OTA international : the open access journal of orthopaedic trauma最新文献

{"title":"A deep learning approach using an ensemble model to autocreate an image-based hip fracture registry.","authors":"Jacobien H F Oosterhoff, Soomin Jeon, Bardiya Akhbari, David Shin, Daniel G Tobert, Synho Do, Soheil Ashkani-Esfahani","doi":"10.1097/OI9.0000000000000283","DOIUrl":"10.1097/OI9.0000000000000283","url":null,"abstract":"<p><strong>Objectives: </strong>With more than 300,000 patients per year in the United States alone, hip fractures are one of the most common injuries occurring in the elderly. The incidence is predicted to rise to 6 million cases per annum worldwide by 2050. Many fracture registries have been established, serving as tools for quality surveillance and evaluating patient outcomes. Most registries are based on billing and procedural codes, prone to under-reporting of cases. Deep learning (DL) is able to interpret radiographic images and assist in fracture detection; we propose to conduct a DL-based approach intended to autocreate a fracture registry, specifically for the hip fracture population.</p><p><strong>Methods: </strong>Conventional radiographs (n = 18,834) from 2919 patients from Massachusetts General Brigham hospitals were extracted (images designated as hip radiographs within the medical record). We designed a cascade model consisting of 3 submodules for image view classification (MI), postoperative implant detection (MII), and proximal femoral fracture detection (MIII), including data augmentation and scaling, and convolutional neural networks for model development. An ensemble model of 10 models (based on ResNet, VGG, DenseNet, and EfficientNet architectures) was created to detect the presence of a fracture.</p><p><strong>Results: </strong>The accuracy of the developed submodules reached 92%-100%; visual explanations of model predictions were generated through gradient-based methods. Time for the automated model-based fracture-labeling was 0.03 seconds/image, compared with an average of 12 seconds/image for human annotation as calculated in our preprocessing stages.</p><p><strong>Conclusion: </strong>This semisupervised DL approach labeled hip fractures with high accuracy. This mitigates the burden of annotations in a large data set, which is time-consuming and prone to under-reporting. The DL approach may prove beneficial for future efforts to autocreate construct registries that outperform current diagnosis and procedural codes. Clinicians and researchers can use the developed DL approach for quality improvement, diagnostic and prognostic research purposes, and building clinical decision support tools.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 5 Suppl","pages":"e283"},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10750455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139049882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current consensus and clinical approach to fragility fractures of the pelvis: an international survey of expert opinion.","authors":"Laura Jill Kleeblad, Sverre A I Loggers, Wietse P Zuidema, Daphne van Embden, Theodore Miclau, Kees-Jan Ponsen","doi":"10.1097/OI9.0000000000000293","DOIUrl":"10.1097/OI9.0000000000000293","url":null,"abstract":"<p><strong>Introduction: </strong>Fragility fractures of the pelvis (FFP) in elderly patients are an underappreciated injury with a significant impact on mobility, independency, and mortality of affected patients and is a growing burden for society/health care. Given the lack of clinical practice guidelines for these injuries, the authors postulate there is heterogeneity in the current use of diagnostic modalities, treatment strategies (both operative and nonoperative), and follow-up of patients with FFP. The goal of this study was to assess international variation in the management of FFP.</p><p><strong>Methods: </strong>All International Orthopaedic Trauma Association (IOTA) steering committee members were asked to select 15 to 20 experts in the field of pelvic surgery to complete a case-driven international survey. The survey addresses the definition of FFP, use of diagnostic modalities, timing of imaging, mobilization protocols, and indications for surgical management.</p><p><strong>Results: </strong>In total, 143 experts within 16 IOTA societies responded to the survey. Among the experts, 86% have >10 years of experience and 80% works in a referral center for pelvic fractures. However, only 44% of experts reported having an institutional protocol for the management of FFP. More than 89% of experts feel the need for a (inter)national evidence-based guideline. Of all experts, 73% use both radiographs and computed tomography (CT) to diagnose FFP, of which 63% routinely use CT and 35% used CT imaging selectively. Treatment strategies of anterior ring fractures were compared with combined (anterior and posterior ring) fractures. Thirty-seven percent of patients with anterior ring fractures get admitted to the hospital compared with 75% of patients with combined fractures. Experts allow pain-guided mobilization in 72% after anterior ring fracture but propose restricted weight-bearing in case of a combined fracture in 44% of patients. Surgical indications are primarily based on the inability to mobilize during hospital admission (33%) or persistent pain after 2 weeks (25%). Over 92% plan outpatient follow-up independent of the type of fracture or treatment.</p><p><strong>Conclusion: </strong>This study shows that there is a great worldwide heterogeneity in the current use of diagnostic modalities and both nonoperative and surgical management of FFP, emphasizing the need for a consensus meeting or guideline.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 5 Suppl","pages":"e293"},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10750456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139049884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial neural networks outperform linear regression in estimating 9-month patient-reported outcomes after upper extremity fractures with increasing number of variables.","authors":"Niels Brinkman, Romil Shah, Job Doornberg, David Ring, Stephen Gwilym, Prakash Jayakumar","doi":"10.1097/OI9.0000000000000284","DOIUrl":"10.1097/OI9.0000000000000284","url":null,"abstract":"<p><strong>Objective: </strong>To compare performance between linear regression (LR) and artificial neural network (ANN) models in estimating 9-month patient-reported outcomes (PROs) after upper extremity fractures using various subsets of early mental, social, and physical health variables.</p><p><strong>Methods: </strong>We studied 734 patients with isolated shoulder, elbow, or wrist fracture who completed demographics, mental and social health measures, and PROs at baseline, 2-4 weeks, and 6-9 months postinjury. PROs included 3 measures of capability (QuickDASH, PROMIS-UE-PF, PROMIS-PI) and one of pain intensity. We developed ANN and LR models with various selections of variables (20, 23, 29, 34, and 54) to estimate 9-month PROs using a training subset (70%) and internally validated them using another subset (15%). We assessed the accuracy of the estimated value being within one MCID of the actual 9-month PRO value in a test subset (15%).</p><p><strong>Results: </strong>ANNs outperformed LR in estimating 9-month outcomes in all models except the 20-variable model for capability measures and 20-variable and 23-variable models for pain intensity. The accuracy of ANN versus LR in the primary model (29-variable) was 83% versus 73% (Quick-DASH), 68% versus 65% (PROMIS-UE-PF), 66% versus 62% (PROMIS-PI), and 78% versus 65% (pain intensity). Mental and social health factors contributed most to the estimations.</p><p><strong>Conclusion: </strong>ANNs outperform LR in estimating 9-month PROs, particularly with a larger number of variables. Given the otherwise relatively comparable performance, aspects such as practicality of collecting greater sets of variables, nonparametric distribution, and presence of nonlinear correlations should be considered when deciding between these statistical methods.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 5 Suppl","pages":"e284"},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10750457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139049883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of neutrophil phenotype categories in geriatric hip fracture patients aids in personalized medicine.","authors":"Thomas M P Nijdam, Bernard N Jukema, Emma J de Fraiture, Roy Spijkerman, Henk Jan Schuijt, Marcia Spoelder, Coen C W G Bongers, Maria T E Hopman, Leo Koenderman, Falco Hietbrink, Detlef van der Velde","doi":"10.1097/OI9.0000000000000291","DOIUrl":"10.1097/OI9.0000000000000291","url":null,"abstract":"<p><strong>Objectives: </strong>The number of geriatric hip fracture patients is high and expected to rise in the coming years, and many are frail and at risk for adverse outcomes. Early identification of high-risk patients is crucial to balance treatment and optimize outcome, but remains challenging. Previous research in patients with multitrauma suggested that neutrophil phenotype analysis could aid in early identification of high-risk patients. This pilot study investigated the feasibility and clinical value of neutrophil phenotype analysis in geriatric patients with a hip fracture.</p><p><strong>Methods: </strong>A prospective study was conducted in a regional teaching hospital in the Netherlands. At the emergency department, blood samples were collected from geriatric patients with a hip fracture and analyzed using automated flow cytometry. Flow cytometry data were processed using an automated clustering algorithm. Neutrophil activation data were compared with a healthy control cohort. Neutrophil phenotype categories were assessed based on two-dimensional visual assessment of CD16/CD62L expression.</p><p><strong>Results: </strong>Blood samples from 45 geriatric patients with a hip fracture were included. Neutrophils showed an increased activation profile and decreased responsiveness to formyl peptides when compared to healthy controls. The neutrophil phenotype of all patients was categorized. The incidence of severe adverse outcome was significantly different between the different categories (<i>P</i> = 0.0331). Moreover, patients with neutrophil phenotype category 0 developed no severe adverse outcomes.</p><p><strong>Conclusions: </strong>Using point-of-care fully automated flow cytometry to analyze the neutrophil compartment in geriatric hip fracture patients is feasible and holds clinical value in determining patients at risk for adverse outcome. This study is a first step toward immuno-based precision medicine for identifying geriatric hip fracture patients that are deemed fit for surgery.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 5 Suppl","pages":"e291"},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10750458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139049886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expedited surgery does not increase transfusion rates for patients with geriatric hip fracture taking factor Xa inhibitors.","authors":"Juntian Wang, Paal Nilssen, Julia Stone, Kathleen Breda, Milton Little, Charles Moon, Carol Lin","doi":"10.1097/OI9.0000000000000292","DOIUrl":"10.1097/OI9.0000000000000292","url":null,"abstract":"<p><strong>Objectives: </strong>Geriatric patients who sustain hip fractures and are taking factor Xa inhibitors (Xa-I) experience surgical delay. Our institution developed a pharmacokinetic protocol to formally guide and expedite surgical timing for these patients. The protocol is based on the patient's renal function and timing of last Xa-I dose. For patients with impaired renal function, longer wait times are recommended. The purpose of this study was to determine the effects of this protocol for patients with geriatric hip fracture taking Xa-I.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Level 1 trauma center.</p><p><strong>Patients/participants: </strong>A total of 164 patients aged 65 and older who were taking Xa-I before admission and underwent hip fracture surgery; 68 patients in the Standard group (2014-2018) and 96 patients in the Expedited group (2020-2022, after protocol implementation).</p><p><strong>Intervention: </strong>Hip fracture surgery.</p><p><strong>Main outcome measurements: </strong>Time to surgery (TTS), transfusion rate, blood loss, 90-day complication rates.</p><p><strong>Results: </strong>The median TTS was significantly shorter in the Expedited group (28.6 hours, interquartile range 21.3 hours) than in the Standard group (44.8 hours, interquartile range 21.1 hours) (<i>P</i> < .001). There were no differences in overall transfusion rates. Multivariable regression analysis demonstrated that time to surgery was not predictive of transfusion rate in all patients (OR 1.00, 95% CI 0.99-1.02, <i>P</i> = .652). There were no differences in blood loss or rates of 90-day complications.</p><p><strong>Conclusion: </strong>Geriatric patients with hip fractures and taking factor Xa inhibitors may warrant earlier surgery without an increased risk of transfusion or bleeding.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 5 Suppl","pages":"e292"},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10750454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139049885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital episode-of-care costs for hip fractures: an activity-based costing analysis.","authors":"Antoine Denis, Julien Montreuil, Yasser Bouklouch, Rudolf Reindl, Gregory K Berry, Edward J Harvey, Mitchell Bernstein","doi":"10.1097/OI9.0000000000000295","DOIUrl":"10.1097/OI9.0000000000000295","url":null,"abstract":"<p><strong>Background: </strong>Despite the large impact of hip fracture care on hospital budgets, accurate episode-of-care costs (EOCC) calculations for this injury remains a challenge. The objective of this article was to assess EOCC for geriatric patients with hip fractures using an activity-based costing methodology and identify intraoperative, perioperative, and patient-specific factors associated with higher EOCC.</p><p><strong>Material and methods: </strong>This is a retrospective cohort study involving a total of 109 consecutive patients with hip fracture treated surgically at a Canadian level-1 trauma center from April 2018 to February 2019. Clinical and demographic data were extracted through the institution's centralized data warehouse. Data acquisition also included direct and indirect costs per episode of care, adverse events, and precise temporal data.</p><p><strong>Results: </strong>The median total EOCC was $13,113 (interquartile range 6658), excluding physician fees. Out of the total cost, 75% was attributed to direct costs, which represented a median expenditure of $9941. The median indirect cost of the EOCC was $3322. Based on the multivariate analysis, patients not operated within the 48 hours guidelines had an increased length of stay by 5.7 days (<i>P</i> = 0.003), representing an increase in EOCC of close to 5000$. Higher American Society of Anesthesiology (ASA) scores were associated with elevated EOCC.</p><p><strong>Conclusion: </strong>The cost of managing a patient with geriatric hip fracture from arrival in the emergency department to discharge from surgical ward represented $13,113. Main factors influencing the EOCC included adherence to the 48-hour benchmark surgical delay and ASA score. High-quality costing data are vital in assessing health care spending, conducting cost effectiveness analyses, and ultimately in guiding policy decisions.</p><p><strong>Level of evidence: </strong>Level III (3), retrospective cohort study.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 4","pages":"e295"},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10695580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138489231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MELD score predicts short-term outcomes after surgical management of proximal humerus fractures: a matched analysis.","authors":"Brendan Y Shi, Alexander Upfill-Brown, Alan Li, Shannon Y Wu, Seth Ahlquist, Christopher M Hart, Thomas J Kremen, Christopher Lee, Alexandra I Stavrakis","doi":"10.1097/OI9.0000000000000289","DOIUrl":"10.1097/OI9.0000000000000289","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to evaluate the difference in 30-day outcomes after surgical management of proximal humerus fractures (PHFs) between patients with and without chronic liver disease as defined by a MELD score greater than 10.</p><p><strong>Design: </strong>This was a retrospective database review.</p><p><strong>Setting: </strong>All centers participating in the American College of Surgeons National Surgical Quality Improvement Program database were included.</p><p><strong>Patients/participants: </strong>Patients with proximal humerus fractures who (1) underwent ORIF, HA, or SA and (2) had calculable MELD scores were included.</p><p><strong>Intervention: </strong>Open reduction and internal fixation, hemiarthroplasty, or shoulder arthroplasty was used for treatment.</p><p><strong>Main outcome measurements: </strong>Thirty-day complications, mortality, readmission, and reoperation rates were measured.</p><p><strong>Results: </strong>Of the total 1732 PHF patients identified, 300 had a MELD score higher than 10. After propensity matching by significant covariates, MELD score higher than 10 was found to be significantly associated with higher rates of 30-day mortality, 30-day readmission, transfusion within 72 hours, and systemic complications. Among patients with a MELD score higher than 10, treatment with SA or HA instead of ORIF was associated with a higher rate of transfusion and longer operative time. There were no significant differences between treatment cohorts regarding mortality, reoperation, readmission, or complications.</p><p><strong>Conclusions: </strong>A MELD score higher than 10 is associated with higher risk of surgical complications, transfusion, and death in patients undergoing surgery for proximal humerus fractures. Among patients with a MELD score higher than 10, ORIF was associated with a lower transfusion rate and shorter operative time than arthroplasty or hemiarthroplasty.</p><p><strong>Level of evidence: </strong>Prognostic Level III.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 4","pages":"e289"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10611337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71415824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The “Human Emotions” and the new “Perrotta Human Emotions Model” (PHEM-2): Structural and functional updates to the first model","authors":"Perrotta Giulio, Basiletti Vanessa, Eleuteri Stefano","doi":"10.17352/ojt.000043","DOIUrl":"https://doi.org/10.17352/ojt.000043","url":null,"abstract":"Background: The first version of the Perrotta Human Emotions Model (PHEM) responded to the need for better structuring, in a functional framework, of emotions and sentiments, giving the proper role to anxiety, according to a neurobiological perspective, in a strategic scheme, but needs structural and functional corrections. Methods: Clinical interview, based on narrative-anamnestic and documentary evidence, and battery of psychometric tests. Results: Statistical comparison of data obtained by administering PHEM-1 versus data obtained by administering PHEM-2 reported an R = 0.999, with p = ≤0.001, as is the case when testing clinical utility by assessing it using MMPI-2-RF and PICI-2. Conclusion: This research confirms the clinical usefulness of administering the PHEM-2, compared with the previous version, during psychotherapeutic encounters conducted according to the brief or otherwise integrated strategic approach.","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136265823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of nonunion for transverse femoral shaft fractures treated with intramedullary nailing: a SIGN database study.","authors":"Brett Jones,&nbsp;Blake Cohoe,&nbsp;Kelsey Brown,&nbsp;Michael Flores,&nbsp;Kevin Peurrung,&nbsp;Terry Smith,&nbsp;David Shearer,&nbsp;Lewis Zirkle","doi":"10.1097/OI9.0000000000000281","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000281","url":null,"abstract":"<p><strong>Introduction: </strong>Nonunion is a common postfracture complication resulting in decreased quality of life for patients in resource-limited settings. This study aims to determine how age, sex, injury mechanism, and surgical intervention affect the rate of nonunion in transverse femur fractures treated with a SIGN intramedullary nail (IMN).</p><p><strong>Methods: </strong>A retrospective study was conducted using the SIGN online surgical database. All patients older than 16 years with simple transverse (<30 degrees), open or closed, femur fractures treated using a SIGN IMN between 2007 and 2021 were included. Our primary outcome of nonunion was measured with the modified Radiographic Union Scale for Tibial fractures (mRUST); scores ≤9 of 16 defined nonunion. The secondary outcome was squat depth. Outcomes were evaluated at follow-up appointments between 240 and 365 days postoperatively. Univariate and multivariate analysis were used for statistical comparison.</p><p><strong>Results: </strong>Inclusion criteria were met for 182 patients. The overall radiographic union rate was 61.0%, and a high proportion (84.4%) of patients could squat with their hips at or below the level of their knees. Older age, retrograde approach, and fracture distraction were associated with nonunion, but sex, injury mechanism, and other surgical variables were not.</p><p><strong>Conclusion: </strong>Poor reduction with fracture distraction was associated with a higher rate of nonunion. Loss of follow-up may have contributed to our overall union rate; however, we observed high rates of functional healing using the SIGN IMN.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 3","pages":"e281"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/58/oi9-6-e281.PMC10368386.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9883059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of a 2.7-mm and 3.5-mm locking compression plate for ulnar fractures: a biomechanical evaluation.","authors":"Jenna M Wahbeh,&nbsp;Benjamin V Kelley,&nbsp;Cyrus Shokoohi,&nbsp;Sang-Hyun Park,&nbsp;Sai K Devana,&nbsp;Edward Ebramzadeh,&nbsp;Sophia N Sangiorio,&nbsp;Devon M Jeffcoat","doi":"10.1097/OI9.0000000000000278","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000278","url":null,"abstract":"<p><strong>Objectives: </strong>Implant prominence after ulnar fracture fixation may be mitigated by the use of lower profile plates. The biomechanical strength and stability of 2.7-mm and 3.5-mm locking compression plates for fixation were compared.</p><p><strong>Methods: </strong>Two fracture conditions, transverse (N = 10) and oblique (N = 10), were evaluated in an in vitro study. Half of the specimens for each condition were fixed with 2.7-mm plates and the other half with 3.5-mm plates, all fixed with conventional dynamic compression mechanisms. Specimens were loaded under ±2 Nm of cyclic axial torsion, then under 10 Nm of cyclic cantilever bending, and bending to failure. Interfragmentary motion and strain were analyzed to determine construct stability as a function of fracture pattern and plate size.</p><p><strong>Results: </strong>Interfragmentary motion was significantly larger in all constructs fixed with 2.7-mm plates, compared with 3.5-mm plates (<i>P</i> < 0.01). The 2.7-mm constructs with transverse fractures had the greatest motion, ranging between 5° and 10° under axial rotation and 5.0-6.0 mm under bending. Motions were the lowest for 3.5-mm constructs with oblique fractures, ranging between 3.2 and 4.2 mm under bending and 2°-3.5° for axial rotation. For oblique fractures, the bending moment at ultimate failure was 31.4 ± 3.6 Nm for the 2.7-mm constructs and 10.0 ± 1.9 Nm for 3.5-mm constructs (<i>P</i> < 0.01). Similarly, for transverse fractures, the bending moment was 17.9 ± 4.0 Nm for the 2.7-mm constructs and 9.7 ± 1.3 Nm for the 3.5-mm constructs (<i>P</i> < 0.01).</p><p><strong>Conclusions: </strong>Although 3.5-mm plates were more effective at reducing fracture motion, they were consistently associated with refracture at the distal-most screw hole under load to failure. By contrast, 2.7-mm plates plastically deformed despite excessive loads, potentially avoiding a subsequent fracture.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 3","pages":"e278"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/65/9c/oi9-6-e278.PMC10368380.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9937125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}