The automized fracture edge detection and generation of three-dimensional fracture probability heat maps.

With proven impact of statistical fracture analysis on fracture classifications, it is desirable to minimize the manual work and to maximize repeatability of this approach. We address this with an algorithm that reduces the manual effort to segmentation, fragment identification and reduction. The fracture edge detection and heat map generation are performed automatically. With the same input, the algorithm always delivers the same output. The tool transforms one intact template consecutively onto each fractured specimen by linear least square optimization, detects the fragment edges in the template and then superimposes them to generate a fracture probability heat map. We hypothesized that the algorithm runs faster than the manual evaluation and with low (< 5 mm) deviation. We tested the hypothesis in 10 fractured proximal humeri and found that it performs with good accuracy (2.5 mm ± 2.4 mm averaged Euclidean distance) and speed (23 times faster). When applied to a distal humerus, a tibia plateau, and a scaphoid fracture, the run times were low (1-2 min), and the detected edges correct by visual judgement. In the geometrically complex acetabulum, at a run time of 78 min some outliers were considered acceptable. An automatically generated fracture probability heat map based on 50 proximal humerus fractures matches the areas of high risk of fracture reported in medical literature. Such automation of the fracture analysis method is advantageous and could be extended to reduce the manual effort even further.

Fractures in Parkinson's Disease: injury patterns, hospitalization, and therapeutic aspects.

AIM: The primary aim of this study was to analyze the frequency and characteristic patterns of fall-related fractures as well as consecutive hospitalization and management relating to such fractures. In addition, important pathognomonic and therapeutic aspects are discussed. METHODS: This retrospective mono-center study was conducted at the University Hospital Frankfurt am Main, Germany. Between 2007 and 2017, a total of 145 PD patients with fall-related fractures were identified via a retrospective systematic query in the hospital information system using the ICD-10 German modification codes G20.0-G20.9. Patients with unclear or falsely coded PD were strictly excluded. RESULTS: The mean age of the cohort was 77.7 years (± 7.5, median 77.) and 57.9% of the cohort were females (n = 84). A total number of 151 fractures were reported, with 140 patients (96.6%) suffering from one, four patients from two (2.8%), and one patient from three fractures (0.6%) at a time. For 43.9% (n = 65) of the cohort, fractures concerned lower extremities (LE) followed by trunk (38.1%, n = 58) and upper extremities (UE, 17.9%, n = 27). Most common fracture types in LE were femoral neck fractures (52.3%, n = 34). Mean length of hospital stay (LOS) was 13.6 days (95% CI 12.4-14.7). In 43.4% (n = 63) of cases, an interim admission to an intensive-care unit (ICU) was necessary. Mean ICU LOS was 2.3 days (95% CI 1.5-3.0), and mean LOS for normal care unit was 10.5 days (95% CI 10.3-12.4). Surgical treatment was necessary in 75.9% of the cases (n = 110). Patients undergoing surgical treatment showed significantly longer LOS compared to conservatively treated patients (p < 0.001). Moreover, fractures of the LE (p = 0.018) and UE (p = 0.010) were associated with a significant longer LOS. CONCLUSION: Fall-related fractures are a common and relevant complication in PD patients leading to increased immobility, frequent hospitalization, and immediate surgical care. Fractures of the lower extremities and trunk were the most common in the cohort for this study. A PD patient presenting to the emergency room or at the general practitioner with a fracture should always be checked for osteoporosis and a fall-related injury should be seen as a red flag for reviewing a patient's individual therapeutic regime.

[Inpatient treatment costs, cost-driving factors and potential reimbursement problems due to fall-related fractures in patients with Parkinson's disease]. / Stationäre Versorgungskosten, kostenverursachende Faktoren und potenzielle Vergütungsprobleme bei durch Morbus Parkinson bedingten Frakturen.

BACKGROUND: In an increasingly economically oriented healthcare system the analysis of disease-specific costs is becoming more and more relevant, especially in chronic diseases with long duration of hospitalization. As a frequent neurodegenerative disease idiopathic Parkinson's disease (IPD) causes high healthcare costs. The pathognomonic affection of mobility and equilibrium often leads to fall-related fractures in the course of the disease, which cause further costs through hospitalization and possibly surgical treatment. OBJECTIVE: The aim of the study was the calculation of inpatient treatment costs of fall-related fractures in IPD as well as the analysis of relevant cost-causing factors. In addition, an alternative calculation of the treatment costs was carried out with the question of potential remuneration problems in the current diagnosis-related groups (DRG) system. METHODS: The basis of this retrospective, single center analysis was the actual revenue of 95 patients treated between January 2011 and January 2018 at the University Hospital Frankfurt am Main. The proceeds were systematically reviewed for relevant demographic, healthcare and disease-related aspects and statistically analyzed for cost-related factors using univariate analysis. The alternative calculation of the treatment costs was carried out according to commonly used health economics methods. RESULTS: The median revenue per patient and injury was 9295 € (±8038 €, median 7148 €) with a mean length of stay of 13.5 days (±7.2 days, median 13 days). The alternative calculation of treatment costs per patient was an average of 9789 € (±6423 €, median 8906 €). High treatment costs were associated with age >75 years (p = 0.028), surgical treatment (p = 0.004), intensive care unit (ICU) stay (p = 0.004), limb fractures (p = 0.028) and an advanced stage of IPD (p = 0.028). Significant differences between actual revenue and calculated costs were found for hospital stays ≥14 days (p = 0.009) and advanced stages of disease (p = 0.036). CONCLUSION: The costs of care in patients with IPD and fall-related fractures are high and relevant to health economics. In general, remuneration based on the DRG system seems to largely cover the costs; however, compensation problems arise especially for patients with a long duration of hospitalization or advanced IPD.

Methylene-bridged, intramolecular donor-acceptor systems based on rare-earth metals and phosphinomethanides.

New geminally bonded intramolecular donor-acceptor systems, Cp2LnCH2PR2 (Ln = Y, Ho, Er, R = CHMe2, CMe3), were prepared by salt elimination reactions between the dicyclopentadienyl-element chlorides (Cp2LnCl, Ln = Y, Ho, Er) and diorganylphosphinomethanides (R2PCH2Li; R = CHMe2, CMe3). These compounds, 1-6, were characterized by elemental analyses, mass spectrometry and X-ray diffraction experiments and the yttrium species additionally by NMR spectroscopy. In the solid state the molecular structures differ from each other, depending on the steric demand of the phosphorus substituents. For all iso-Pr-substituted compounds, dimers [Cp2LnCH2P(CHMe2)2]2 with six-membered Ln-C-P-Ln-C-P rings in a chair-like conformation were observed. The sterically more demanding tert-butyl groups prevent dimerization but instead lead to species that undergo complexation of LiCl units by two monomers: [Cp2LnCH2P(CMe3)2·LiCl]. The solution NMR data for the yttrium compounds are consistent with the solid-state structures. Conversion with phenylacetylene afforded heteroleptic cyclobutane-like alkynyl-rare-earth metal complexes [Cp2Ln(µ-C[triple bond, length as m-dash]CPh)]2 [Ln = Y (7), Ho (8), Er (9)]. Treatment of compounds 1-6 with 1,8-diethynylanthracene led to single metalation and dimerization and products with similar structural motifs as observed for complexes 7-9. Reactions with dihydrogen and carbon dioxide resulted in Y-C bond breaking, yielding Cp2YH/R2PCH3 and CO2 insertion products, respectively.

A Neutral Silicon/Phosphorus Frustrated Lewis Pair.

Frustrated Lewis pairs (FLPs) have a great potential for activation of small molecules. Most known FLP systems are based on boron or aluminum atoms as acid functions, few on zinc, and only two on boron-isoelectronic silicenium cation systems. The first FLP system based on a neutral silane, (C2F5)3SiCH2P(tBu)2 (1), was prepared from (C2F5)3SiCl with C2F5 groups of very high electronegativity and LiCH2P(tBu)2. 1 is capable of cleaving hydrogen, and adds CO2 and SO2. Hydrogen splitting was confirmed by H/D scrambling reactions. The structures of 1, its CO2 and SO2 adducts, and a decomposition product with CO2 were elucidated by X-ray diffraction.