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PloS One 2024Depending on the degree of fracture, pelvic fracture can be accompanied by vascular damage, and in severe cases, it may progress to hemorrhagic shock. Pelvic radiography...
Depending on the degree of fracture, pelvic fracture can be accompanied by vascular damage, and in severe cases, it may progress to hemorrhagic shock. Pelvic radiography can quickly diagnose pelvic fractures, and the Association for Osteosynthesis Foundation and Orthopedic Trauma Association (AO/OTA) classification system is useful for evaluating pelvic fracture instability. This study aimed to develop a radiomics-based machine-learning algorithm to quickly diagnose fractures on pelvic X-ray and classify their instability. data used were pelvic anteroposterior radiographs of 990 adults over 18 years of age diagnosed with pelvic fractures, and 200 normal subjects. A total of 93 features were extracted based on radiomics:18 first-order, 24 GLCM, 16 GLRLM, 16 GLSZM, 5 NGTDM, and 14 GLDM features. To improve the performance of machine learning, the feature selection methods RFE, SFS, LASSO, and Ridge were used, and the machine learning models used LR, SVM, RF, XGB, MLP, KNN, and LGBM. Performance measurement was evaluated by area under the curve (AUC) by analyzing the receiver operating characteristic curve. The machine learning model was trained based on the selected features using four feature-selection methods. When the RFE feature selection method was used, the average AUC was higher than that of the other methods. Among them, the combination with the machine learning model SVM showed the best performance, with an average AUC of 0.75±0.06. By obtaining a feature-importance graph for the combination of RFE and SVM, it is possible to identify features with high importance. The AO/OTA classification of normal pelvic rings and pelvic fractures on pelvic AP radiographs using a radiomics-based machine learning model showed the highest AUC when using the SVM classification combination. Further research on the radiomic features of each part of the pelvic bone constituting the pelvic ring is needed.
Topics: Humans; Machine Learning; Pelvic Bones; Fractures, Bone; Male; Adult; Female; Middle Aged; Radiography; Algorithms; ROC Curve; Aged; Area Under Curve; Radiomics
PubMed: 38814948
DOI: 10.1371/journal.pone.0304350 -
Turkish Journal of Medical Sciences 2023Developmental dysplasia of the hip (DDH) is the most common cause of secondary hip arthrosis. The primary purpose of this study was to assess the results of an oversized...
BACKGROUND/AIM
Developmental dysplasia of the hip (DDH) is the most common cause of secondary hip arthrosis. The primary purpose of this study was to assess the results of an oversized hemispherical cup via the press-fit technique used for Crowe type II and III DDH without screws and to determine if adequate medialization and initial stability of the acetabular component would allow us to avoid screw and graft use.
MATERIALS AND METHODS
Between February 2012 and May 2020, the current study analyzed 43 hips with Crowe type II and III DDH treated with a porous-coated cup by placing the press-fit technique or screw. The acetabular cup was fixed with the press-fit technique without additional screws in 27 hips and with screws in 16 hips. The inclusion criterion in this study was a minimum 2-year-period after the surgery.
RESULTS
The mean duration of follow-up was 6.83 2.67 years in the press-fit group and 6.21 2.01 years in the screw group. The mean age of the patients was 47.96 12.37 years in the press-fit group and 50.5 12.37 years in the screw group. Measurements revealed that the hip center of rotation (HCR) was located more medially and superiorly postoperatively than preoperatively in both groups. The mean cup coverage in the screw group was 85.58% 7.51% (75.3%-97.2%), while it was less than 90.41% 6.15% (76.3%-98.2%) in the press-fit group (p = 0.038). No component was revised because of loosening, and all of the implants were radiologically stable within the observation period. No statistically significant differences were observed regarding the postoperative limp-length discrepancy between the groups (p = 0.496).
CONCLUSION
Press-fit implantation of a porous-coated acetabular component without screws can also be used as an alternative method for THA in Crowe type II and III DDH. The initial stability was obtained using the press-fit technique with a small cup positioned more medially and superiorly, which may allow the surgeon to avoid screw and graft use.
Topics: Humans; Female; Male; Middle Aged; Adult; Arthroplasty, Replacement, Hip; Hip Prosthesis; Bone Screws; Bone Transplantation; Developmental Dysplasia of the Hip; Hip Dislocation, Congenital; Acetabulum; Treatment Outcome; Prosthesis Design
PubMed: 38813005
DOI: 10.55730/1300-0144.5712 -
BMC Musculoskeletal Disorders May 2024To digitally measure the fixation trajectory of anatomical plates used in the combined reduction of quadrilateral acetabular fractures via the posterior approach, and to...
OBJECTIVE
To digitally measure the fixation trajectory of anatomical plates used in the combined reduction of quadrilateral acetabular fractures via the posterior approach, and to develop anatomical plates that align with the characteristics of the pelvis in the Chinese population.
METHODS
Pelvic computed tomography (CT) data from 102 adult patients were collected at the Affiliated Hospital of Zunyi Medical University. This group included 51 males and 51 females, aged between 20 and 60 years. Using Mimics software (version 21.0), a three-dimensional model of each pelvic data point was reconstructed. The fixation path for the combined reset anatomical steel plate was drawn, where the curves on the fixation path were approximated as arcs. The radius of curvature and length of these curves were measured, and an anatomical steel plate was designed to best fit the pelvic structure.
RESULTS
The combined anatomical reduction plate fixation system for quadrilateral acetabular fractures using a posterior approach consisted of two parts: a locking plate and a reduction plate. The posterior wall region (r2), ischial region (r3), quadrilateral region (r4), and bending region (r5), and the total length of the reduction plate were significantly smaller in females (P < 0.05). Similarly, the posterior wall region (R3), distal posterior wall region (R4), and the total length of the locking plate were significantly smaller in females (P < 0.05). Additionally, the anterior superior iliac spine side (r1) and the total length of the T-shaped auxiliary plate were significantly smaller in females (P < 0.05). The bending angle (< A) was also significantly smaller in females (P < 0.05).
CONCLUSIONS
The pelvic surface structure is irregular and varies greatly among individuals.Compared to the traditional steel plate, The combined reduction anatomical plate designed in this study demonstrated high precision and improved conformity to the anatomical structure of the pelvis.
Topics: Humans; Female; Male; Bone Plates; Acetabulum; Adult; Middle Aged; Fracture Fixation, Internal; Fractures, Bone; Young Adult; Tomography, X-Ray Computed; Imaging, Three-Dimensional
PubMed: 38807120
DOI: 10.1186/s12891-024-07522-x -
Scientific Reports May 2024With the recent increase in traffic accidents, pelvic fractures are increasing, second only to skull fractures, in terms of mortality and risk of complications. Research...
With the recent increase in traffic accidents, pelvic fractures are increasing, second only to skull fractures, in terms of mortality and risk of complications. Research is actively being conducted on the treatment of intra-abdominal bleeding, the primary cause of death related to pelvic fractures. Considerable preliminary research has also been performed on segmenting tumors and organs. However, studies on clinically useful algorithms for bone and pelvic segmentation, based on developed models, are limited. In this study, we explored the potential of deep-learning models presented in previous studies to accurately segment pelvic regions in X-ray images. Data were collected from X-ray images of 940 patients aged 18 or older at Gachon University Gil Hospital from January 2015 to December 2022. To segment the pelvis, Attention U-Net, Swin U-Net, and U-Net were trained, thereby comparing and analyzing the results using five-fold cross-validation. The Swin U-Net model displayed relatively high performance compared to Attention U-Net and U-Net models, achieving an average sensitivity, specificity, accuracy, and dice similarity coefficient of 96.77%, of 98.50%, 98.03%, and 96.32%, respectively.
Topics: Humans; Deep Learning; Fractures, Bone; Pelvic Bones; Male; Female; Adult; Middle Aged; Algorithms; Aged; Pelvis; Image Processing, Computer-Assisted; Adolescent; Young Adult
PubMed: 38806582
DOI: 10.1038/s41598-024-63093-w -
International Journal of Nanomedicine 2024There is an ongoing need for improved healing response and expedited osseointegration on the Ti implants in acetabular fracture sites. To achieve adequate bonding and...
INTRODUCTION
There is an ongoing need for improved healing response and expedited osseointegration on the Ti implants in acetabular fracture sites. To achieve adequate bonding and mechanical stability between the implant surface and the acetabular fracture, a new coating technology must be developed to promote bone integration and prevent bacterial growth.
METHODS
A cylindrical Ti substrate mounted on a rotating specimen holder was used to implant Ca, P, and Sr ions at energies of 100 KeV, 75 KeV and 180 KeV, respectively, using a low-energy accelerator to synthesize strontium-substituted hydroxyapatite at varying conditions. Ag ions of energy 100 KeV were subsequently implanted on the as-formed surface at the near-surface region to provide anti-bacterial properties to the as-formed specimen.
RESULTS
The properties of the as-formed ion-implanted specimen were compared with the SrHA-Ag synthesized specimens by cathodic deposition and low-temperature high-speed collision technique. The adhesion strength of the ion-implanted specimen was 43 ± 2.3 MPa, which is well above the ASTM standard for Ca-P coating on Ti. Live/dead cell analysis showed higher osteoblast activity on the ion-implanted specimen than the other two. Ag in the SrHA implanted Ti by ion implantation process showed superior antibacterial activity.
DISCUSSION
In the ion implantation technique, nano-topography patterned surfaces are not concealed after implantation, and their efficacy in interacting with the osteoblasts is retained. Although all three studies examined the antibacterial effects of Ag ions and the ability to promote bone tissue formation by MC3T3-E1 cells on SrHA-Ag/Ti surfaces, ion implantation techniques demonstrated superior ability. The synthesized specimen can be used as an effective implant in acetabular fracture sites based on their mechanical and biological properties.
Topics: Titanium; Silver; Strontium; Anti-Bacterial Agents; Acetabulum; Animals; Coated Materials, Biocompatible; Osseointegration; Mice; Surface Properties; Fractures, Bone; Durapatite; Osteoblasts; Hydroxyapatites; Prostheses and Implants; Ions; Humans; Cell Line
PubMed: 38803996
DOI: 10.2147/IJN.S464905 -
Cureus Apr 2024Fat embolism syndrome (FES) is a rare but serious multisystem syndrome that occurs after 0.9% to 2.2% of fractures, with long bone and pelvic fractures being the most...
Fat embolism syndrome (FES) is a rare but serious multisystem syndrome that occurs after 0.9% to 2.2% of fractures, with long bone and pelvic fractures being the most common. The classic triad of FES consists of neurological impairment, respiratory insufficiency, and petechial rash, which develops 12-72 hours after the initial incident. We hereby present a case of a patient who developed persistent altered consciousness, seizures, and hypoxia secondary to a comminuted sacral fracture. Although the patient could not survive owing to multiple factors, imaging played a pivotal role in expediting the diagnostic process and aiding early management.
PubMed: 38803752
DOI: 10.7759/cureus.59107 -
Cureus Apr 2024Iliac stress fractures (ISF) are uncommon in sports, particularly among runners, and are attributed to repetitive loading and other predisposing factors. ISF poses...
Iliac stress fractures (ISF) are uncommon in sports, particularly among runners, and are attributed to repetitive loading and other predisposing factors. ISF poses diagnostic challenges due to nonspecific symptoms and the limited sensitivity of conventional imaging procedures. The reported case is about a 51-year-old male marathon runner with consecutive bilateral ISF. Initial symptoms included mechanical pain in the right buttock, leading to a diagnosis confirmed via pelvic MRI. Conservative management with eight weeks rest from sport activity was indicated with symptom resolution and return to sport. However, 20 days after returning to sport, the patient developed left-sided symptoms post-resumption of running, with MRI confirming a new ISF. An additional eight weeks of rest was prescribed, allowing the patient to resume sport at preinjury levels. ISF should be considered in runners presenting with gluteal pain, emphasizing the importance of early diagnosis. MRI emerges as a valuable tool for accurate diagnosis, guiding appropriate management strategies. Conservative management focusing on rest is paramount for favorable outcomes and optimizing runners' health and performance.
PubMed: 38800197
DOI: 10.7759/cureus.59013 -
BMC Geriatrics May 2024Fragility fractures of the pelvis (FFPs) represent a significant health burden, particularly for the elderly. The role of sarcopenia, an age-related loss of muscle mass...
BACKGROUND
Fragility fractures of the pelvis (FFPs) represent a significant health burden, particularly for the elderly. The role of sarcopenia, an age-related loss of muscle mass and function, in the development and impact of these fractures is not well understood. This study aims to investigate the prevalence and impact of osteoporosis and sarcopenia in patients presenting with FFPs.
METHODS
This retrospective study evaluated 140 elderly patients with FFPs. The diagnosis of sarcopenia was assessed by psoas muscle area (PMA) and the height-adjusted psoas muscle index (PMI) measured on computed tomography (CT) scans. Clinical data, radiological findings and functional outcomes were recorded and compared with the presence or absence of sarcopenia and osteoporosis.
RESULTS
Our study cohort comprised 119 female (85.0%) and 21 (15.0%) male patients. The mean age at the time of injury or onset of symptoms was 82.26 ± 8.50 years. Sarcopenia was diagnosed in 68.6% (n = 96) patients using PMA and 68.8% (n = 88) using PMI. 73.6% (n = 103) of our study population had osteoporosis and 20.0% (n = 28) presented with osteopenia. Patients with sarcopenia and osteoporosis had longer hospital stays (p < 0.04), a higher rate of complications (p < 0.048) and functional recovery was significantly impaired, as evidenced by a greater need for assistance in daily living (p < 0.03). However, they were less likely to undergo surgery (p < 0.03) and the type of FFP differed significantly (p < 0.04). There was no significant difference in mortality rate, pre-hospital health status, age or gender.
CONCLUSION
Our study highlights the important role of sarcopenia in FFPs in terms of the serious impact on health and quality of life in elderly patients especially when osteoporosis and sarcopenia occur together. Identifying and targeting sarcopenia in older patients may be an important strategy to reduce pelvic fractures and improve recovery. Further research is needed to develop effective prevention and treatment approaches that target muscle health in the elderly.
Topics: Humans; Sarcopenia; Male; Female; Retrospective Studies; Aged, 80 and over; Aged; Risk Factors; Pelvic Bones; Osteoporosis; Psoas Muscles; Osteoporotic Fractures; Tomography, X-Ray Computed; Prevalence; Fractures, Bone
PubMed: 38797837
DOI: 10.1186/s12877-024-05082-2 -
Cancers May 2024The standard treatment for locally advanced cervical cancer typically includes concomitant chemoradiation, a regimen known to induce severe hematologic toxicity (HT).... (Review)
Review
The standard treatment for locally advanced cervical cancer typically includes concomitant chemoradiation, a regimen known to induce severe hematologic toxicity (HT). Particularly, pelvic bone marrow dose exposure has been identified as a contributing factor to this hematologic toxicity. Chemotherapy further increases bone marrow suppression, often necessitating treatment interruptions or dose reductions. A systematic search for original articles published between 1 January 2006 and 7 January 2024 that reported on chemoradiotherapy for locally advanced cervical cancer and hematologic toxicities was conducted. Twenty-four articles comprising 1539 patients were included in the final analysis. HT of grade 2 and higher was observed across all studies and frequently exceeded 50%. When correlating active pelvic bone marrow and HT, significant correlations were found for volumes between 10 and 45 Gy and HT of grade 3 and higher. Several dose recommendations for pelvic bone and pelvic bone marrow sparing to reduce HT were established, including V10 < 90-95%, V20 < 65-86.6% and V40 < 22.8-40%. Applying dose constraints to the pelvic bone/bone marrow is a promising approach for reducing HT, and thus reliable implementation of therapy. However, prospective randomized controlled trials are needed to define precise dose constraints and optimize clinical strategies.
PubMed: 38791920
DOI: 10.3390/cancers16101842 -
International Journal of Molecular... May 2024Primary hip osteoarthritis (pOA) develops without an apparent underlying reason, whereas secondary osteoarthritis arises due to a known cause, such as developmental...
Distinctiveness of Femoral and Acetabular Mesenchymal Stem and Progenitor Populations in Patients with Primary and Secondary Hip Osteoarthritis Due to Developmental Dysplasia.
Primary hip osteoarthritis (pOA) develops without an apparent underlying reason, whereas secondary osteoarthritis arises due to a known cause, such as developmental dysplasia of the hips (DDH-OA). DDH-OA patients undergo total hip arthroplasty at a much younger age than pOA patients (50.58 vs. 65 years in this study). Recently, mesenchymal stem and progenitor cells (MSPCs) have been investigated for the treatment of osteoarthritis due to their immunomodulatory and regenerative potential. This study identified cells in subchondral bone expressing common MSPC markers (CD10, CD73, CD140b, CD146, CD164, CD271, GD2, PDPN) in vivo and compared the proportions of these populations in pOA vs. DDH-OA, further correlating them with clinical, demographic, and morphological characteristics. The differences in subchondral morphology and proportions of non-hematopoietic cells expressing MSPC markers were noted depending on OA type and skeletal location. Bone sclerosis was more prominent in the pOA acetabulum (Ac) in comparison to the DDH-OA Ac and in the pOA Ac compared to the pOA femoral head (Fh). Immunophenotyping indicated diagnosis-specific differences, such as a higher proportion of CD164+ cells and their subsets in DDH-OA, while pOA contained a significantly higher proportion of CD10+ and GD2+ cells and subsets, with CD271+ being marginally higher. Location-specific differences showed that CD271+ cells were more abundant in the Fh compared to the Ac in DDH-OA patients. Furthermore, immunohistochemical characterization of stromal bone-adjacent cells expressing MSPC markers (CD10, CD164, CD271, GD2) in the Ac and Fh compartments was performed. This research proved that immunophenotype profiles and morphological changes are both location- and disease-specific. Furthermore, it provided potentially effective targets for therapeutic strategies. Future research should analyze the differentiation potential of subsets identified in this study. After proper characterization, they can be selectively targeted, thus enhancing personalized medicine approaches in joint disease management.
Topics: Humans; Mesenchymal Stem Cells; Female; Male; Osteoarthritis, Hip; Middle Aged; Aged; Acetabulum; Developmental Dysplasia of the Hip; Adult; Biomarkers; Femur; Immunophenotyping
PubMed: 38791213
DOI: 10.3390/ijms25105173