Indian Journal of Orthopaedics最新文献

{"title":"Deep Learning for Automatic Knee Osteoarthritis Severity Grading and Classification","authors":"Shakti Kinger","doi":"10.1007/s43465-024-01259-4","DOIUrl":"https://doi.org/10.1007/s43465-024-01259-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>Knee osteoarthritis (OA) is a prevalent condition that significantly impacts the quality of life, often leading to the need for knee replacement surgery. Accurate and timely identification of knee degeneration is crucial for effective treatment and management. Traditional methods of diagnosing OA rely heavily on radiological assessments, which can be time-consuming and subjective. This study aims to address these challenges by developing a deep learning-based method to predict the likelihood of knee replacement and the Kellgren–Lawrence (KL) grade of knee OA from X-ray images.</p><h3 data-test=\"abstract-sub-heading\">Methodology</h3><p>We employed the Osteoarthritis Initiative (OAI) dataset and utilized a transfer learning approach with the Inception V3 architecture to enhance the accuracy of OA detection. Our approach involved training 14 different models—Xception, VGG16, VGG19, ResNet50, ResNet101, ResNet152, ResNet50V2, ResNet101V2, ResNet152V2, Inception V3, Inception, ResNetV2, DenseNet121, DenseNet169, DenseNet201—and comparing their performance.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The study incorporated pixel ratio computation and picture pre-processing, alongside a decision tree model for prediction. Our experiments revealed that the Inception V3 model achieved the highest training accuracy of 91% and testing accuracy of 67%, with notable performance in both training and validation phases. This model effectively identified the presence and severity of OA, correlating with the Kellgren–Lawrence scale and facilitating the assessment of knee replacement needs.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>By integrating advanced deep learning techniques with radiological diagnostics, our methodology supports radiologists in making more accurate and prompt decisions regarding knee degeneration. The Inception V3 model stands out as the optimal choice for knee X-ray analysis, contributing to more efficient and timely healthcare delivery for patients with knee osteoarthritis.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Internal Bracing in Multi-ligamentous Knee Injury Reconstruction: A Systematic Review","authors":"Abbie Randall, Richard Pearse, Shahnawaz Khan, Henry Atkinson","doi":"10.1007/s43465-024-01260-x","DOIUrl":"https://doi.org/10.1007/s43465-024-01260-x","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Multi-ligament Knee Injuries (MLKI) are often caused by a high-energy impact resulting in dislocation of the knee joint. Given the higher degree of instability associated with these MLKIs, surgical fixation with adjunctive internal bracing and the use of suture augmentation have been proposed with the intention of better restoring knee stability and improving the long-term outcomes of surgery. This systematic review seeks to appraise the current literature in relation to the role of internal bracing in the management of MLKI.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>All randomised control trials, observational studies, cohort studies, and cross-sectional studies containing patients with multi-ligamentous knee injuries managed with the use of internal bracing or suture tape augmentation were included in this review. The primary outcomes of interest were re-operation and failure rates, with secondary outcomes focussed on patient-reported outcome measures (PROMs) and examination findings of knee stability.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>282 studies were identified for screening, 13 of which were suitable for inclusion and five of these had injuries with Schenck grade III or above. Of the studies identified, failure rates ranged from 0 to 13.6%. Lysholm score was the most commonly utilised PROM tool with scores ranging from 61.8 to 95. Stiffness requiring MUA ± adhesiolysis was a common complication identified across studies.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The use of internal bracing in Multi-ligament Knee Injuries appears to be as effective as not using an internal bracing technique. The post-operative PROMs and relatively low failure rates reflect promising outcomes for the ongoing use of internal bracing in MLKI. However, further prospective studies directly comparing braced versus non-braced ligamentous repairs are required in order to definitively determine if the use of the internal brace does allow for increased joint stability and early rehabilitation.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single/ Multiple Dose Percutaneously Injected LR-PRP Enhances Union Rate in Fracture Delayed Unions: A Prospective Case Series","authors":"Kishor Kunal, Nitesh Gahlot, Neeraj Choudhary, Abhay Elhence","doi":"10.1007/s43465-024-01265-6","DOIUrl":"https://doi.org/10.1007/s43465-024-01265-6","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Average bone healing times of common fractures in adults ranges from 3 to 12 weeks and is location dependent. Platelet Rich Plasma (PRP) stimulates natural healing process through growth factors contained in platelets and has been employed for the same in delayed unions. </p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>All patients &gt; 18 years and documented delayed union were included in the study. Patients were followed up monthly after each Leucocyte-rich PRP (LR-PRP) injection and a decision for repeat PRP injection was taken on basis of visible impression in radiograph after previous injection.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Total 36 patients were studied in which 5 patients were lost to follow-up. Union was achieved in 28/31 (90.3%). 20 (71.4%) patients required only single PRP injections. 4 (14.3%) patients required 2 PRP injections, 3 (10.7%) patients required 3 PRP injections and 1 (3.6%) patient required 4 PRP injection. There was no significant correlation of number of PRPs to time from 1st PRP-union or time from last PPR- union.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Single/multiple dose percutaneously administered LR-PRP can be used as a fruitful alternative to catalyze union in patients having delayed union irrespective of site of injury.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Accuracy of CT-Based Three-Dimensional Templating in Predicting Implant Sizes in Patients Undergoing Robot-Assisted Total Knee Arthroplasty","authors":"Neeraj Adkar, Mangesh Patil, Swapnil Vaidya, Rajendra Kumbar, Ravi Kerhalkar, Girish Mote, Satwik Thareja, Prajwal Sadalagi, Supreet Bajwa","doi":"10.1007/s43465-024-01244-x","DOIUrl":"https://doi.org/10.1007/s43465-024-01244-x","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Computed tomography (CT) based three-dimensional templating is increasingly being used to predict implant sizes in total knee arthroplasty (TKA). However, the existing data is heterogeneous, and the majority of studies lack adequate statistical power. This study investigated whether preoperative CT-based planning in robot-assisted TKA (RA-TKA) helps in predicting the accurate size of implant used.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This is a single-center retrospective study of 632 consecutive RA-TKA surgeries. All surgeries were performed using a fully automatic Cuvis RA-TKA system. Cohen’s Kappa (κ) coefficient was used to measure the level of agreement between the predicted and the final implant sizes.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 632 knees were operated on 384 patients. A total of 136 unilateral cases whereas 248 patients had both knees operated on. For the tibial component, in 21.7% cases a bigger implant size was used while in 11.8% cases a smaller size was used. For the femoral component, in 5.1% cases a bigger implant size was used while in 4.9% cases a smaller size was used. The agreement between the predicted and actual implant sizes was <i>moderate</i> for the tibial component [κ = 0.56 (95% CI: 0.51 to 0.61); p &lt; 0.001] and <i>almost perfect</i> for the femoral component [κ = 0.87 (95% CI: 0.84 to 0.90); p &lt; 0.001].</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>This study suggests that planning of RA-TKA using a CT-based model can be valuable to surgeons in accurately predicting the component size for femur and to a lesser degree for tibia. Future studies should investigate the potential predictors of discordance between the predicted and actual tibial implant sizes.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-Tunnel Knotless Anchor Fixation for Lateral Meniscus Posterior Root Tears: A Novel Technique","authors":"Manit Arora, Chiranjeev Jani, Tapish Shukla","doi":"10.1007/s43465-024-01262-9","DOIUrl":"https://doi.org/10.1007/s43465-024-01262-9","url":null,"abstract":"<p>Lateral meniscus posterior root tears (LMPRTs) are radial tears that occur within 10 mm of the posterior root tibial connection, also known as lateral meniscus posterior root avulsions. A common surgical approach for LMPRT (2) that contributes to positive biomechanical outcomes is independent transtibial pullout repair.(6,7,8) If this treatment is performed on people who need both LMPRT repair and ACL restoration, an extra tibial tunnel is required. The installation of a tibial tunnel increases surgical challenges and lengthens operation time, as well as the danger of iatrogenic damage to the normal architecture of the knee. To circumvent these drawbacks, we have developed a novel technique for intra-tunnel LMPRT repair using a knotless anchor construct at the upper posterior edge of the tibial tunnel. A stab incision is made to create the standard antero lateral portal and after introducing the trochar and the scope, a round of diagnostic arthroscopy is performed and the posterior root of lateral meniscus tear is identified. After creating an anteromedial portal, With help of 1 fiber tape, a loaded bite is taken with the help of a first pass mini device (Smith &amp; Nephew), via the antero medial portal, deep into the posterior root ( around 5 mm), using a self winching technique, and reduction of the LMPRT is checked. The position for the anchor entry is visualized in the superior edge of the tibial tunnel along its posterior wall, and the tapes are passed through the knotless anchor extra-articulately outside the AM portal. Thereafter, the anchor is shuttled in through the AM portal and punched in the footprint on the posterior-superior edge of the tibial tunnel with visualization of the reduction of the LMPR to the footprint. This technique offers a simple solution to a complex problem in the form of a simple procedure. This technique is a good choice when a tear of the posterior root of the LM occurs.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal Fibulectomy for Giant Cell Tumours: What Works!","authors":"Ashwin Prajapati, Harsha S. S. Tadala, Ashish Gulia, Ajay Puri","doi":"10.1007/s43465-024-01231-2","DOIUrl":"https://doi.org/10.1007/s43465-024-01231-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Giant cell tumor of bone (GCTB) is the most common primary tumor of proximal fibula. Because of its close proximity to vascular structures, common peroneal nerve (CPN) and attachment of lateral collateral ligament (LCL), proximal fibulectomy poses unique challenges. We analyzed oncological and functional outcome of patients who underwent proximal fibulectomy for GCTB of proximal fibula.</p><h3 data-test=\"abstract-sub-heading\">Material and methods</h3><p>Between January 2006 and December 2020, 23 patients underwent proximal fibulectomy for GCTB of proximal fibula, four were recurrent tumors. Mean resection length was 9 cm (5 to 15 cm). The LCL and biceps tendon were not reconstructed in 22 cases. The common peroneal nerve was sacrificed in seven patients including three recurrent cases. Functional status was assessed using the Musculoskeletal Tumour Society (MSTS) scoring system.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>There were two vascular complications and one infection. With 4 patients lost to follow up, mean follow up was 90 months (12 to 197). No patient had local or distant recurrence. Mean MSTS score was 26 (21 to 30). Eleven of 23 patients (48%) had loss of common peroneal nerve function with poorer functional outcome. No patient had symptoms suggestive of knee instability.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Proximal fibulectomy is oncologically safe. Reconstruction of the LCL attachment is not mandatory and patients do not have symptomatic knee instability. Functional outcomes are compromised after sacrifice of common peroneal nerve and may be potentially improved with tendon transfers at index surgery.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reverse Allograft Prosthetic-Composite Versus Endoprosthesis Reconstruction for Massive Proximal Humerus Bone Loss: A Systematic Review and Meta-analysis of Outcomes and Complications","authors":"Kevin A. Hao, Caroline T. Gutowski, Victoria E. Bindi, Ramesh C. Srinivasan, Jonathan O. Wright, Joseph J. King, Thomas W. Wright, Catherine J. Fedorka, Bradley S. Schoch, Keegan M. Hones","doi":"10.1007/s43465-024-01248-7","DOIUrl":"https://doi.org/10.1007/s43465-024-01248-7","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>This systematic review and meta-analysis sought to compare the clinical outcomes after proximal humerus reconstruction with a reverse allograft-prosthetic composite (APC) versus reverse endoprosthesis.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Per PRISMA guidelines, we queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles reporting clinical outcomes of reverse APC or reverse endoprosthesis reconstruction of the proximal humerus for massive bone loss secondary to tumor, fracture, or failed arthroplasty. We compared postoperative range of motion, outcome scores, and the incidence of complications and revision surgery.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Of 259 unique articles, 18 articles were included (267 APC, 260 endoprosthesis). There were no significant differences between the APC and endoprosthesis cohort for postoperative forward elevation (<i>P</i> = .231), external rotation (<i>P</i> = .634), ASES score (<i>P</i> = .420), Constant score (<i>P</i> = .414), MSTS (<i>P</i> = .815), SST (<i>P</i> = .367), or VAS (<i>P</i> = .714). Rate of complications was 15% (31/213) in the APC cohort and 19% (27/144) in the endoprosthesis cohort. The rate of revision surgery was 12% after APC cohort and 7% after endoprosthesis. APC-specific complications included a 10% APC nonunion/malunion/resorption rate and 6% APC fracture/fragmentation rate.</p><h3 data-test=\"abstract-sub-heading\">Discussion</h3><p>Reverse APC and endoprosthesis are reasonable options for proximal humerus reconstruction. APC carries additional risks for complications, warranting evaluation of patients’ healing capacity and surgeon experience.</p><h3 data-test=\"abstract-sub-heading\">Level of Evidence</h3><p>Level IV; Systematic Review.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Observational Study of Clinico-radiological Co-relation of Carrying Angle in Children","authors":"Gauri A. Patki, Binoti A. Sheth, Lomash Bharati","doi":"10.1007/s43465-024-01254-9","DOIUrl":"https://doi.org/10.1007/s43465-024-01254-9","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>The purpose of this study is to establish the correlation of clinically measured carrying angle with four radiological angles, i.e., Humerus–Elbow–Wrist angle (HEWA), Humero-ulnar angle, Metaphyseal–Diaphyseal angle, and Baumann’s angle, and to find out which of the above-mentioned angles co-relates best with the clinically measured carrying angle.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We studied 100 patients in the age group of 2–12 years after Ethics committee approval and informed consent from parents. Clinical angle was measured using goniometer and radiological angles marked on antero-posterior elbow X-ray using a standard method. Collected data were studied using statistical tests to find out correlation.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Pearson correlation coefficient for humerus–elbow–wrist angle found to be 0.674 followed by Humero-Ulnar angle (<i>r</i> = 0.417). Regression coefficient for humerus–elbow–wrist angle is 0.635 (<i>p</i> value &lt; 0.001).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Humerus–Elbow–Wrist angle correlates better compared to other radiological angles in assessment of varus–valgus angulations of elbow &amp; will not only play a vital role in pre- operative planning of deformity corrections but also in the evaluation &amp; comparison of the post-operative functional outcomes.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occurrence of Patellofemoral Joint Osteoarthritis in Long-Term Postoperative Cases of Open-Wedge High Tibial Osteotomy: Differences in Symptoms Based on Patient-Standing Type Evaluation with and Without Patellofemoral Joint Osteoarthritis","authors":"Noriyuki Gomi, Hiroaki Muramoto, Yusuke Kataoka","doi":"10.1007/s43465-024-01250-z","DOIUrl":"https://doi.org/10.1007/s43465-024-01250-z","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>To examine the frequency of patellofemoral joint (PFJ) osteoarthritis (OA) and its symptoms in the long-term course of open-wedge high tibial osteotomy (OWHTO).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We analyzed 113 joints of 91 patients. OA and osteonecrosis (ON) developed in 91 and 22 joints, after an average postoperative period of 127.5 ± 19.5 months. For X-ray evaluation, the standing femorotibial angle (FTA), % mechanical axis (%MA), Caton–Deschamps index (CDI), patellar tilt angle (TA), lateral patellar shift (LPS), and PFJ space width (medial [MJS] and lateral [LJS]) were analyzed. PFJ-associated symptoms were evaluated using the hospital for special surgery patellar score (HSS-PS) and knee injury and osteoarthritis outcome score patellofemoral subscale (KOOS-PF). Statistical analysis was performed with paired and unpaired t tests, and a risk rate of less than 1% was significantly judged.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Preoperative FTA and CDI decreased from 180.8° to 170.0° and 0.88 to 0.70 at the final follow-up. Preoperative %MA lateralized from 20.8 to 66.0 at the final follow-up. TA and LPS values decreased significantly compared with before surgery until plate removal. The MJS and LJS significantly decreased, and OA with a joint space &lt; 3 mm occurred in 14 cases. However, HSS-PS and KOOS-PF scores were not significantly different between the groups with and without OA.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>PFJ OA occurred in 12.4% cases in the long-term postoperative course of OWHTO; however, no symptomatic difference was found in the group with or without OA.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delirium in Lower Limb Trauma: The Incidence and Risk Factors in a Prospective Observational Study","authors":"Aravind Balachandran, Manoj Nagar, Prateek Behera, Priyanka Kashyap","doi":"10.1007/s43465-024-01251-y","DOIUrl":"https://doi.org/10.1007/s43465-024-01251-y","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Delirium poses a significant challenge in musculoskeletal trauma patients, particularly the elderly, contributing to elevated morbidity and mortality. Despite unclear pathogenesis, various risk factors have been identified. This prospective observational study, conducted in a tertiary center, aims to estimate delirium incidence and identify associated risk factors in adult patients undergoing lower limb trauma surgeries.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Between August 2021 and December 2022, 150 patients with lower limb trauma admitted for surgery were included. Initial assessments recorded Mini-Mental State Examination scores, Injury Severity Scores, and potential risk factors. Confusion Assessment Method scoring done preoperatively (excluding emergencies) and postoperatively on days 2 and 5 or at discharge. Daily delirium screening utilized Nursing 4-Abbreviated Trauma score, with severity assessed using CAM-Severity score. Risk factor analysis categorized patients into Group A (delirium) and Group B (non-delirium), with primary endpoint being delirium occurrence.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The study revealed a 10% delirium incidence. Delirium severity ranged from mild to severe. The median age (in years) was 79 vs 46 in delirium and non-delirium group respectively. Delirium patients had longer hospital stay (13 vs 8, <i>p</i> value 0.011). Similarly, factors like female gender, delayed surgery, hyponatremia, hypoproteinaemia, increased injury severity, midazolam use during induction, multiple blood transfusions, and heightened postoperative pain intensity were found significant (<i>p</i> value &lt; 0.05).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>This study enhances our understanding of delirium in lower limb trauma patients undergoing surgeries. Identified risk factors offer insights for targeted interventions, emphasizing the need for comprehensive preoperative assessments and management strategies to reduce delirium incidence and improve patient outcomes.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}