Search

• The number of undocumented migrants has increased drastically in the past decade, while during COVID-19 the amount has seen further exponential increase. Between the Hungarian–Serbian border near the Southern City of Szeged, 4 meter high walls were created in 2018 aiming to better control the influx of undocumented migrants. • The number of patients has exponentially increased. In 2018 there were a total of 21 patients whereas in 2022 a total of 711 patients were admitted. With a direct relation to the migrant number, the financial costs have also shown an exponential increase and will continue to do so in this fashion. • While assessing the fracture patterns, we saw a constant ratio of calcaneal (AO82) and ankle (AO44) fractures as expected, but increased numbers in more proximal fractures in consecutive years, with 2022 having the highest proportion of proximal fractures as well as open and bilateral fractures which had also increased in the same noticeable fashion. • In 2020 and 2021, the ratio of costs allocated to surgery (52 % and 50 % respectively) was almost the same but this ratio drastically increased in 2022; more surgeries were required due to more complex injuries. The Traumatology Clinic of the University of Szeged is a level one Trauma center situated near the Hungarian - Serbian border, where a 4 m tall fence constructed in 2018 serves as a barricade leading to numerous trauma cases. The objective of this study is to characterize the epidemiology of injuries, challenges, and recent trends whilst treating these undocumented migrants in Hungary. A national retrospective mono-centrical study was performed, examining 982 patients who were admitted to the emergency trauma center in the University of Szeged between January 2018 and December 2022, using data from our electronic administrative system (eMedSol). Factors such as basic epidemiology, country of origin, fractures- according to the AO classification- and its respective treatments, mechanism of injury, duration of stay, and costs were assessed to set as a basis for prediction using a regression model. A total of 982 patients from 2018 to 2022 were included in the study. Patterns of injury included calcaneal fractures in 2018 and 2019 whereas in 2021 and 2022 along with the exponential increase in patient number, bilateral calcaneal fractures, open and multi-fragmentary tibial fractures were also observed. Additionally, seasonal variations, favoring the months of September through November were observed. Treatment cost ratios, especially surgeries, have also been consistent with the pattern of proximalizing injuries; more proximal surgeries indicate higher surgical costs which is evidently visible in the significantly higher cost ratio dedicated to surgery in 2022. While migration seems to be a global problem affecting governments and citizens alike, rarely do we understand the direct consequences of illegal migration affecting healthcare services. Hungary in particular created a 4 m tall wall between Serbia in 2019 with means of preventing illegal migration, which in turn led to gradual and later an exponential increase in the number of injured patients particularly in the years 2021 and 2022. Undocumented migrant cases have increased exponentially between 2018 and 2022, with certain patterns seen not only in the injury types but also in seasonal variations and cost expectations. Injuries have been showing a trend of proximalization and have been of more serious quality, including bilateral and/or open injuries. Revisions after surgery were virtually impossible due to the discharging of patients back to border control after their definitive treatment. The need for adequate quality surgical care, manpower and financial aid should be considered. [ABSTRACT FROM AUTHOR]

Fractures in poliomyelitic limbs are a challenge to surgeons, due to polio's sequelae and morphological disorders, which make conventional osteosynthesis difficult. We present a retrospective study of 62 patients and 73 non-simultaneous fractures in their lower limbs. Average age was 61,7 years and 53,2% were females. We analyzed the preinjury functional level, etiology of the fracture, fracture pattern, treatment used (be conservative or surgical), and implant used in surgical cases. We treated 85,1% of them surgically and 37,9% of them maintained the same functional situation as before the fracture. 55,4% of them experienced the need to add some mechanical aids after the lesion and 6,8% lost the ability to walk. Most of the surgical treatments employed were similar as the ones used in non-poliomyelitic patients, although some cases required atypical implants, such as a Multiloc (® DePuy Synthes) humeral nail for a tibial shaft fracture, due to narrow bone. Mortality along the 1st year was 2.7%. We found similar functional and radiological results as those described in non-poliomyelitic limbs. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to analyze clinical effects between far cortical locking (FCL) system and standard plating techniques in the treatment of lower limb fractures and identify potential preoperative risk factors for complications in patients treated with FCL system.Method: We retrospectively analyzed 76 patients treated with FCL system (the study group) and 68 patients treated with standard plating techniques (the control group) between January 2014 and January 2017. Patients were followed up for a minimum of one year. Surgery-related complications, fixation features, fracture healing rates, the radiographic union scores, and knee functions (Kolment scores) were analyzed between the two groups in the study. Besides, we analyzed eight preoperative characteristics for surgery-related complications, including age, gender, presence of risk factors affecting bone healing, cause of injury, AO/OTA fracture classifications, facture sites, presence of open fractures, and presence of bone losses.Results: The distributions of baseline date were similar between the two groups (P＞0.05). The average number of FCL screws was 4.5 (range: 3-9) in the study group. The average time to union was 2.8 ± 0.9 months in the study group and 3.6 ± 1.0 months in the control group (P＜0.001), and average time to whole weight bearing was 2.3 ± 0.8 months and 2.8 ± 1.2 months, respectively (P = 0.004). Regarding radiographic union score, the study group scores were significantly higher than the control group scores at 1 and 3 months after surgery (P＜0.001), while it becomes insignificant between the two groups at 6 and 12 months after surgery (P = 0.19 and P = 0.15).The working lengths, fracture healing rates, complication rates, and Kolment scores were similar between the two groups (P＞0.05). In the multivariate analysis, fracture sites (OR = 5.34; 95% CI, 1.11-25.75; P = 0.03) and presence of open fractures (OR = 6.19; 95% CI, 1.05-36.38; P = 0.04) were significant associated with complications, whereas other variables were not included.Discussion: FCL system can truly accelerating bone healing and allow earlier whole weight bearing. Fracture healing rates and complication rates were similar between patients treated with FCL implants or conventional plating techniques. Patients with shaft fractures and open fractures trended to have higher complication rates.Conclusions: FCL system is superior to standard plating technique in terms of early callus formation, but standard plating technique is not inferior to FCL system in terms of final fracture healing, surgery-related complication, and function outcome. Fracture site and presence of open fracture are the independent factors for complications in patients treated with FCL system. [ABSTRACT FROM AUTHOR]

In this study, we examined the lower limb fracture healing time in children using random forest (RF) and Self Organizing feature Maps (SOM) methods. The study sample was obtained from the pediatric orthopedic unit in University Malaya Medical Centre. Radiographs of long bones of lower limb fractures involving the femur, tibia and fibula from children ages 0–12 years, with ages recorded from the date and time of initial injury. Inputs assessment extracted from radiographic images included the following features: type of fracture, angulation of the fracture, contact area percentage of the fracture, age, gender, bone type, type of fracture, and number of bone involved. RF is initially used to rank the most important variables that effecting bone healing time. Then, SOM was applied for analysis of the relationship between the selected variables with fracture healing time. Due to the limitation of available dataset, leave one out technique was applied to enhance the reliability of RF. Results showed that age and contact area percentage of fracture were identified as the most important variables in explaining the fracture healing time. RF and SOM applications have not been reported in the field of pediatric orthopedics. We concluded that the combination of RF and SOM techniques can be used to assist in the analysis of pediatric fracture healing time efficiently. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cirugía Ortopédica y Traumatologia (English Edition) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Discrete parameters from ground reaction force (GRF) are been considered in gait analysis studies. However, principal component analysis (PCA) may provide additional insight into gait analysis for considering the complete pattern of GRF. This study aimed at testing the application of PCA to discriminate the vertical GRF pattern between control group (CG) and patients with lower limb fractures (FG), as well as proposing a score to quantify the abnormality of gait. Thirty-eight healthy subjects participated of CG and 13 subjects in FG, five subjects from FG were also evaluated after physiotherapeutic treatment (FGA). The GRF was measured by an instrumented treadmill. Principal component coefficients (PCCs) were obtained by singular value decomposition using GRF of complete stride. Two, four and six PCCs were used to obtain the standard distance (D). The classification between groups was mainly given by the first PC, which indicated higher loading factors during push off of affected side and heel strike of unaffected side. The classification performance achieved 92.2% accuracy with two PCCs, 94.1% with four PCCs and 96.1% with six PCCs. Four subjects reached normal boundary after treatment, with all FGA subjects presenting decreased D. This study demonstrates that PCA is an adequate method for discriminating normal and abnormal gait and D allows an objective evaluation of the progress and effectiveness of rehabilitation treatment. [Copyright &y& Elsevier]