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Sensors (Basel, Switzerland) Feb 2024When a limb suffers a fracture, rupture, or dislocation, it is traditionally immobilized with plaster. This may induce discomfort in the patient, as well as excessive... (Review)
Review
When a limb suffers a fracture, rupture, or dislocation, it is traditionally immobilized with plaster. This may induce discomfort in the patient, as well as excessive itching and sweating, which creates the growth of bacteria, leading to an unhygienic environment and difficulty in keeping the injury clean during treatment. Furthermore, if the plaster remains for a long period, it may cause lesions in the joints and ligaments. To overcome all of these disadvantages, orthoses have emerged as important medical devices to help patients in rehabilitation, as well as for self-care of deficiencies in clinics and daily life. Traditionally, these devices are produced manually, which is a time-consuming and error-prone method. From another point of view, it is possible to use imageology (X-ray or computed tomography) to scan the human body; a process that may help orthoses manufacturing but which induces radiation to the patient. To overcome this great disadvantage, several types of 3D scanners, without any kind of radiation, have emerged. This article describes the use of various types of scanners capable of digitizing the human body to produce custom orthoses. Studies have shown that photogrammetry is the most used and most suitable 3D scanner for the acquisition of the human body in 3D. With this evolution of technology, it is possible to decrease the scanning time and it will be possible to introduce this technology into clinical environment.
Topics: Humans; Orthotic Devices; Tomography, X-Ray Computed; Technology; Fractures, Bone; Extremities
PubMed: 38474907
DOI: 10.3390/s24051373 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jan 2022Patients with hand trauma are usually examined in emergency departments of hospitals. Hand fractures are frequently observed in patients with hand trauma. Here, we aim...
BACKGROUND
Patients with hand trauma are usually examined in emergency departments of hospitals. Hand fractures are frequently observed in patients with hand trauma. Here, we aim to develop a computer-aided diagnosis (CAD) method to assist physicians in the diagnosis of hand fractures using deep learning methods.
METHODS
In this study, Convolutional Neural Networks (CNN) were used and the transfer learning method was applied. There were 275 fractured wrists, 257 fractured phalanx, and 270 normal hand radiographs in the raw dataset. CNN, a deep learning method, were used in this study. In order to increase the performance of the model, transfer learning was applied with the pre-trained VGG-16, GoogLeNet, and ResNet-50 networks.
RESULTS
The accuracy, sensitivity, specificity, and precision results in Group 1 (wrist fracture and normal hand) dataset were 93.3%, 96.8%, 90.3%, and 89.7%, respectively, with VGG-16, were 88.9%, 94.9%, 84.2%, and 82.4%, respectively, with Resnet-50, and were 88.1%, 90.6%, 85.9%, and 85.3%, respectively, with GoogLeNet. The accuracy, sensitivity, specificity, and precision results in Group 2 (phalanx fracture and normal hand) dataset were 84.0%, 84.1%, 83.8%, and 82.8%, respectively, with VGG-16, were 79.4%, 78.5%, 80.3%, and 79.7%, respectively, with Resnet-50, and were 81.7%, 81.3%, 82.1%, and 81.3%, respectively, with GoogLeNet.
CONCLUSION
We achieved promising results in this CAD method, which we developed by applying methods such as transfer learning, data augmentation, which are state-of-the-art practices in deep learning applications. This CAD method can assist physicians working in the emergency departments of small hospitals when interpreting hand radiographs, especially when it is difficult to reach qualified colleagues, such as night shifts and weekends.
Topics: Deep Learning; Fractures, Bone; Hand; Humans; Neural Networks, Computer; Radiography
PubMed: 35099027
DOI: 10.14744/tjtes.2020.06944 -
Archives of Orthopaedic and Trauma... May 2023Degloving of the sole of the foot is a rare and serious injury because the heel pad cannot be replaced by similar tissue. The management is challenging and only a few...
BACKGROUND
Degloving of the sole of the foot is a rare and serious injury because the heel pad cannot be replaced by similar tissue. The management is challenging and only a few cases have been reported with different treatment regimens.
METHODS
Here, we report on a 46-year-old female patient with complex foot trauma consisting of complete avulsion of the heel pad at the hindfoot and a soft tissue defect at the posterior aspect of the heel accompanied by rupture of the anterior tibial tendon and fractures of the talus, calcaneus and midfoot. The sole of the foot was fixed to the calcaneus with multiple temporary Kirschner wires and moist wound dressings. The anterior tibial tendon was sutured. The soft tissue defect at the posterior heel was treated with a free anterolateral thigh flap. The fractures were fixed in staged procedures.
RESULTS
At 2-year follow-up, the patient had a durable soft tissue cover over the heel with full sensation over the sole and a pliable flap over the posterior aspect of the heel. The patient was able to fully bear weight and was pain free during her daily activities in comfortable, custom shoes. All fractures had healed, the talar neck fracture after one revision and bone grafting. The foot was plantigrade and stable with preserved painless but limited range of motion at the ankle, subtalar and mid-tarsal joints.
CONCLUSION
The unique tissue at the sole of the foot can be salvaged even in cases of full degloving at the hindfoot with the simple method of anchorage with multiple temporary K-wires. Traumatic defects of the vulnerable skin at the posterior aspect of the heel requires durable coverage with free flap coverage. With staged treatment of all bone and soft tissue injuries, a favorable result can be obtained even in case of a complex foot trauma.
Topics: Humans; Female; Middle Aged; Heel; Free Tissue Flaps; Bone Wires; Fractures, Bone; Foot; Fracture Fixation, Internal; Foot Injuries; Ankle Injuries; Treatment Outcome
PubMed: 35467124
DOI: 10.1007/s00402-022-04439-9 -
Journal of Orthopaedic Surgery and... Jun 2021Academic trauma institutions rely on fracture databases as research and quality control tools. Frequently, these databases are populated by trainees, but the...
INTRODUCTION
Academic trauma institutions rely on fracture databases as research and quality control tools. Frequently, these databases are populated by trainees, but the completeness and accuracy of such databases has not yet been evaluated. The purpose of this study is to determine the capture rate of a resident-populated database in collecting extremity fractures and to determine the accuracy of assigned Orthopaedic Trauma Association (OTA) classifications.
MATERIALS AND METHODS
A retrospective study was performed at a level 1 trauma center of all adult patients who underwent treatment for extremity fractures after an emergency department or inpatient consultation. A 20% random sample was taken from these entries and compared to a resident-populated fracture database designed to capture the same patients. For all matching records containing a resident-assigned OTA classification, relevant imaging was blindly reviewed by a trauma fellowship-trained orthopedic attending surgeon for fracture pattern classification. Resident OTA classifications were compared to this gold standard to determine overall accuracy rate.
RESULTS
Three hundred eighteen (80%) out of 400 entries were captured by the resident-populated database. Two hundred thirty-one of these 318 entries contained an OTA classification. One hundred fifty-three (66%) of these 231 entries demonstrated concordance between resident and attending assigned OTA classifications. On subgroup analysis, 133 (70%) of the 190 lower extremity classifications were accurately identified as compared to just 20 (49%) of the 41 upper extremity classifications (p = 0.009). Seventy-nine (65%) of the 121 end segment fractures showed agreement versus 42 (67%) of the 63 diaphyseal injury patterns (p = 0.85). Accuracy of classification did not significantly vary by resident year of training (p = 0.142).
CONCLUSION
Trainee generated databases at academic institutions may be subject to incomplete data entry and inaccurate fracture classifications. Quality control measures should be instituted to ensure accuracy in such databases if efforts are invested with the expectation of useful information.
Topics: Academic Medical Centers; Databases, Factual; Extremities; Female; Fractures, Bone; Humans; Male; Orthopedic Surgeons; Quality Control; Registries; Retrospective Studies
PubMed: 34098974
DOI: 10.1186/s13018-021-02478-3 -
Journal of Bone and Mineral Research :... Jul 2018Our objective was to determine the associations of peripheral bone strength and microarchitecture with incident clinical and major osteoporotic fracture among older men...
Volumetric Bone Mineral Density and Failure Load of Distal Limbs Predict Incident Clinical Fracture Independent HR-pQCT BMD and Failure Load Predicts Incident Clinical Fracture of FRAX and Clinical Risk Factors Among Older Men.
Our objective was to determine the associations of peripheral bone strength and microarchitecture with incident clinical and major osteoporotic fracture among older men after adjusting for major clinical risk factors. We used a prospective cohort study design with data from 1794 men (mean age 84.4 years) in the Osteoporotic Fractures in Men (MrOS) study. Eligible men attended the year 14 visit, had high-resolution peripheral quantitative computed tomography (HR-pQCT) scans of the distal radius and distal or diaphyseal tibia, DXA measured BMD, and were followed for mean 1.7 years for incident fracture. Failure load was estimated using finite element analysis. We used Cox proportional hazards models with standardized HR-pQCT parameters as exposure variables. Primary outcome was clinical fracture (n = 108). Covariates included either Fracture Risk Assessment Tool (FRAX) major osteoporotic fracture probability calculated with BMD (FRAX-BMD), or individual clinical risk factors (CRF) including age, total hip BMD, race, falls, and prevalent fracture after age 50 years. Lower failure load was associated with higher risk of incident clinical fracture and incident major osteoporotic fracture. For clinical fracture with FRAX-BMD adjustment, the associations ranged from hazard ratio (HR) 1.58 (95% CI, 1.25 to 2.01) to 2.06 (95% CI, 1.60 to 2.66) per SD lower failure load at the diaphyseal tibia and distal radius. These associations were attenuated after adjustment for individual CRFs, but remained significant at the distal sites. Associations of volumetric BMD with these outcomes were similar to those for failure load. At the distal radius, lower trabecular BMD, number, and thickness, and lower cortical BMD, thickness, and area were all associated with higher risk of clinical fracture, but cortical porosity was not. Among community-dwelling older men, HR-pQCT measures including failure load, volumetric BMD, and microstructure parameters at peripheral sites (particularly distal radius) are robust independent predictors of clinical and major osteoporotic fracture. © 2018 American Society for Bone and Mineral Research.
Topics: Aged; Aged, 80 and over; Bone Density; Extremities; Fractures, Bone; Hip; Humans; Male; Osteoporotic Fractures; ROC Curve; Risk Assessment; Risk Factors; Tibia; Tomography, X-Ray Computed; Weight-Bearing
PubMed: 29624722
DOI: 10.1002/jbmr.3433 -
Journal of Physiotherapy Oct 2017What is the effect of exercise on increasing participation and activity levels and reducing impairment in the rehabilitation of people with upper limb fractures?
QUESTION
What is the effect of exercise on increasing participation and activity levels and reducing impairment in the rehabilitation of people with upper limb fractures?
DESIGN
Systematic review of controlled trials.
PARTICIPANTS
Adults following an upper limb fracture.
INTERVENTION
Any exercise therapy program, including trials where exercise was delivered to both groups provided that the groups received different amounts of exercise.
OUTCOME MEASURES
Impairments of body structure and function, activity limitations and participation restrictions.
RESULTS
Twenty-two trials were identified that evaluated 1299 participants with an upper limb fracture. There was insufficient evidence from 13 trials to support or refute the effectiveness of home exercise therapy compared with therapist-supervised exercise or therapy that included exercise following distal radius or proximal humeral fractures. There was insufficient evidence from three trials to support or refute the effectiveness of exercise therapy compared with advice/no exercise intervention following distal radius fracture. There was moderate evidence from five trials (one examining distal radius fracture, one radial head fracture, and three proximal humeral fracture) to support commencing exercise early and reducing immobilisation in improving activity during upper limb rehabilitation compared with delayed exercise and mobilisation. There was preliminary evidence from one trial that exercise to the non-injured arm during immobilisation might lead to short-term benefits on increasing grip strength and range of movement following distal radius fracture. Less than 40% of included trials reported adequate exercise program descriptions to allow replication according to the TIDieR checklist.
CONCLUSION
There is emerging evidence that current prescribed exercise regimens may not be effective in reducing impairments and improving activity following an upper limb fracture. Starting exercise early combined with a shorter immobilisation period is more effective than starting exercise after a longer immobilisation period.
REGISTRATION
CRD42016041818. [Bruder AM, Shields N, Dodd KJ, Taylor NF (2017) Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review. Journal of Physiotherapy 63: 205-220].
Topics: Exercise Therapy; Fractures, Bone; Humans; Treatment Outcome; Upper Extremity
PubMed: 28941967
DOI: 10.1016/j.jphys.2017.08.009 -
American Family Physician Dec 2003Fractures of the toe are one of the most common lower extremity fractures diagnosed by family physicians. Toe fractures most frequently are caused by a crushing injury... (Review)
Review
Fractures of the toe are one of the most common lower extremity fractures diagnosed by family physicians. Toe fractures most frequently are caused by a crushing injury or axial force such as stubbing a toe. Joint hyperextension and stress fractures are less common. Most patients have point tenderness at the fracture site or pain with gentle axial loading of the digit. Anteroposterior and oblique radiographs generally are most useful for identifying fractures, determining displacement, and evaluating adjacent phalanges and digits. Referral is indicated in patients with circulatory compromise, open fractures, significant soft tissue injury, fracture-dislocations, displaced intra-articular fractures, or fractures of the first toe that are unstable or involve more than 25 percent of the joint surface. Most children with fractures of the physis should be referred, but children with selected nondisplaced Salter-Harris types I and II fractures may be treated by family physicians. Stable, nondisplaced toe fractures should be treated with buddy taping and a rigid-sole shoe to limit joint movement. Displaced fractures of the lesser toes should be treated with reduction and buddy taping. Patients with displaced fractures of the first toe often require referral for stabilization of the reduction.
Topics: Fracture Fixation; Fractures, Bone; Humans; Toes
PubMed: 14705761
DOI: No ID Found -
Journal of Musculoskeletal & Neuronal... Jun 2020Forward falls are among the most frequent causes of upper extremity fractures. This study investigated the safety considerations to prevent wrist injuries during...
OBJECTIVE
Forward falls are among the most frequent causes of upper extremity fractures. This study investigated the safety considerations to prevent wrist injuries during bimanual forward falls.
METHODS
A biomechanical model was developed with two separated arms to facilitate investigation of asymmetrical contact and predict the impact force applied to each hand separately. To validate the developed model, a series of fall experiments were conducted in which one hand collided with a hard surface, while the other collided with a soft surface.
RESULTS
The results show that the impact force applied to each hand is independent of the other. Using these results and our model, the safety aspects of human forward falls were analyzed with a view to preventing injuries. Specifically, we sought to determine the safe range of surface stiffness and damping to ensure that the occurrence of forward falls does not lead to trauma.
CONCLUSION
The results of this study can be applied in the design of compliant flooring to ensure the safety of people in environments with potential fall hazards. From a robotics viewpoint, the results are applicable in the design of compliant flooring for shared workplaces, where robots collaborate with people and collisions between humans and robots may cause falls.
Topics: Accidental Falls; Adult; Arm; Biomechanical Phenomena; Floors and Floorcoverings; Fractures, Bone; Hardness; Humans; Male; Models, Theoretical; Young Adult
PubMed: 32481233
DOI: No ID Found -
Archives of Orthopaedic and Trauma... May 2022The aim of this study was to provide a more precise statement on the outcome after surgical treatment of a bony mallet thumb and possibly give a treatment recommendation... (Review)
Review
INTRODUCTION
The aim of this study was to provide a more precise statement on the outcome after surgical treatment of a bony mallet thumb and possibly give a treatment recommendation regarding the surgical fixation method.
PATIENTS AND METHODS
All patients (n = 16) who underwent a surgical treatment for an acute bony mallet thumb fracture between January 2006 and July 2019 were enrolled. The surgical method, complications, the range of motion, tip pinch, lateral key pinch, overall grip strength, visual analog score, Disability of the Arm, Shoulder and Hand Score, Mayo Wrist Score, Patient-Rated Wrist Evaluation Score, Buck-Gramcko Score and radiologic parameters were evaluated. Further, a comprehensive literature search on PubMed was conducted covering a period from 1956 to 2021 to include all possible matching articles on the treatment of the bony mallet thumb (n = 21 articles).
RESULTS
Surgical treatment was very inhomogenous including indirect and direct K-wire fixation, screw fixation, plate fixation and anchor fixation methods. The IP joint range of motion and thumb strength ranged from 66 to 94% in comparison to the contralateral side. An open reduction led to worse functional scores compared to a closed reduction. Treatment methods in the literature were also very inhomogenous with a very low patient count, often even pooling data of bony mallet thumb fractures with bony mallet finger fractures. The risk for infection was higher in K-wire fixation methods than in open reduction and internal fixation methods.
CONCLUSION
The evidence for the best treatment of a bony mallet thumb fracture is low. On one hand the functional outcome can be inferior using an open reduction approach, but on the other hand, K-wire fixation methods with a closed reduction approach showed a higher risk for infection. Future multi-center research must be conducted to find the best treatment procedure for the best outcome of the patient.
Topics: Bone Plates; Bone Wires; Finger Injuries; Fracture Fixation, Internal; Fractures, Bone; Humans; Range of Motion, Articular; Tendon Injuries; Thumb; Treatment Outcome; Wrist Injuries
PubMed: 35032189
DOI: 10.1007/s00402-021-04333-w -
BMC Research Notes Mar 2020Wrist deformity in older people is common following treatment for a wrist fracture, particularly after non-surgical treatment. A cohort of older wrist fracture patients...
OBJECTIVE
Wrist deformity in older people is common following treatment for a wrist fracture, particularly after non-surgical treatment. A cohort of older wrist fracture patients were surveyed by telephone regarding perceived deformity, bother with deformity and patient-reported wrist function. The objectives were to: (1) determine whether older patients with wrist fractures perceived a deformity of their wrist and if they were bothered by it; (2) test if there were associations between deformity and treatment-type and between deformity and function; (3) test for associations between bother and treatment-type and between bother and function; (4) measure the test-retest reliability of the 'bother' question.
RESULTS
Of 98 eligible patients who were invited to participate, 41 responded. Out of 41, 14 (34%) believed they had a deformity and 4 (10%) reported that they were bothered by the appearance of their wrist. Deformity was associated with non-surgical treatment (RR = 3.85, p = 0.006) but was not significantly associated with functional outcomes (p = 0.15). All those who were bothered belonged to the non-surgical treatment group. Bother was significantly associated with poorer functional outcomes (p = 0.006) and this association was clinically significant (MD = 35 points). The deformity and bother questions were found to have excellent test-retest reliability; κ = 1.00 and κ = 0.92, respectively.
Topics: Aged; Aged, 80 and over; Aging; Female; Fractures, Bone; Hand Deformities, Acquired; Humans; Joint Deformities, Acquired; Male; Wrist; Wrist Injuries
PubMed: 32197641
DOI: 10.1186/s13104-020-05013-5