with osteoporosis. Therefore, a reasonable advice is to consider pharmacological treatment for osteoporosis in those UC patients who already present fragility fractures, which bring a high risk of subsequent fractures. Therapy has also to be considered in patients with a high risk of fracture even if it did not yet happen, and particularly when they had long periods of corticosteroid therapy or cumulative high dosages. In patients without fragility fractures or steroid treatment, a medical decision about treatment could be guided by the FRAX tool to determine the intervention threshold. Among drugs for osteoporosis treatment, the bisphosphonates are the most studied ones, with the best and longest evidence of efficacy and safety. Despite this, several questions are still open, such as the duration of treatment, the necessity to discontinue it, the indication of therapy in young patients, particularly in those without previous fractures. Further, it has to be mentioned that a long-term bisphosphonates use in primary osteoporosis has been associated with an increased incidence of dramatic side-effects, even if uncommon, like osteonecrosis of the jaw and atypical sub-trochanteric and diaphyseal femoral fractures. UC is a long-lasting disease and the majority of patients is relatively young. In this scenario primary prevention of fragility fracture is the best cost-effective strategy. Vitamin D supplementation, adequate calcium intake, suitable physical activity (when possible), removing of risk factors for osteoporosis like smoking, and avoiding falling are the best medical acts.展开更多
BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechani...BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty(THA).AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA.METHODS Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited.All patients underwent a salvage surgical procedure,i.e.,cephalomedullary nail removal and conversion to THA.The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia.All patients underwent clinical and radiographic follow-ups for at least 24 mo.Complications and re-operations were recorded.RESULTS Seventy-four patients met the inclusion criteria(male:29;female:45;mean age:73.8-years-old;range:65-89)and were included in the current study.The average operative time was 117 min(76-192 min).The average blood loss was 585 mL(430-1720 mL).Among the 74 patients,43(58.1%)required transfusion of three or more blood units.Two patients died within the 4th d after surgery because of pulmonary embolism,and 1 patient died 9 mo after surgery due to ischemic myocardial infarction.The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%.In 3 cases out of 71(4.2%)periprosthetic acetabular fracture was observed during the followup.One of these periacetabular fractures occurred intraoperatively.An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71(7.0%).Four of these patients needed a re-operation to fix the fracture with plates and cerclages;in one of these patients,femoral stem revision was also necessary.In 4 patients out of 71(5.6%),an early THA dislocation was observed,whereas in 1 case(1.4%)a late THA dislocation was observed.Three patients out of 71(4.2%)developed a periprosthetic joint infection during the study follow-up.CONCLUSION The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate.展开更多
基金Supported by Shanghai Tongren Hospital,Shanghai Jiaotong University School of Medicine,No.TRYJ2024 LC16the National Natural Science Foundation of China,No.82102577the Laboratory Open Fund of Key Technology and Materials in Minimally Invasive Spine Surgery,No.2024JZWC-YBA05.
文摘BACKGROUND Retrograde pubic ramus screw placement is an effective technique but requires substantial surgical expertise and specialized equipment.The management of osteoporotic anterior pelvic ring injuries remains challenging due to technical difficulties and a high risk of complications.AIM To introduce a novel and simplified surgical approach that utilizes a custom-designed handheld pelvic alignment guide(HPAG)in combination with a 6.0 mm hollow screw,aiming to enhance the accuracy,efficiency,and safety of retrograde pubic ramus screw fixation in osteoporotic pelvic fragility fractures.METHODS The HPAG and 6.0 mm hollow screw were employed during surgical treatment.A 2.0-3.0 cm incision was made to expose the optimal screw entry point.Intraop-erative pelvic inlet and obturator oblique views were used to monitor fracture reduction and guide screw insertion.Clinical outcomes and fracture reduction quality were evaluated using Matta,visual analog scale,and Majeed scores during follow-ups.A representative case is presented to demonstrate the surgical procedure in detail.RESULTS No perioperative complications were observed.The mean operative time was 35.2±6.97 minutes,with a screw insertion time of 7.25±1.86 minutes,an average incision length of 2.8±0.67 cm,and mean blood loss of 43.25±15.64 mL.At one-year follow-up,seven patients achieved excellent Majeed scores and three achieved good scores.CONCLUSION No perioperative complications were observed.The mean operative time was 35.2±6.97 minutes,with a screw insertion time of 7.25±1.86 minutes,an average incision length of 2.8±0.67 cm,and mean blood loss of 43.25±15.64 mL.At one-year follow-up,seven patients achieved excellent Majeed scores and three achieved good scores.
文摘Background: Reduced bone density is a major risk factor for fragility fracture. Previous studies reported, that 69% to 100% of patients with fragility fractures had low bone mineral density (BMD). Objective: The objective of the study is to estimate the prevalence of osteoporosis and osteopenia among patients with fragility fractures. Results: The result of the study revealed that the mean age of patients included in the study was 65.11 ± 10.17 and the majority (77.3%) were females. The most common sites of fractures were the femur, radius and vertebra (30.7%, 17.0% and 14.8% respectively). Moreover, more than 95% of patients with fragility fracture who underwent BMD testing had low bone mineral density. In female with fragility fracture the prevalence of osteoporosis was higher in comparison to male (58.8% and 45.0% respectively). Conclusion: Our data showed that low BMD measurement is prevalent in patient with fragility fracture. It also highlighted the importance of implementation of Fracture liaison service, to reduce the gap between fragility fracture and osteoporosis treatment.
基金the Portuguese research foundation FCT(Fundacao para a Ciencia e Tecnologia)for providing financial support(SFRH/BD/48100/2008)MFC Pereira and A Mauricio acknowledge FEDER Funds through Programa Operacional Factores de Com-petitividade-COMPETE,and FCT Project PEst-OE/CTE/UI0098/2011
文摘The aim of this study was to identify three-dimensional microstructural changes of trabecular bone with age and gender, using micro-computed tomography. Human trabecular bone from two disease groups, osteoporosis and osteoarthritis was analyzed. A prior analysis of the effects of some procedure variables on the micro-CT results was performed. Preliminary micro-CT scans were performed with three voxel resolutions and two acquisition conditions. On the reconstruction step, the image segmentation was performed with three different threshold values. Samples were collected from patients, with coxarthrosis (osteoarthritis) or fragility fracture (osteoporosis). The specimens of the coxarthrosis group include twenty females and fifteen males, while the fragility fracture group was composed by twenty three females and seven males. The mean age of the population was 69 ± 11 (females) and 67 ± 10 years (males), in the coxarthrosis group, while in the fragility fracture group was 81 ± 6 (females) and 78 ± 6 (males) years. The 30 μm voxel size provided lower percentage difference for the microarchitecture parameters. Acquisition conditions with 160 μA and 60 kV permit the evaluation of all the volume’s sample, with low average values of the coefficients of variation of the microstructural parameters. No statistically significant differences were found between the two diseases groups, neither between genders. However, with aging, there is a decrease of bone volume fraction, trabecular number and fractal dimension, and an increase of structural model index and trabecular separation, for both disease groups and genders. The parameters bone specific surface, trabecular thickness and degree of anisotropy have different behaviors with age, depending on the type of disease. While in coxarthrosis patients, trabecular thickness increases with age, in the fragility fracture group, there is a decrease of trabecular thickness with increasing age. Our findings indicate that disease, age and gender do not provide significant differences in trabecular microstructure. With aging, some parameters exhibit different trends which are possibly related to different mechanisms for different diseases.
文摘According to World Health Organization,one in six people will be older than 60 by 2030.The rising life expectancy is anticipated to contribute to a subsequent increase of geriatric fractures worldwide.Osteosarcopenia,which is the coexistence of osteoporosis and sarcopenia,greatly affects older people.Recent studies have tried to identify the prevalence of osteosarcopenia in older populations as well as its correlation with fragility fractures such as hip fractures.The latter pose a major burden on both health loss and costs worldwide.Increasing amount of evidence suggests that osteosarcopenia in patients with hip fractures contributes to higher rates of mortality and complications.At the same time,research focuses on the molecular basis of the interplay between osteoporosis and sarcopenia by utilizing genomic or proteomic approaches.These promising studies could reveal potential preventive or diagnostic biomarkers to optimize the management of osteosarcopenia in hip fractures patients.The fact that bones and muscle can also function as endocrine organs further highlights the complex relationship between osteoporosis and sarcopenia,underscoring the need for a better understanding of the role of myokines and osteokines in osteosarcopenia.Finally,the impact of osteosarcopenia on pain management and rehabilitation after hip fracture surgery,requires further assessment.
文摘BACKGROUND Osteoporotic fractures,whether due to postmenopausal or senile causes,impose a significant financial burden on developing countries and diminish quality of life.Recent advancements in artificial intelligence(AI)algorithms have demonstrated immense potential in predicting osteoporotic fractures.AIM To assess and compare the efficacy of AI models against dual-energy X-ray absorptiometry(DXA)and the Fracture Risk Assessment Tool(FRAX)in predicting fragility fractures.METHODS We conducted a literature search in English using electronic databases,including PubMed,Web of Science,and Scopus,for studies published until May 2024.The keywords employed were fragility fractures,osteoporosis,AI,deep learning,machine learning,and convolutional neural network.The inclusion criteria for selecting publications were based on studies involving patients with proximal femur and vertebral column fractures due to osteoporosis,utilizing AI algorithms,and analyzing the site of fracture and accuracy for predicting fracture risk using SPSS version 29(Chicago,IL,United States).RESULTS We identified 156 publications for analysis.After applying our inclusion criteria,24489 patients were analyzed from 13 studies.The mean area under the receiver operating characteristic curve was 0.925±0.69.The mean sensitivity was 68.3%±15.3%,specificity was 85.5%±13.4%,and positive predictive value was 86.5%±6.3%.DXA showed a sensitivity of 37.0% and 74.0%,while FRAX demonstrated a sensitivity of 45.7%and 84.7%.The P value for sensitivity between DXA and AI was<0.0001,while for FRAX it was<0.0001 and 0.2.CONCLUSION This review found that AI is a valuable tool to analyze and identify patients who will suffer from fragility fractures before they occur,demonstrating superiority over DXA and FRAX.Further studies are necessary to be conducted across various centers with diverse population groups,larger datasets,and a longer duration of follow-up to enhance the predictive performance of the AI models before their universal application.
文摘Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review of the management of OVCFs.The purpose of this study is to review background information,diagnosis,and surgical and non-surgical management of the OVCFs.A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed.Combinations of the following terms were used:compression fractures,vertebral compression fractures,osteoporosis,osteoporotic compression fractures,vertebroplasty,kyphoplasty,bisphosphonates,calcitonin,and osteoporosis treatments.Additional articles were also included by examining the reference list of articles found in the search.OVCFs,especially those that occur over long periods,can be asymptomatic.Symptoms of acute OVCFs include pain localized to the mid-line spine,a loss in height,and decreased mobility.The primary treatment regimens are pain control,medication management,vertebral augmentation,and anterior or posterior decompression and reconstructions.Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain.Bisphosphonates and denosumab are the first-line treatments for osteoporosis.Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief.Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications.Calcium and vitamin D supplementation can have a protective and therapeutic effect.Management of OVCFs must be combined with multiple approaches.Appropriate exercises and activity modification are important in fracture prevention.Medication with different mechanisms of action is a critical long-term causal treatment strategy.The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods.Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present.The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.
文摘<strong>Background and Objectives:</strong> Osteoporosis causes fragility fractures which increase the morbidity and mortality in the elderly. Our objective was to look at the hospital admissions due to fragility fractures and site of fractures. <strong>Methods: </strong>This is a retrospective study of a 2-year period (2017-2018), in which we evaluated all the admissions of fragility fractures at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. A Fragility Fracture is a fracture which occurs in patients with low bone mass due to a fall from a standing height. The data were gathered from the Quadru Med patient care system for patients over the age of 50 years: sex, site of fracture, previous fractures, and treatment meted out. The hospitalization rate for fragility fractures was calculated by taking into consideration of all the adult admissions to the orthopaedic department. Ethical approval was obtained from the Institutional Review Board of the Hospital and the Imam Abdul Rahman Bin Faisal University, Dammam. <strong>Results:</strong> During the study period 187 patients with fragility fractures were admitted. The mean age was 68.55 ± 12.43 years;fracture femur was the most common with 136 (72.7%), tibia 15 (8%) and spine 14 (7.5%). At the time of discharge based on the T score of spine 50 were osteopenic and 45 were osteoporotic. Overall adult admission for the study period was 1410 patients and 13.26% were patients with fragility fractures. There were 3 (1.6%) deaths within the first 30 days in the hospital. <strong>Conclusions:</strong> Fracture femur was the most common fragility fracture seen in our study. Orthopaedic surgeons should be ready to treat all fragility fractures and treat osteoporosis appropriately so that a second fracture is prevented.
文摘BACKGROUND The National Institute for Health and Care Excellence(NICE)guidelines have advised further research is required into investigating the added prognostic value of bone mineral density(BMD)in the assessment of fracture risk with the Fracture Risk Assessment Tool(FRAX)score.AIM To investigate the significance of BMD in fracture neck of femur patients and compare it to the outcome of the FRAX score.METHODS Inclusion criteria for this study were all patients who underwent dual-energy Xray absorptiometry(DXA)scan following fracture neck of femur between 2015 and 2017.Analysis of BMD,FRAX scores and patient demographic data was undertaken.RESULTS A total of 69 patients were included in the study,mean age 74.1 years.There was no significant difference between mean BMD of the femoral neck in males(0.65)as compared to females(0.61)(P=0.364).Analyses showed no significant correlation between BMD and menopause age(rs=-0.28,P=0.090).A significant difference was seen of the femoral neck BMD between the different fracture pattern types(P=0.026).A stronger correlation was observed between BMD of femoral neck and FRAX major score(rs=-0.64,P<0.001)than with BMD of lumbar spine and FRAX major score(rs=-0.37,P=0.003).CONCLUSION This study demonstrated that BMD of the femoral neck measured by DXA scan is of added prognostic value when assessing patients for risk of fracture neck of femur in combination with the FRAX predictive scoring system.
文摘BACKGROUND Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality.However,data on the clinical outcomes of open ankle fracture management in patients older than 70 is minimal.AIM To evaluate the clinical outcomes following open ankle fracture management in patients older than 70.Our secondary aim is to look at predictors of poor outcomes.METHODS Following local research and audit department registration,22 years of prospectively collated data from an electronic database in a district general hospital were assessed.All patients older than 70 years of age with an open ankle fracture requiring surgical intervention were identified.Demographic information,the nature,and the number of surgical interventions were collated.Complications,including surgical site infection(SSI),venous thromboembolic events(VTEs)during hospital stay,and mortality rate,were reviewed.RESULTS A total of 37 patients were identified(median age:84 years,range:70-98);n=30 females median age:84 years,range:70-97);n=7 males median age:74 years,range:71-98))who underwent surgical intervention after an open ankle fracture.Sixteen patients developed SSIs(43%).Superficial SSIs(n=8)were managed without surgical intervention and treated with antibiotics and regular dressing changes.Deep SSIs(n=8;20%)required a median of 3(range:2-9)surgical interventions,with four patients requiring multiple washouts and one patient having metalwork removed.VTE incidence was 5%during the hospital stay.Eight patients died within 30 d,and mortality at one year was 19%.The 10-year mortality rate was 57%.The presence of a history of stroke,cancer,or prolonged inpatient stay was found to be predictive of lower survivorship in this population(log-rank test:cancer P=0.008,stroke P=0.001,length of stay>33 d P=0.015).The presence of a cardiac history was predictive of wound complications(logistic regression,P=0.045).Age,number of operations,and diabetic history were found to be predictive of an increase in the length of stay(general linear model;age P<0.001,number of operations P<0.001,diabetes P=0.041).CONCLUSION An open ankle fracture in a patient older than 70 years has at least a 20%chance of requiring repeated surgical intervention due to deep SSIs.The presence of a cardiac history appears to be the main predictor for wound complications.
文摘The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of bone damage in the patient affected by UC. It is wise to assess vitamin D status in ulcerative colitis patients to recognize who is predisposed to low levels of vitamin D, whose deficiency has to be treated with oral or parenteral vitamin D supplementation. An adequate dietary calcium intake or supplementation and physical activity, if possible, should be guaranteed. Osteoporotic risk factors, such as smoking and excessive alcohol intake, must be avoided. Steroid has to be prescribed at the lowest possible dosage and for the shortest possible time. Moreover, conditions favoring falling have to been minimized, like carpets, low illumination, sedatives assumption, vitamin D deficiency. It is advisable to assess the fracture risk in all UC patient by the fracture assessment risk tool (FRAX<sup>®</sup> tool), that calculates the ten years risk of fracture for the population aged from 40 to 90 years in many countries of the world. A high risk value could indicate the necessity of treatment, whereas a low risk value suggests a follow-up only. An intermediate risk supports the decision to prescribe bone mineral density (BMD) assessment and a subsequent patient revaluation for treatment. Dual energy X-ray absorptiometry bone densitometry can be used not only for BMD measurement, but also to collect data about bone quality by the means of trabecular bone score and hip structural analysis assessment. These two indices could represent a method of interesting perspectives in evaluating bone status in patients affected by diseases like UC, which may present an impairment of bone quality as well as of bone quantity. In literature there is no strong evidence for instituting pharmacological therapy of bone impairment in UC patients for clinical indications other than those that are also applied to the patients with osteoporosis. Therefore, a reasonable advice is to consider pharmacological treatment for osteoporosis in those UC patients who already present fragility fractures, which bring a high risk of subsequent fractures. Therapy has also to be considered in patients with a high risk of fracture even if it did not yet happen, and particularly when they had long periods of corticosteroid therapy or cumulative high dosages. In patients without fragility fractures or steroid treatment, a medical decision about treatment could be guided by the FRAX tool to determine the intervention threshold. Among drugs for osteoporosis treatment, the bisphosphonates are the most studied ones, with the best and longest evidence of efficacy and safety. Despite this, several questions are still open, such as the duration of treatment, the necessity to discontinue it, the indication of therapy in young patients, particularly in those without previous fractures. Further, it has to be mentioned that a long-term bisphosphonates use in primary osteoporosis has been associated with an increased incidence of dramatic side-effects, even if uncommon, like osteonecrosis of the jaw and atypical sub-trochanteric and diaphyseal femoral fractures. UC is a long-lasting disease and the majority of patients is relatively young. In this scenario primary prevention of fragility fracture is the best cost-effective strategy. Vitamin D supplementation, adequate calcium intake, suitable physical activity (when possible), removing of risk factors for osteoporosis like smoking, and avoiding falling are the best medical acts.
文摘BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty(THA).AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA.METHODS Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited.All patients underwent a salvage surgical procedure,i.e.,cephalomedullary nail removal and conversion to THA.The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia.All patients underwent clinical and radiographic follow-ups for at least 24 mo.Complications and re-operations were recorded.RESULTS Seventy-four patients met the inclusion criteria(male:29;female:45;mean age:73.8-years-old;range:65-89)and were included in the current study.The average operative time was 117 min(76-192 min).The average blood loss was 585 mL(430-1720 mL).Among the 74 patients,43(58.1%)required transfusion of three or more blood units.Two patients died within the 4th d after surgery because of pulmonary embolism,and 1 patient died 9 mo after surgery due to ischemic myocardial infarction.The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%.In 3 cases out of 71(4.2%)periprosthetic acetabular fracture was observed during the followup.One of these periacetabular fractures occurred intraoperatively.An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71(7.0%).Four of these patients needed a re-operation to fix the fracture with plates and cerclages;in one of these patients,femoral stem revision was also necessary.In 4 patients out of 71(5.6%),an early THA dislocation was observed,whereas in 1 case(1.4%)a late THA dislocation was observed.Three patients out of 71(4.2%)developed a periprosthetic joint infection during the study follow-up.CONCLUSION The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate.
