Vertebral bone quality score as a new tool for osteoporosis diagnosis in patients undergoing lumbosacral fusion surgery: a single center cohort study.

Osteoporosis, a common bone disorder, increases fracture and spinal surgery complications risk. This study evaluates the potential of the Magnetic Resonance Imaging (MRI)-based Vertebral Bone Quality (VBQ) score as an alternative for assessing bone density in lumbosacral fusion surgery patients. In a prospective cohort study from April 2021 to November 2022, 134 patients with lumbar degenerative diseases underwent lumbar Dual-Energy X-ray Absorptiometry (DXA) and lumbosacral non-contrast T1-weighted MRI. VBQ scores were calculated and analyzed using IBM SPSS Statistics and MedCalc software. Osteopenia/Osteoporosis patients exhibited significantly higher VBQ scores than normal bone mineral density patients (3.37 ± 0.51 vs. 2.99 ± 0.44, P<0.001). VBQ correlated significantly with lumbar DXA T scores (r value= -0.415, p<0.001). Receiver Operating Characteristic (ROC) analysis showed VBQ AUC values of 0.730 (CI 95% 0.647-0.803, P<0.001) and 0.839 (CI 95% 0.765-0.897, P<0.001) for Osteopenia/Osteoporosis and osteoporosis diagnosis, respectively. The study suggests MRI-derived VBQ scores may benefit pre-lumbosacral fusion surgery bone density assessment, potentially improving patient care and aiding osteoporosis detection in spinal surgery candidates.

Management strategies for neglected simultaneous bilateral femoral neck fractures: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Simultaneous bilateral femoral neck fractures are rare and challenging, often occurring due to high-energy trauma in younger adults or low-energy trauma compounded by metabolic issues in elderly populations. Neglected cases, particularly in the context of narcotic addiction and limited access to healthcare, present unique management dilemmas. This study aims to contribute insights into the clinical presentation, management strategies, and outcomes of two neglected simultaneous bilateral femoral neck fractures. CASE PRESENTATION: We present two cases: a 65-year-old woman and a 45-year-old man, both with a history of narcotic addiction, who presented with neglected simultaneous bilateral femoral neck fractures. Both cases demonstrated significant pain and functional impairment necessitating surgical intervention. CLINICAL DISCUSSION: Treatment involved one-stage bilateral hip hemiarthroplasty, which successfully restored function without postoperative complications during follow-up periods of 14 and 16 months. Discussion includes the challenges of diagnosing and managing neglected fractures in vulnerable populations, emphasizing the importance of early recognition and tailored surgical approaches. CONCLUSION: Our study suggests the efficacy of one-stage bilateral hip hemiarthroplasty in managing neglected simultaneous bilateral femoral neck fractures due to narcotic addiction. However, variability in outcomes across different surgical techniques highlights the need for individualized treatment plans based on patient-specific factors.

Designing, implementing, and evaluating a basic surgical skills bootcamp: An effective approach to enhance competency in surgical residency training.

INTRODUCTION: Recent technological advances have facilitated the development of new educational methods, such as simulation-based learning, in specialized bootcamps to enhance the learning of surgical residents. This study aimed to design, implement, and evaluate a basic surgical skills bootcamp for residents in general surgery, orthopedics, neurosurgery, and gynecology based on the learning gap in the current educational program. METHODS: This intervention study focused on the design, implementation, and evaluation of a basic surgical skills bootcamp in a simulated operating room for first-year surgical residents in general surgery, orthopedics, neurosurgery, and gynecology. RESULTS: The study resulted in the creation of a comprehensive course plan and the execution of a 6-day training program. Evaluation of educational outcomes confirmed high learner satisfaction, improvement in Multiple Choice Questions (MCQ) exam scores, and acceptable scores in the Objective Structured Clinical Examination (OSCE). CONCLUSION: The findings of this study suggest that surgical bootcamps, when designed based on needs assessment and in line with scientific bootcamp design principles, play a crucial role in enhancing the satisfaction, knowledge, and skills of surgical residents.

External iliac artery thrombosis as a result of acetabular fixation through the ilioinguinal approach: a case report.

Introduction and importance: Acetabular fractures mostly occur in young people who are involved in high-energy trauma and they are treated by orthopedic trauma surgeons. Patients with acetabular fractures are at high risk for different kinds of complications. We report a case of postoperative thrombosis of the external iliac artery following fixation surgery performed by an ilioinguinal approach while receiving thromboprophylaxis during admission to the hospital. Case presentation: A 57-year-old healthy woman presented with a left both-column acetabular fracture and underwent acetabular fixation through the ilioinguinal approach. The patient was receiving antithrombotic prophylaxis medications in the course of treatment. Clinical discussion: During her convalescence, while at the hospital, she was diagnosed with left external iliac artery thrombosis, needing surgical thrombectomy. These severe and rare complications will lead to uncertainty about a commonly used ilioinguinal approach. Postoperative arterial thrombosis may be rare in patients undergoing acetabular fixation surgery but searching for signs and symptoms of this condition is always necessary. Conclusion: It is possible to prevent severe complications by performing a routine measurement of the distal arterial pressure after similar surgeries.

Platelet-rich plasma versus corticosteroid: a randomized controlled trial on tennis elbow patients resistant to nonsurgical treatments.

Background: Although some studies on tennis elbow indicate corticosteroid (CS) effectiveness in the short term, according to the role of race, this study evaluates the efficacy of platelet-rich plasma (PRP) compared with CS for a more cost-effective treatment. Methods: This randomized controlled trial included 30 positive-resisted wrist extension patients with a minimum five visual analog scale (VAS) pain score. Participants were randomly assigned to treatment or control groups via computer-generated randomization and were matched for baseline and clinical characteristics. Cases received either 40 mg of prednisolone acetate or 2 ml of PRP, followed for 1 month. VAS and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were the primary outcomes. Results: The median VAS and the mean DASH scores had a statistically significant difference in the PRP and CS groups before and after injection (P<0.001).The mean DASH difference between preinjection and follow-up time in the PRP and CS groups was 59.72±14.17 and 43.16±10.87, respectively, with a mean difference of 16.55 (95% CI 7.10-26.00) and a significant difference (P=0.001).The mean VAS pain score difference in preinjection and follow-up time had a statistically significant difference between the PRP and CS groups (P=0.026), and the mean VAS pain score difference in the CS group was 6.46±1.50 and 7.73±0.96 in the PRP group. Conclusion: In conclusion, larger studies with parallel groups and more diverse CS doses and types with baseline matching are needed to confirm the short-term benefits of PRP. Investigating the effects of different CS doses using ultrasound techniques is recommended.

Cortical bridging a union predictor: A prospective study after intramedullary nailing of the femoral shaft fractures.

Early prediction of the union helps for timely intervention, reduction of hospitalization, treatment costs, and disability in cases of nonunion. With this in mind, we tried to find how long any cortical bridging predicts the union in femoral shaft fractures. A prospective study of 113 femoral shaft fractures treated with reamed, locked intramedullary nailing was performed. Radiographs were taken during months 2 to 4, 6, 9, and one-year follow-up. The cortical bridging (presence and number) was assessed by anterior-posterior and lateral views. The ROC curve provides the prediction of the union. The overall nonunion rate was 10.6% (12 of 113 fractures). Age and diabetes mellitus were statistically significant with nonunion (p value < 0.001). The final analysis demonstrated that any cortical bridging at four months postoperatively was the most accurate and earlier indicator (105 of 113, 92.9% accuracy), while it was 84.9% at six months in bicortical and 80.5% accuracy at nine months in tricortical bridging. Low-cost and simple radiographic imaging presents cortical bridging in any form 4 months after surgery that precisely predicts a union in femoral shaft fractures.

Intraosseous Lipoma of Calcaneus, Rare Cause of Chronic Calcaneal Pain: A Case Report.

Intraosseous lipoma is a rare, benign primary tumor occurring in the bone. Herein, we reported a 45-year-old man with chronic right posterior heel pain. In this study, the man was treated conservatively due to plantar fasciitis. During a one-month follow-up visit, the patient had no symptoms of relief in the right heel pain. Initially, calcaneal X-ray was taken, which revealed an expansile unicameral lytic lesion with central calcification on the right calcaneus. Moreover, computed tomography scan revealed an expansile lytic lesion on the right calcaneus. The diagnosis was confirmed as calcaneal lipoma in magnetic resonance imaging. The patient underwent curettage and autogenous iliac crest corticocancellous bone graft under general anesthesia. In a 3-month postoperative follow-up, the patient returned to full ambulation. Postoperative radiographs demonstrated continued remodeling and healing of the graft site. The purpose of this article was to increase awareness among clinicians about the existence of this rare cause of calcaneal pain.

Diagnostic investigations of PLA2G16 and CDH11 expression levels as independent prognostic markers of human osteosarcoma.

INTRODUCTION: The aim of this study was to facilitate and deepen the understanding of the associations of the clinical significance of PLA2G16 and CDH11 in patients with osteosarcoma. MATERIAL AND METHODS: We collected 50 paired osteosarcoma tissues and adjacent normal bone tissues and evaluated the expression of PLA2G16 and CDH11 by quantitavise reverse transcriptase real-time polymerase chain reaction. RESULTS: PLA2G16 expression was upregulated in osteosarcoma tissues when compared with adjacent normal bone tissues, and the difference was statistically significant (4.78 ±0.70 vs. 1.31 ±0.65; p < 0.05). Our data indicated that high expression of PLA2G16 was significantly related to advanced TNM stage and metastasis or recurrence (p < 0.05). The expression level of CDH11 was lower in osteosarcoma tissues (median relative expression level ± SD: 6.29 ±1.43) than adjacent normal bone tissues (mean ± SD: 13.72 ±3.08, p < 0.05). Our findings demonstrated that decreased expression of CDH11 was strongly linked to advanced TNM stage, and metastasis or recurrence (p < 0.05). Log-rank analysis showed that patients with high expression of PLA2G16 have shorter overall survival than those with low expression. Moreover, shorter overall survival was significantly correlated with decreased expression of CDH11. Multivariate Cox proportional hazards analysis showed that PLA2G16 (p = 0.028; HR = 2.621; 95% CI) and CDH11 (p = 0.023; HR = 2.81; 95% CI) expression and also metastasis or recurrence (p = 0.03; HR = 2.531; 95% CI) were independent prognostic factors for poor overall survival of osteosarcoma patients. CONCLUSIONS: These findings suggest that PLA2G16 and CDH11 expression can be independent prognostic factors for poor overall survival of patients with osteosarcoma.

Diagnostic Efficacy of UBI Scan in Musculoskeletal Infections.

BACKGROUND: Limited recent studies have demonstrated that 99mTc-UBI scan can be a helpful method in precise diagnosis of infection. In the current study, we aimed to investigate the diagnostic efficacy of 99mTc-UBI scan in detection of musculoskeletal infections. METHODS: Fifty patients with suspected musculoskeletal infections (painful THA, TKA, implant and nonunion) were enrolled in this study. After injection of 99mTc-Ubiquicidin 29-41, up to 30 minutes, dynamic imaging was performed every 1 minute. Whole body anterior and posterior images were acquired at 60 and 120 min (5 min/frame). A polygonal region of interest (ROI) was drawn manually around the area of increased accumulation of tracer (lesion) and anatomically similar area on the contralateral side (background) and the lesion to background ratio (LBR) was calculated. Then, patients underwent surgical procedures to assess infection by tissue sampling and histopathologic studies as gold standard. The receiver operating characteristics (ROC) analysis was performed to find a cut-off value for LBR and determining the diagnostic efficacy of UBI scan in musculoskeletal infections. RESULTS: Histopathologic studies revealed infection in 38 patients. The mean LBR was significantly higher in infected patients (2.05 ± 0.41 vs. 1.52 ± 0.22; P < 0.001). ROC analysis showed that a cut-off point of 1.74 for LBR will have 94.7% sensitivity, 83.3% specificity and 92% accuracy for diagnosis of musculoskeletal infections. CONCLUSION: UBI scan is a useful diagnostic tool for evaluation of patients with suspected musculoskeletal infection. However, UBI imaging has some limitations which result in some incorrect diagnoses. It is important to interpret the results of the scan with regard to the clinical findings.