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Abstract Background Ankle fractures are prevalent injuries that necessitate precise diagnostic tools. Traditional diagnostic methods have limitations that can be addressed using machine learning techniques, with the potential to improve accuracy and expedite diagnoses. Methods We trained various deep learning architectures, notably the Adapted ResNet50 with SENet capabilities, to identify ankle fractures using a curated dataset of radiographic images. Model performance was evaluated using common metrics like accuracy, precision, and recall. Additionally, Grad-CAM visualizations were employed to interpret model decisions. Results The Adapted ResNet50 with SENet capabilities consistently outperformed other models, achieving an accuracy of 93%, AUC of 95%, and recall of 92%. Grad-CAM visualizations provided insights into areas of the radiographs that the model deemed significant in its decisions. Conclusions The Adapted ResNet50 model enhanced with SENet capabilities demonstrated superior performance in detecting ankle fractures, offering a promising tool to complement traditional diagnostic methods. However, continuous refinement and expert validation are essential to ensure optimal application in clinical settings.

Abstract Background Posterior malleolus fractures are known to be associated with ankle instability. The complexities involved in obtaining precise laboratory-based spatial pressure measurements of the ankle highlight the significance of exploring the biomechanical implications of these fractures. Methods Finite element analysis was utilized to examine the stress distribution across the contact surface of the ankle joint, both in its natural state and under varied sagittal fracture line angles. The study aimed to identify stress concentration zones and understand the influence of sagittal angles on stress distribution. Results Three distinct stress concentration zones were identified on the ankle's contact surface: the anterolateral tibia, the anteromedial tibia, and the fracture line. The most significant stress was observed at the fracture line when a fracture occurs. Stress at the fracture line notably spikes as the sagittal angle decreases, which can potentially compromise ankle stability. Larger sagittal angles exhibited only minor stress variations at the contact surface's three vertices. It was inferred that sagittal angles below 60° might pose risks to ankle stability. Conclusions The research underscores the potential implications of fractures on the stress profile of the ankle joint, emphasizing the role of the contact surface in ensuring stability. The identification of three zones of stress concentration and the influence of sagittal angles on stress distribution offers a valuable reference for therapeutic decision-making. Further, the study reinforces the importance of evaluating sagittal fracture angles, suggesting that angles below 60° may compromise ankle stability.

Abstract Background Data on the epidemiological characteristics and prognostic factors of patients with pelvic fractures are lacking, particularly in China. This study aimed to summarise the clinical and epidemiological characteristics of patients with pelvic fractures in eastern Zhejiang Province, China, and to identify risk factors for poor prognosis. Methods The clinical data of 369 patients with pelvic fractures admitted to the Ningbo No. 6 Hospital between September 2020 and September 2021 were retrospectively analysed. Data on the demographic characteristics; fracture classification; injury time, cause, and site; treatment plan; and prognosis were collected using the Picture Archiving and Communication System and the Hospital Information System. Differences in constituent proportions were analysed using the chi-square test. Logistic regression analysis was used to identify factors affecting patient prognosis. Statistical significance was set at p ≤ 0.05. Results Among the 369 patients, there were 206 men and 163 women, at a ratio of 1.26:1, and the average age was 53.64 ± 0.78 years. More than 50% of patients were aged 41–65 years. The average length of hospital stay was 18.88 ± 1.78 days. The three most common causes of pelvic fractures were traffic accidents (51.2%), falls from height (31.44%), and flat-ground falls (14.09%). There were significant differences in the distribution of the three causes of injury depending on age (p

BackgroundThis study aims to explore the relationship between urinary phytoestrogen mixed metabolites and the risk of osteoarthritis (OA).MethodsUsing data from the National Health and Nutrition Examination Survey (NHANES), a Weighted Quantile Sum (WQS) regression analysis was conducted to determine the dominant metabolites. Additionally, a Bayesian kernel machine regression (BKMR) model was utilized to explore the combined effects of phytoestrogen mixed metabolites on OA.ResultsCompared to the lowest quartile group, the highest quartile group of Enterodiol showed a 46% increased risk of OA (OR = 1.46, 95% CI: 1.09-1.96), while the highest quartile group of Enterlactone showed a 30% decreased risk of OA (OR = 0.70, 95% CI: 0.52-0.96). The WQS regression model analysis revealed a positive relationship between urinary phytoestrogen mixed metabolites and OA risk, with Enterodiol found to have the highest weight in this association. The BKMR model indicated that the association between urinary phytoestrogens and OA increased with concentration but did not reach statistical significance. The univariate exposure-response function demonstrated a positive association between Enterodiol and OA.ConclusionsThere is a positive relationship between urinary phytoestrogen mixed metabolites and OA, with Enterodiol being an important factor influencing OA risk.

Objective Surgical treatment for Schatzker type II tibial plateau fractures remains challenging and requires high‐quality research. The aim of the study is to compare the “windowing” and “open book” techniques for the treatment of Schatzker type II tibial plateau fractures. Methods In this prospective study, all patients with Schatzker type II tibial plateau fractures between January 2014 and December 2017 were managed by open reduction and internal fixation using an anterolateral incision approach. “Windowing” group included 78 patients (53 men and 25 women), with an average age of 57.7 ± 13.5 years, who underwent the “windowing” technique, in which the procedure was performed through a small cortical window against the depressed zone of the lateral plateau. The “open book” group included 80 patients (56 men and 24 women), with an average age of 54.8 ± 12.4 years, who underwent the technique. The clinical outcomes included the Rasmussen classification of knee function and grading of post‐traumatic arthritis. The radiographic outcome (x‐ray and computed tomography [CT]) was the reduction quality of the lateral plateau based on the modified Rasmussen radiological assessment. The patient‐reported outcome was visual analogue scale (VAS) scores. Results The mean follow‐up time for the158 patients was 32 months (range, 24–42 months). The time elapsed from injury to surgery in “windowing” group and “open book” group were 3.7 ± 1.2 (range, 1–10 days) and 3.5 ± 1.4 days (range, 1–11 days), respectively, with no significant difference between the groups (P > 0.05). The operation times did not differ significantly between the “windowing” group (61.0 ± 8.3 min, range, 45–120 min) and the “open book” group (61.2 ± 10.4 min, range, 40–123 min) (P > 0.05). After surgery, CT revealed five (6.4%) and 15 (18.8%) cases of articular depression in the “windowing” and “open book” groups, respectively. Significant differences were observed in the articular depression of tibial plateau fractures between the groups (P 0.05). VAS scores were similar between the groups at 24 months after surgery (P > 0.05). There were significant differences in the number of severe post‐traumatic arthritis (grades 2 and 3) cases between the groups (P

Purpose: This study was designed to investigate (1) the contour of the distal tibial cutting surface, and (2) the bone mineral density (BMD) of the distal tibial cutting surface used during total ankle arthroplasty (TAA). Methods: Eight-four distal tibial models were created using foot and ankle computerized tomographic (CT) images taken from normal people. The distal tibial cutting surface for TAA was determined to be 10 mm proximal to the tibial plafond. The bony contour and BMD values were determined from the CT image at that level. A bounding box was made on the contour and the width and length of the contour was measured. Regional BMD was evaluated by Hounsfield units (HU) value measurement, with 7 regions of interest (ROI) on 8 different directions for all the 84 CT images. Two different observers made independent measurements and mean HU values for all the 56 ROIs were calculated. Results: Great variations were found among the contours of the cutting surface especially in term of the shape of the anterior and posterior tibial tubercle, and the fibular notch. These variations could be grouped into six categories. For the BMD of the cutting surface, the medial border of the cutting surface did not included cortical bone. The HU value of seven ROIs, which included cortical bone, were significantly greater than all the other ROIs. Few statistical differences were found by multiple comparisons among HU value of all the 49 ROIs without cortex. Conclusions: Great variability existed in the shape and the BMD of the distal tibial cutting surface.

Posttraumatic infections can occur in orthopedic trauma patients, especially in open fractures. Rapid and accurate identification of pathogens in orthopedic trauma is important for clinical diagnosis and antimicrobial treatment. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been successfully used for first-line identification of pathogens grown on culture plates. However, for direct analysis of liquid clinical specimens, pre-purification of the sample is necessary. Herein, we investigated the feasibility of coupling Fc-MBL@Fe3O4 enrichment with MALDI-TOF MS profiling in the identification of pathogens in liquid-cultured samples. This method is successfully used for the identification of pathogens in a patient with an open-leg fracture obtained at sea. Pathogens were enriched by Fc-MBL@Fe3O4 from briefly pre-cultured liquid media and identified by MALDI-TOF MS. We identified an opportunistic pathogen, Vibrio alginolyticus, which is uncommon in clinical orthopedic trauma infection but exists widely in the sea. Therefore, combining Fc-MBL@Fe3O4 enrichment and MALDI-TOF MS profiling has great potential for direct identification of microbes in clinical samples.

Purpose: The study described a novel surgical treatment of Haraguchi type 1 posterior malleolar fracture in tri-malleolar fracture and patient outcomes at intermediate period follow-up. Methods: All patients from January 2015 to December 2017 with tri-malleolar fracture of which posterior malleolar fractures were Haraguchi type 1, were surgically treated in this prospective study. Lateral and medial malleolar fractures were managed by open reduction and internal fixation through dual incision approaches. 36 cases of Haraguchi type 1 posterior malleolar fractures were randomly performed by percutaneous posteroanterior screw fixation with the aid of medial exposure (group 1). And 40 cases were performed by percutaneous anteroposterior screw fixation (group 2). Clinical outcomes, radiographic outcomes and patient-reported outcomes were recorded. Results: Seventy-six patients with mean follow-up of 30 months were included. There were no significant differences in the mean operation time (81.0 ± 11.3 vs. 77.2 ± 12.4), ankle function at different periods of follow-up, range of motions and visual analog scale (VAS) at 24 months between the two groups ( p > 0.05). However, the rate of severe post-traumatic arthritis (Grade 2 and 3) and the rate of step-off rather than gap in radiological evaluation were lower in group 1 than that in group 2 ( p < 0.05). Conclusion: Using our surgical technique, more patients had good outcome with a lower rate of severe post-traumatic arthritis, compared with the group of percutaneous anteroposterior screw fixation. Percutaneous posteroanterior screw fixation can be a convenient and reliable alternative in treating Haraguchi type 1 posterior malleolar fracture.

Abstract Background Postoperative transfer metatarsalgia is a common complication after hallux valgus surgeries. Shortening of the first metatarsal is traditionally thought to be the primary cause of it. However, we speculate the abnormal loading pattern during gait is the real reason. This study is to determine specific differences in the loading patterns between reconstructive hallux valgus (HV) feet with and without postoperative transfer metatarsalgia, so as to find risky loading characteristics of this complication. Methods Thirty feet with postoperative transfer metatarsalgia were recruited as pain group, while another 30 postoperative feet without pain as controls. All participants were asked to walk barefoot at self-selected speed through a plantar force measuring plate (Rs-Scan Inc.) for three times. Certain plantar load variables were recorded or calculated, and their differences between two groups were compared. Results For pain group, the maximum plantar force and force time integral of the first metatarsal decrease significantly; the force time integral of the central rays (second plus third metatarsal) does not significantly differ with that in the controls, but their cumulative load percentage to the whole foot is higher. In pain group, the time point when central rays reached their peak force during the push-off is significantly later than that in controls. And the regional instant load percentage at this moment presented significantly higher for central rays, while significantly lower for the first metatarsal and the hallux compared to the controls. Conclusions For hallux valgus feet with postoperative metatarsalgia, the load function of the first metatarsal is obviously impaired. But for central rays, indicative difference is not reflected in either peak or cumulative load during the gait cycle, but in the instant load distribution when central rays reach their peak load. So we can conclude that whether the remaining regions can adequately share certain load during walking, especially around the time metatarsalgia often occurs, plays an unnegligible role. So surgeons should pay more attention to reconstruct a foot where load can be evenly distributed.

Abstract Background The sustentacular screw is essential to maintain the stability of the subtalar joint during ORIF (open reduction with internal fixation) of calcaneal fractures. Currently, the screw is still inserted based on surgeons’ anatomical experiences and nearly 40% of screws are misplaced from the sustentaculum. Previous studies demonstrated some methods of sustentacular screw placement through anatomical measurements or navigation system. The purposes of this study are to design an assistant guidance device that can effectively improve the accuracy of sustentacular screw placement and to compare the accuracy of this technique with traditional screw placement based on experience. Methods A customized guidance device is designed, aiming to improve the accuracy of sustentacular screw placement. Twenty cadaveric specimens are used in the present study. Ten specimens are allocated into the guidance-assisted group, and others are included in the traditional screw insertion group. A total of 40 sustentacular screw placements are performed in each group. Fluoroscopic images are obtained after each screw placement. Only the screw that captures the sustentaculum both on the lateral and axial X-ray views was regarded as an accurate placement. Results The accuracy rate in the guidance-assisted group is 87.5% (35 out of 40 times of insertions) while in the traditional screw insertion group, the accuracy rate is 65% (26 out of 40 times of insertions). A significant difference is found between the two groups (p = 0.018). Conclusions The guidance-assisted technique is a convenient approach that can effectively improve the accuracy of sustentacular screw placement during the ORIF of calcaneal fractures. This study provides a novel technique that significantly facilitates sustentacular screw insertion and improves its accuracy.

Objective This study was performed to evaluate the safety and efficacy of a single cannulated iliac screw combined with reconstruction plate fixation for crescent pelvic fractures (Day type II). Method Thirty adult patients (23 men, 7 women) with a mean age of 42.3 years (range, 22–81 years) were retrospectively reviewed. The time interval between the injury and the operation ranged from 3 to 14 days. The duration of screw insertion, the frequency of C-arm X-ray examination, and the intraoperative blood loss volume were recorded. The minimum follow-up was 12 months (mean, 29 months; range, 12–36 months). Radiographic evaluation was performed using the Matta and Tornetta criteria. Results According to the Matta and Tornetta radiological criteria, the reduction was rated as excellent in 20 patients and good in 10 patients. Based on the Majeed functional evaluation at the follow-up appointment, the outcome was rated as excellent in 28 patients and good in 2 patients. Conclusion This technique can restrict damage to the surrounding soft tissues, decrease complications, and promote good clinical results.

Category: Ankle Arthritis Introduction/Purpose: Some complications of total ankle arthroplasty could not be reduced by improvement of surgeon experience. The purposes of the study were to determine whether there were variations in term of (1) intraoperative complications, (2) postoperative complication, (3) reoperation, revision and failure, and (4) postoperative radiographic findings among different studies. Methods: A comprehensive search was conducted. There were 953 for initial review. Initially, 136 irrelevant records, 174 review articles, 46 case reports and 1 retracted paper were excluded. Of the remaining 596 papers, 23 ultimately met our inclusion for final review. Results: Intraoperative fractures rates were higher studies of BP-type. Most of the pain or stiffness, malalignments, impingements, cysts were occurred in studies of STAR, HINTEGRA, Agility and Salto. Polyethylene insert fractures were occurred in most studies of STAR. Ten reported postoperative osseous fractures which all resulted from patients used STAR and BP-type. Reoperation rates were higher in studies of STAR, BP-type, Agility and Salto. Arthrodesis rates were lower from HINTEGRA. Arthrodesis rates from STAR, BP-type and Salto were higher than their revision rates. Periprosthetic lucency rates were lower from studies of HINTEGRA. The lucency rates of tibia were higher than talus. Cyst could be more easily observed from studies of STAR, Agility and Salto. All the osteoarthritis were reported in studies of STAR, BP-type and Agility. Conclusion: Currently the complication rates of TAA significantly decrease with modern implants, surgeons experience and patients selection. Some design-specific features of different prostheses were found in our study which could implicate variations in the complications and radiographic findings. We believed that these result could further improve the implant design.