Clinics in Orthopedic Surgery最新文献

{"title":"Epidemiology and Characteristics of Ankle and Foot Injuries in Electric Scooter-Related Accidents.","authors":"Tae Gyun Kim, Jae Gyu Choi, Youn Moo Heo, Jin Woong Yi, In Uk Yeo, Hyun Sik Ryu, Hyun Soo Choi, Jae Hwang Song","doi":"10.4055/cios23312","DOIUrl":"10.4055/cios23312","url":null,"abstract":"<p><strong>Background: </strong>The use of electric scooters (e-scooters) continues to increase as a simple, inexpensive means of transport, resulting in a sharp increase in the incidence of scooter-related accidents. No study to date has closely examined the injury extent to the lower leg, joints, and extremities from e-scooter-related accidents. Here, we investigated the epidemiology and injury patterns of such accidents, focusing on injuries to the ankle and foot.</p><p><strong>Methods: </strong>Based on data from a single tertiary hospital's database, the demographics of 563 patients with scooter-associated injuries were analyzed retrospectively. Among the patients, 229 patients who were injured by e-scooter riding were further investigated. Based on the data, the general demographics of whole scooter-associated injuries and the injury characteristics and fracture cases of the lower leg, ankle, and foot were analyzed.</p><p><strong>Results: </strong>During the 4-year study period, the number of patients injured by e-scooters increased every year. Lower extremities were the most common injury site (67.2%) among riders, whereas injuries to the head and neck (64.3%) were more common in riders of non-electric scooters. Among the lower leg, ankle, and foot injuries of riders (52 cases), the ankle joint (53.8%) was the most commonly injured site, followed by the foot (40.4%) and lower leg (21.2%). The fracture group scored significantly higher on the Abbreviated Injury Scale than the non-fracture group (<i>p</i> < 0.001). Among the fracture group (20 cases), ankle fractures (9 cases) were most common, including pronation external rotation type 4 injuries (4 cases) and pilon fractures (2 cases). Five patients (25%) had open fractures, and 12 patients (60%) underwent surgical treatment.</p><p><strong>Conclusions: </strong>The ankle and foot are the most common injury sites in e-scooter-related accidents. Given the high frequency and severity of e-scooter-related ankle and foot injuries, we suggest that more attention be paid to preventing these types of injuries with greater public awareness of the dangers of using e-scooters.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10973611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Results in Older, Middle-aged, and Younger Patients after Primary Anterior Cruciate Ligament Reconstruction: Minimum 10-Year Follow-up.","authors":"Kyoung Ho Yoon, Se Min Lee, Jae Young Park, Hee Sung Lee, Sung Hyun Hwang","doi":"10.4055/cios22344","DOIUrl":"10.4055/cios22344","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament (ACL) reconstruction is commonly performed to prevent decreased knee function and restore stability in middle-aged and even older patients. However, few studies have compared the long-term clinical outcomes of ACL reconstruction between older, younger, and middle-aged patients. The purpose of this study was to compare the long-term clinical outcomes of ACL reconstruction in older patients with those in younger and middle-aged patients.</p><p><strong>Methods: </strong>A total of 352 patients who underwent primary ACL reconstruction between January 2003 and March 2008 were retrospectively reviewed and classified into three groups (group A: 246 [age, 20-29 years], group B: 72 [age, 40-49 years], group C: 34 [age, 50-65 years]). The mean follow-up period was 14.2 ± 1.6 years. Clinical outcomes were evaluated and compared between groups.</p><p><strong>Results: </strong>The differences in the range of motion, clinical scores, and stability tests were not statistically significant among the three groups. The difference in the graft failure rate among the three groups was significant (group A: 16 [6.5%], group B: 7 [9.7%], group C: 6 [17.6%]; <i>p</i> = 0.040). In particular, when compared between the two groups, there was a significant difference between group A and group C (<i>p</i> = 0.036). The 10-year survival rates were 93.5%, 90.3%, and 82.4% for groups A, B, and C, respectively (<i>p</i> = 0.048).</p><p><strong>Conclusions: </strong>Although graft failure rates were higher in older patients than younger and middle-aged patients, clinical outcomes of ACL reconstruction in older patients were comparable to those of younger and middle-aged patients in terms of the range of motion, clinical scores, and stability tests at a minimum follow-up of 10 years.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10825243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70330587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rectangular-Tunnel Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon-Patellar Bone Autograft Can Reduce Early Donor Site Morbidity While Maintaining Comparable Short-term Clinical Outcomes.","authors":"Do Weon Lee, Du Hyun Ro, Myung Chul Lee, Hyuk-Soo Han","doi":"10.4055/cios21264","DOIUrl":"10.4055/cios21264","url":null,"abstract":"<p><strong>Background: </strong>Rectangular tunnel and graft have been recently designed to closely resemble the native anatomy in anterior cruciate ligament reconstruction (ACLR). This study was performed to compare the short-term clinical outcomes between rectangular and round femoral tunnels in ACLR using quadriceps tendon-patellar bone (QTPB) autografts.</p><p><strong>Methods: </strong>A total of 78 patients who underwent primary ACLR with QTPB autografts performed by three senior surgeons and had at least 1 year of postoperative follow-up were retrospectively reviewed. Patients who underwent rectangular tunnel ACLR (n = 40) were compared to those treated with the conventional round tunnel ACLR (n = 38). Outcomes including knee stability, clinical scores, quadriceps strength, associated complications, postoperative knee range of motion, and cross-sectional area of the graft were assessed.</p><p><strong>Results: </strong>Significant improvements in knee stability and clinical scores were observed after surgery in both groups (all <i>p</i> < 0.001). The postoperative measurements of knee stability and clinical scores were not significantly different between the two groups. Knee extension strength deficit at 60°/sec was significantly less in the rectangular tunnel group than in the round tunnel group at postoperative 6 months (41.7% vs. 48.9%, <i>p</i> = 0.032). The cross-sectional area of the partial-thickness QTPB graft was approximately 60% of the full-thickness QTPB graft.</p><p><strong>Conclusions: </strong>In the short-term, rectangular tunnel ACLR was comparable to round tunnel ACLR with QTPB autograft despite the smaller cross-sectional area. Additionally, the rectangular tunnel ACLR allowed partial-thickness grafting technique, which could subsequently reduce early donor site morbidity.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10825259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70330761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Usefulness of Computer-Assisted Three-Dimensional Analysis and Weight-Bearing Radiographs in Ankle Osteoarthritis.","authors":"Si-Wook Lee, Chang-Jin Yon, Jae-Ho Kim, Jung-Min Lee, Jae-Ho Lee, Yu-Ran Heo","doi":"10.4055/cios23221","DOIUrl":"10.4055/cios23221","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the degree of deformation in patients with ankle osteoarthritis (OA), it is essential to measure the three-dimensional (3D), in other words, stereoscopic alignment of the ankle, subtalar, and foot arches. Generally, measurement of radiological parameters use two-dimensional (2D) anteroposterior and lateral radiographs in a weight-bearing state; however, computer-aided 3D analysis (Disior) using weight-bearing cone-beam computed tomography (CBCT) has recently been introduced.</p><p><strong>Methods: </strong>In this study, we compared the 2D human radiographic method with a stereoscopic image in patients with ankle arthritis. We enrolled 57 patients diagnosed with OA (28 left and 29 right) and obtained both standing radiographs and weight-bearing CBCT. Patients were divided by the Takakura stage. The interclass correlation coefficient (ICC) for each result was confirmed.</p><p><strong>Results: </strong>On the ICC between 2D radiographs and 3D analysis, the tibiotalar surface angle and lateral talo-1st metatarsal angle showed a good ICC grade (> 0.6), while other parameters did not have significant ICC results. Three-dimension was superior to radiographs in terms of statistical significance.</p><p><strong>Conclusions: </strong>We demonstrated that 2D and stereoscopic images are useful for the diagnosis of OA. Our study also confirmed that the radiographic features affected by ankle OA varied. However, according to the results, the typical radiography is not sufficient to diagnose and determine a treatment plan for ankle OA. Therefore, the method of using 3D images should be considered.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10825248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Denosumab as a Nonsurgical Management of Aneurysmal Bone Cysts in the Pelvis.","authors":"Ayman Mohammad El Masry, Sherif Ishak Azmy, Mohamed Abdel Rahman Mustafa, Mohammad Abdelmoemen Abuelhadid","doi":"10.4055/cios22228","DOIUrl":"10.4055/cios22228","url":null,"abstract":"<p><strong>Background: </strong>Aneurysmal bone cysts (ABCs) are infrequent, benign, and locally destructive lesions that most commonly occur during the first two decades of life. They usually affect the metaphysis of the long bones, but the pelvis is involved in 8%-12% of the cases. The management of pelvic ABCs is a challenging issue due to difficulties in choosing the appropriate approach, adjacent neurovascular bundles, the risk of intraoperative bleeding with difficulty achieving good hemostasis, and the risk of injury to the hip or sacroiliac joints. Limited data exist concerning the use of denosumab as a non-surgical treatment for pelvic ABCs. Our hypothesis was that denosumab might be an effective and safe solo treatment of cases with ABCs in the pelvis.</p><p><strong>Methods: </strong>We retrospectively assessed 20 patients with ABCs in the pelvis, who were treated by denosumab as a solo agent without surgery. Patients were assessed regarding disease control, the incidence of recurrence and non-oncological complications, and functional outcome.</p><p><strong>Results: </strong>The mean follow-up period was 38.5 months. Disease control was achieved in 16 patients (80%), with no local recurrence. Tolerable drug-related complications occurred in 15% of cases. The mean Musculoskeletal Tumor Society score was 92.3%.</p><p><strong>Conclusions: </strong>Denosumab may provide a reliable option in the nonsurgical treatment of ABCs of pelvic origin with expected lower morbidity than the surgical solution and tolerable complications. Further studies on the safety profile and long-term effects of denosumab especially in skeletally immature patients are required.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10825244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Unfixable Inferior Pole Fractures of the Patella Using an All-Suture Internal Fixation Technique.","authors":"Pongpak Bhumiwat, Bradley W Fossum, Rony-Orijit Dey Hazra, Phob Ganokroj","doi":"10.4055/cios23111","DOIUrl":"10.4055/cios23111","url":null,"abstract":"<p><p>Inferior pole fractures of the patella are a type of patellar fracture that has various complexities. Most current techniques are associated with hardware-related complications, which is one of the main concerns when treating this complex fracture. We present a new technique that does not require metal implant removal, causes little to no irritation of the quadriceps muscle, and provides strong fixation that allows for early range of motion postoperatively.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10825245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the May-Thurner Syndrome a Major Risk Factor for Deep Vein Thrombosis in Total Hip Arthroplasty?","authors":"Chaemoon Lim, Young Ho Roh, Dae Whan Kim, Kwang Woo Nam","doi":"10.4055/cios23128","DOIUrl":"10.4055/cios23128","url":null,"abstract":"<p><strong>Background: </strong>May-Thurner syndrome (MTS) is iliac vein compression syndrome associated with postoperative deep vein thrombosis (DVT) resulting from chronic compression of the left iliac vein against lumbar vertebrae by the overlying right or left common iliac artery. MTS is not well known as a risk factor for DVT after total hip arthroplasty (THA). We evaluated the incidence of DVT after THA and analyzed if the MTS is a risk factor for DVT after THA. We hypothesized that MTS would be associated with an increased risk of developing DVT after THA.</p><p><strong>Methods: </strong>All patients > 65 years of age who underwent THA between January 1, 2009, and January 12, 2017, were identified. Among them, the patients who presented for postoperative DVT of the lower extremity were reviewed with medical record data. MTS was diagnosed with computed tomography (CT) angiography of the lower extremity. We analyzed the demographic data, symptoms, diagnoses, and treatment of MTS patients.</p><p><strong>Results: </strong>A total of 492 consecutive patients aged > 65 years who underwent operation for THA were enrolled. Among them, 5 patients (1.0%) presented for postoperative DVT of the lower extremity. After reviewing the CT angiography of the lower extremity, 4 out of 5 DVT patients (80%) were identified as having MTS. All MTS patients were female and presented with pain and swelling of the left leg. All MTS patients were treated with systemic anticoagulation, aspiration thrombectomy, and percutaneous transluminal angioplasty. Complete resolution of thrombus was observed in all patients.</p><p><strong>Conclusions: </strong>If the diagnosis of MTS is delayed, the morbidity and mortality rates are significantly increased. Orthopedic surgeons should be aware of MTS as a risk factor for DVT after THA. Moreover, preoperative evaluation with duplex sonography or CT angiography to confirm MTS should be considered. In this regard, this study is considered to have sufficient clinical value for early diagnosis and appropriate treatment of MTS after THA.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10825252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age as a Risk Factor for Intraoperative Periprosthetic Femoral Fractures in Cementless Hip Hemiarthroplasty for Femoral Neck Fractures: A Retrospective Analysis.","authors":"Itay Ashkenazi, Nissan Amzallag, Shai Factor, Mohamed Abadi, Samuel Morgan, Aviram Gold, Nimrod Snir, Yaniv Warschawski","doi":"10.4055/cios23157","DOIUrl":"10.4055/cios23157","url":null,"abstract":"<p><strong>Background: </strong>Understanding the risk factors and outcomes of intraoperative periprosthetic femoral fractures (IPFF) during hip arthroplasty is crucial for appropriate perioperative management. Previous studies have identified risk factors for IPFF in total hip arthroplasty patients, but data for hip hemiarthroplasty (HA) is lacking. The aim of this study was to determine the age associated with increased rates of IPFF in patients undergoing HA.</p><p><strong>Methods: </strong>We retrospectively reviewed patients aged 65 years and above who underwent a cementless HA for a displaced femoral neck fracture and had a minimum of 1-year follow-up. Patients were stratified into five age groups (65-79, 80-84, 85-89, 90-94, and ≥ 95 years) and further divided into two subgroups (under 95 years and 95 years or older). The presence, location, and treatment of IPFF, as well as the effect of IPFF on the postoperative weight-bearing status, were compared between groups. A multivariate logistic regression was also performed. A total of 1,669 met the inclusion criteria and were included in the study.</p><p><strong>Results: </strong>The rates of IPFF were significantly higher for patients 95 years or older (<i>p</i> = 0.030). However, fracture location (greater trochanter fractures, <i>p</i> = 0.839; calcar fractures, <i>p</i> = 0.394; and femoral shaft fractures <i>p</i> = 0.110), intraoperative treatment (<i>p</i> = 0.424), and postoperative weight-bearing status (<i>p</i> = 0.229) were similar between the groups. While mortality and nonorthopedic-related readmissions were significantly higher for patients 95 years or older, orthopedic-related readmissions (<i>p</i> = 0.148) and revisions at the latest follow-up (<i>p</i> = 0.253) were comparable between groups. In a regression analysis, age over 95 years (odds ratio, 2.049; <i>p</i> = 0.049) and body mass index (odds ratio, 0.935; <i>p</i> = 0.016) were independently associated with IPFF.</p><p><strong>Conclusions: </strong>The findings of this study suggest that age over 95 years is a significant, independent risk factor for IPFF in patients undergoing cementless HA. Although we were unable to show an impact on perioperative outcomes and orthopedic complications, when operating on patients 95 years or older, surgeons should be aware of the increased risk of IPFF and consider the use of stem designs and fixation types associated with decreased IPFF rates.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10825253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographical Differences in Wound Complication Rates Following the Sinus Tarsi Approach in Displaced Intra-articular Calcaneal Fractures: A Systematic Review of the Literature.","authors":"Robin Eelsing, Ahmad Masih Ahmadi, Jens Anthony Halm, Tim Schepers","doi":"10.4055/cios23241","DOIUrl":"10.4055/cios23241","url":null,"abstract":"<p><strong>Background: </strong>The sinus tarsi approach (STA) has gained popularity for the treatment of displaced intra-articular calcaneal fractures. No large studies comparing wound complications worldwide after STA surgery are available. The aim of this systematic review was to compare postoperative wound complication (POWC) and postoperative wound infection (POWI) rates following STA surgery between continents and countries and their differences in climate.</p><p><strong>Methods: </strong>A literature search was performed using the databases of PubMed, Embase, and the Cochrane Library. Studies published before January 1, 2000, including < 10 patients and written in a language other than English were excluded.</p><p><strong>Results: </strong>In total, 86 studies containing 4,392 surgeries via STA from 20 different countries were included. The mean POWC was 5.9% and the mean POWI was 4.4%. The highest median POWC rate was in North America (8.5%) and the lowest in South America (2.0%). No significant differences were found in the POWC and POWI rates between countries (<i>p</i> = 0.178 and <i>p</i> = 0.570, respectively), but significant differences were found between the POWC and POWI rates between continents (<i>p</i> = 0.011 and <i>p</i> = 0.036, respectively). The number of surgeries per year and climate differences, as represented by mean local temperature, were not correlated with both the POWC/POWI rates and functional outcome scores.</p><p><strong>Conclusions: </strong>Significant differences between the POWC and POWI rates were found between continents but not between individual countries. With a mean POWC of 5.9% and a mean POWI rate of 4.4%, STA has an intrinsic low risk for complications given the minimally invasive nature of the approach and is inevitably becoming the gold standard for calcaneal surgery.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10825260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automatic Segmentation and Radiologic Measurement of Distal Radius Fractures Using Deep Learning.","authors":"Sanglim Lee, Kwang Gi Kim, Young Jae Kim, Ji Soo Jeon, Gi Pyo Lee, Kyung-Chan Kim, Suk Ha Jeon","doi":"10.4055/cios23130","DOIUrl":"10.4055/cios23130","url":null,"abstract":"<p><strong>Background: </strong>Recently, deep learning techniques have been used in medical imaging studies. We present an algorithm that measures radiologic parameters of distal radius fractures using a deep learning technique and compares the predicted parameters with those measured by an orthopedic hand surgeon.</p><p><strong>Methods: </strong>We collected anteroposterior (AP) and lateral X-ray images of 634 wrists in 624 patients with distal radius fractures treated conservatively with a follow-up of at least 2 months. We allocated 507 AP and 507 lateral images to the training set (80% of the images were used to train the model, and 20% were utilized for validation) and 127 AP and 127 lateral images to the test set. The margins of the radius and ulna were annotated for ground truth, and the scaphoid in the lateral views was annotated in the box configuration to determine the volar side of the images. Radius segmentation was performed using attention U-Net, and the volar/dorsal side was identified using a detection and classification model based on RetinaNet. The proposed algorithm measures the radial inclination, dorsal or volar tilt, and radial height by index axes and points from the segmented radius and ulna.</p><p><strong>Results: </strong>The segmentation model for the radius exhibited an accuracy of 99.98% and a Dice similarity coefficient (DSC) of 98.07% for AP images, and an accuracy of 99.75% and a DSC of 94.84% for lateral images. The segmentation model for the ulna showed an accuracy of 99.84% and a DSC of 96.48%. Based on the comparison of the radial inclinations measured by the algorithm and the manual method, the Pearson correlation coefficient was 0.952, and the intraclass correlation coefficient was 0.975. For dorsal/volar tilt, the correlation coefficient was 0.940, and the intraclass correlation coefficient was 0.968. For radial height, it was 0.768 and 0.868, respectively.</p><p><strong>Conclusions: </strong>The deep learning-based algorithm demonstrated excellent segmentation of the distal radius and ulna in AP and lateral radiographs of the wrist with distal radius fractures and afforded automatic measurements of radiologic parameters.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10825247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}