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Translational Medicine @ UniSa 2024- Hip fracture is the most common cause of hospitalization in frail geriatric subjects due to osteoporosis and recurrent falls. The clinical practice guidelines for... (Review)
Review
- Hip fracture is the most common cause of hospitalization in frail geriatric subjects due to osteoporosis and recurrent falls. The clinical practice guidelines for rehabilitation after surgery in patients with hip fractures recommend to start treatment early. However, the outbreak of SARS-CoV-2 pandemic between December 2019 and January 2020 forced to lockdown. Thus, telerehabilitation seemed the best solution to remote assistance. In this scenario, the aim of our study is to assess the effects of telerehabilitation and to clarify and rearrange the knowledge about its usability and feasibility in patients after hip fracture in emergency conditions, such as the pandemic of SARS-CoV-2. Three databases were systematically searched from caption to December 2023, considering only articles published in peer-reviewed journals, with the use of three macro-areas: 'telerehabilitation', 'remote rehabilitation' and 'hip fracture'. In the present review, 26 articles were considered eligible and 10 were included. Heterogeneous results were found due to the different characteristics of the patients recruited in the studies, designs and type of the studies, and reporting/conducting of the research. Also, the typologies of telerehabilitation provided were various. In conclusion, this review demonstrated that telerehabilitation is safe, effective and well tolerated from patients and seems to be not inferior to the conventional physiotherapy. It also plays a positive role in psychological rehabilitation, in the prevention of complications and in the maintenance of achieved goals. However, further studies are needed to guide the clinical practice in providing the better posology and typology of telerehabilitation.
PubMed: 38560615
DOI: 10.37825/2239-9747.1048 -
The Journal of Craniofacial Surgery Sep 2023The incidence of pediatric craniofacial fractures and heterogeneity of fractures is known to increase with age. This study aimed to determine the occurrence of...
The incidence of pediatric craniofacial fractures and heterogeneity of fractures is known to increase with age. This study aimed to determine the occurrence of associated injuries (AIs) to craniofacial fractures and identify differences in patterns of and predictors for AIs in children and teenagers. A 6-year retrospective cross-sectional cohort study was designed and implemented. The study population included 397 patients aged 19 years or less diagnosed with craniofacial fracture at Helsinki University Hospital from 2013 to 2018. Boys (71.0%) and teenagers (64.7%) were predominated. Associated injuries were more common in teenagers than children. Teenagers had more often AI in 2 or more organ systems. Assault and intoxication by alcohol were observed only in teenagers and predominantly boys. A total of 27.0% of all patients sustained AIs. In 18.1%, brain injury was reported. In children, motor vehicle accident (MVA) was an independent predictor for AI. In teenagers, independent predictors for AI were female sex, isolated cranial fracture, combined cranial fracture, and high-energy trauma mechanism. Injury patterns and AI related to craniofacial fractures in the pediatric population are age-specific, requiring multidisciplinary collaboration in the diagnosis, treatment, and follow-up of such trauma. Predictors for AIs increase in complexity with age, and the role of sex as a predictor is evident in teenagers.
Topics: Male; Child; Humans; Female; Adolescent; Retrospective Studies; Cross-Sectional Studies; Fractures, Bone; Accidents, Traffic; Multiple Trauma; Skull Fractures
PubMed: 37202848
DOI: 10.1097/SCS.0000000000009343 -
JCEM Case Reports Sep 2023Children with hepatoblastoma have an increased incidence of fractures, but data are limited. Previous reports document an average of 4 fractures per child with...
Children with hepatoblastoma have an increased incidence of fractures, but data are limited. Previous reports document an average of 4 fractures per child with hepatoblastoma. We present a severe case of a premature 4-month-old with multiple fractures in the setting of Beckwith-Wiedemann syndrome and hepatoblastoma. Although prematurity is a known risk for metabolic bone disease, it did not entirely explain the severity. Our patient underwent chemotherapy and surgical resection of his hepatoblastoma. Once deemed stable, he received a dose of zoledronic acid (ZA). One month post treatment with ZA, a skeletal survey revealed healing of the rib and femoral fractures and no new fractures. Five months post ZA, the skeletal survey revealed no new fractures and motor development was appropriate. An extensive search revealed scant literature on the rate or cause of pathologic fractures in patients with newly diagnosed hepatoblastoma. A better understanding of fracture risk in this population may guide prevention strategies, screening, and treatment. In our case, prematurity and substantial chronic illness may have compounded the known fracture risk associated with hepatoblastoma and may provide insight into the pathophysiology and prevention of fractures in this setting.
PubMed: 37908208
DOI: 10.1210/jcemcr/luad110 -
Cureus Oct 2023Chronic exertional compartment syndrome is an incapacitating condition that primarily affects athletes and individuals with high activity levels. The exact etiology of... (Review)
Review
Chronic exertional compartment syndrome is an incapacitating condition that primarily affects athletes and individuals with high activity levels. The exact etiology of the condition is unknown to date, but multiple factors play a role in its occurrence. The clinical presentation includes pain, tightness, muscle weakness, paresthesia, and cramps. Common tools utilized during the diagnostic approach include intramuscular compartment pressure measurement, advanced imaging to exclude other disorder entities, near-infrared spectrometry, and shear wave elastography, with the clinical diagnosis being the gold standard. Management includes both conservative and surgical options. Conservative treatment includes gait re-training and botulinum toxin injections. Further, the operative treatment has variable approaches and may be combined with conservative modalities. This article reviews the literature on chronic exertional compartment syndrome and elucidates future recommendations.
PubMed: 38022185
DOI: 10.7759/cureus.47797 -
PloS One 2023Myomectomy, a surgery to remove multiple leiomyomas from the uterus, is a treatment option for uterine fibroids (UF) in premenopausal patients. Osteoporosis and bone...
Myomectomy, a surgery to remove multiple leiomyomas from the uterus, is a treatment option for uterine fibroids (UF) in premenopausal patients. Osteoporosis and bone fractures are known to be strongly associated with menopausal status or hormonal changes. However, no studies have discussed the association between myomectomy and osteoporosis or fractures. This study investigated the risk of osteoporosis or fractures (vertebrae, hip, and others) in Korean patients who had undergone myomectomy without bilateral oophorectomy. We used data from the 10-year claims database of the Korean National Health Insurance from January 2009 to December 2020. Data for patients who had undergone myomectomy without oophorectomy (n = 211,969) and the control group (n = 450,124) who were randomly selected from the database were extracted. The incidence and hazard ratios (HRs) of osteoporosis or fracture between the myomectomy patients and the control group were calculated. A Cox proportional hazards model was used to analyze hazard ratios and 95% confidence intervals (CI). Subgroup analyses were performed based on age. The adjusted hazard ratios for osteoporosis and total fractures were 0.934 (95% CI: 0.916-0.954, P<0.001) and 0.919 (95% CI: 0.896-0.941, P<0.001), respectively, in the myomectomy group. The adjusted hazard ratios according to fracture site were 0.857 (95% CI: 0.799-0.92, P<0.001) for vertebral fractures, 0.706 (95% CI: 0.48-1.037, P = 0.076) for hip fractures, and 0.919 (95% CI: 0.896-0.943, P<0.001) for other fractures. In conclusion, patients who have undergone myomectomy might have a decreased risk of osteoporosis or fractures.
Topics: Female; Humans; Cohort Studies; Uterine Myomectomy; Osteoporosis; Hip Fractures; Spinal Fractures; Leiomyoma
PubMed: 37972094
DOI: 10.1371/journal.pone.0294405 -
PloS One 2023The immovable nature of built heritage means that it is particularly vulnerable during times of armed conflict. Although impacts from small arms and shrapnel leave...
The immovable nature of built heritage means that it is particularly vulnerable during times of armed conflict. Although impacts from small arms and shrapnel leave relatively inconspicuous impact scars, they elevate the risk of future stone deterioration. This study investigates the subsurface damage caused by bullet impacts, which is not apparent from surface inspection, in order to better understand the geometry and mechanics of this form of conflict damage to heritage. Controlled firearm experiments were conducted to simulate conflict damage to sandstone and limestone buildings. The bullet impacts created conical fractures or zones of increased fracture intensity below the impact, radial fractures, and spallation, in addition to a crater. Dynamic fracture distinguishes the formation of these features from quasi static cone crack experiments, while the lack of a shockwave differentiates these bullet impacts from hypervelocity experiments. Damage was created by momentum transfer from the bullet, so that differences in target properties had large effects on the nature of the damage. The crater in the limestone target was almost an order of magnitude deeper than the sandstone crater, and large open fractures formed in the limestone below the crater floor, compared with zones of increased fracture intensity in the sandstone target. Microstructural analysis of subsurface damage showed that fracture intensity decreased with increasing distance from the impact centre, suggesting that regions proximal to the impact are at increased risk of future deterioration. Conical subsurface fractures dipping away from the impact beneath multiple impact craters could link up, creating a continuous fracture network. By providing pathways for moisture and other weathering agents, fractures enlarge the region at increased risk of deterioration. Their lack of surface expression makes understanding their formation a vital part of future surveying and post conflict assessments.
Topics: Humans; Fractures, Bone; Firearms; Calcium Carbonate; Weather
PubMed: 37878563
DOI: 10.1371/journal.pone.0292351 -
Medicina Oral, Patologia Oral Y Cirugia... May 2024Assess the correlation between the position of the third molar (M3) and fractures of the mandibular angle and condyle using panoramic radiographs to offer valuable data...
BACKGROUND
Assess the correlation between the position of the third molar (M3) and fractures of the mandibular angle and condyle using panoramic radiographs to offer valuable data references for oral clinical research.
MATERIAL AND METHODS
A retrospective cross-sectional study was undertaken, involving the collection of 409 cases of mandibular fracture in the Yanbian University Hospital. The case records and panoramic radiographs of mandibular angle fracture (78 cases) and condylar fracture (106 cases) were evaluated.
RESULTS
In the comparative analysis between the mandibular angle fracture group and the condylar fracture group, statistical significance was observed in the variables of M3 existence (P = 0.002), eruption of M3 from the alveolar cavity (P = 0.003), P&G position classification (P = 0.001), deep impactions (Classes IC, IIC, IIIB, and IIIC) (P < 0.001), and the presence of impacted M3 in both groups (P < 0.001).Regarding M3 roots, the mandibular angle fracture group exhibited the highest prevalence of multiple roots at 75.4%, surpassing the 64.6% observed in the condylar fracture group. The prevalence of proximal angles in the mandibular angle group and the condyle group was the highest, accounting for 64.6% and 61.5%, respectively. The percentage of M3 in the two groups was 80% and 43.1%, respectively, with a significant difference (P < 0.001).
CONCLUSIONS
Impacted mandibular third molars (M3) elevate the risk of mandibular angle fractures, while their absence or normal eruption reduces this risk and protects against condylar process fractures. The fracture risk is influenced by the M3's position: P&G Class II and Class B impactions, where M3s emerge partially from the alveolar bone, are significantly associated with mandibular angle fractures. In contrast, the absence of M3 or its placement in P&G Class I and Class A positions tends to correlate with a higher incidence of condylar process fractures.
PubMed: 38794934
DOI: 10.4317/medoral.26604 -
The Journals of Gerontology. Series A,... Aug 2023Falls occur annually in 25% of adults aged ≥65 years. Fall-related injuries are increasing, highlighting the need to identify modifiable risk factors.
BACKGROUND
Falls occur annually in 25% of adults aged ≥65 years. Fall-related injuries are increasing, highlighting the need to identify modifiable risk factors.
METHODS
Role of fatigability on prospective, recurrent, and injurious fall risk was examined in 1 740 men aged 77-101 years in the Osteoporotic Fractures in Men Study. The 10-item Pittsburgh Fatigability Scale measured perceived physical and mental fatigability (0-50/subscale) at Year 14 (2014-16); established cut-points identified men with more severe perceived physical (≥15, 55.7%), more severe mental (≥13, 23.7%) fatigability, or having both (22.8%). Prospective, recurrent (≥2), and injurious falls were captured by triannual questionnaires ≥1 year after fatigability assessment; risk of any fall was estimated with Poisson generalized estimating equations, and likelihood of recurrent/injurious falls with logistic regression. Models adjusted for age, health conditions, and other confounders.
RESULTS
Men with more severe physical fatigability had a 20% (p = .03) increased fall risk compared with men with less physical fatigability, with increased odds of recurrent and injurious falls, 37% (p = .04) and 35% (p = .035), respectively. Men with both more severe physical and mental fatigability had a 24% increased risk of a prospective fall (p = .026), and 44% (p = .045) increased odds of recurrent falling compared with men with less severe physical and mental fatigability. Mental fatigability alone was not associated with fall risk. Additional adjustment for previous fall history attenuated associations.
CONCLUSIONS
More severe fatigability may be an early indicator to identify men at high risk for falls. Our findings warrant replication in women, as they have higher rates of fatigability and prospective falls.
Topics: Male; Humans; Female; Aged; Prospective Studies; Fractures, Bone; Risk Factors; Physical Examination; Fatigue
PubMed: 36801938
DOI: 10.1093/gerona/glad061 -
PloS One 2023In this study, we present a deep learning model for fracture classification on shoulder radiographs using a convolutional neural network (CNN). The primary aim was to...
In this study, we present a deep learning model for fracture classification on shoulder radiographs using a convolutional neural network (CNN). The primary aim was to evaluate the classification performance of the CNN for proximal humeral fractures (PHF) based on the AO/OTA classification system. Secondary objectives included evaluating the model's performance for diaphyseal humerus, clavicle, and scapula fractures. The training dataset consisted of 6,172 examinations, including 2-7 radiographs per examination. The overall area under the curve (AUC) for fracture classification was 0.89, indicating good performance. For PHF classification, 12 out of 16 classes achieved an AUC of 0.90 or greater. Additionally, the CNN model had excellent overall AUC for diaphyseal humerus fractures (0.97), clavicle fractures (0.96), and good AUC for scapula fractures (0.87). Despite the limitations of the study, such as the reliance on ground truth labels provided by students with limited radiographic assessment experience, our findings are in concordance with previous studies, further consolidating CNN as potent fracture classifiers in plain radiographs. The inclusion of multiple radiographs with different views from each examination, as well as the generally unselected nature of the sample, contributed to the overall generalizability of the study. This is the fifth study published by our group on AI in orthopaedic radiographs, which has consistently shown promising results. The next challenge for the orthopaedic research community will be to transfer these results from the research setting into clinical practice. External validation of the CNN model should be conducted in the future before it is considered for use in a clinical setting.
Topics: Humans; Shoulder; Clavicle; Deep Learning; Scapula; Humerus; Shoulder Fractures; Thoracic Injuries
PubMed: 37647274
DOI: 10.1371/journal.pone.0289808 -
Biology of Sport Oct 2023Epidemiological studies on fractures in European professional football (soccer) are in abundance. However, such data are lacking in Middle Eastern professional...
Epidemiological studies on fractures in European professional football (soccer) are in abundance. However, such data are lacking in Middle Eastern professional footballers and information on fracture treatment is scarce. The aim of this study is to describe the epidemiology of fractures across seven seasons in Qatar Stars League (QSL) footballers. A prospective study of fractures in professional male footballers over 7 consecutive seasons (2013 to 2020), involving 3255 players and 106 team' seasons. Time loss and injuries and illnesses were recorded using standardised digital tools in accordance with international consensus procedures. Fractures were recorded according to onset mechanism, location, diagnoses, treatment and return to play. A total of 108 players sustained fractures during 638,247 hours of player exposure (88.9% training and 11.1% matches), representing 2.7% of all time-loss injuries. The incidence was 0.17 fractures per 1000 h of exposure (match and training incidence of 0.9 and 0.07 fractures / 1000 h, respectively), equivalent to an average of one fracture per team per season. Fractures mostly occurred in the feet (28.2%), hands (21.1%), shoulders (11.3%) and head (i.e., face) (9.9%). Mean (median) absence was 71 (47 days), with 4.6% refractures. Only 34.3% of the fractures required surgery and nearly all players (98.1%) returned to play at the professional level. Almost all professional football players with fractures return to play at the same competitive level after an average of 10 weeks of absence (mean absence was 71 ± 81 (median: 47, Inter Quartile Range [14-93]) days). One in ten continue to play with symptoms and one in twenty may refracture. Long-term effects of fractures are still unknown.
PubMed: 37867759
DOI: 10.5114/biolsport.2023.125588