The effect of teriparatide on fracture healing after atypical femoral fracture: A systematic review and meta-analysis.

This meta-analysis demonstrated that a greater prevalence of delayed union and nonunion and a longer time to fracture healing in the group that did not receive TPTD treatment after AFFs than in the group that received TPTD treatment. PURPOSE: To date, there is no hard evidence for medical management after atypical femoral fracture (AFF), even though weak data indicate faster healing with teriparatide (TPTD). Herein, we aimed to investigate the effect of postfracture TPTD treatment on AFF healing using a pairwise meta-analysis focusing on delayed union, nonunion, and fracture healing time. METHODS: A systematic search of the MEDLINE (PUBMED), Embase, and Cochrane Library databases was performed for studies investigating the effect of TPTD after AFF up to October 11, 2022. We compared the incidence of delayed union and nonunion and the time of fracture healing between the TPTD ( +) and TPTD (-) groups. RESULTS: The 6 studies analyzed a total of 214 AFF patients, including 93 who received TPTD therapy after AFF and 121 who did not. The pooled analysis showed a significantly higher rate of delayed union in the TPTD (-) group than in the TPTD ( +) group (OR, 0.24; 95% CI, 0.11-0.52; P < 0.01; I2 = 0%), and a higher nonunion rate was observed in the TPTD (-) group than in the TPTD ( +) group with low heterogeneity (OR, 0.21; 95% CI, 0.06-0.78; P = 0.02; I2 = 0%). The TPTD (-) group required 1.69 months longer to achieve fracture union than the TPTD ( +) group, with statistical significance (MD = - 1.69, 95% CI: - 2.44 to - 0.95, P < 0.01; I2 = 13%). Subgroup analysis for patients with complete AFF showed that the TPTD (-) group had a higher rate of delayed union with low heterogeneity (OR, 0.22; 95% CI, 0.10-0.51; P < 0.01; I2 = 0%), but there was no significant difference in the nonunion rate between TPTD ( +) and TPTD (-) groups (OR, 0.35; 95% CI, 0.06-2.21; P = 0.25; I2 = 0%). Fracture healing took significantly longer in the TPTD (-) group (MD = - 1.81, 95% CI: - 2.55 to - 1.08; P < 0.01; I2 = 48%). The reoperation rate showed no significant difference between the two groups (OR, 0.29; 95% CI, 0.07-1.20; P = 0.09; I2 = 0%). CONCLUSIONS: The current meta-analysis supported the hypothesis that TPTD treatment following AFF might benefit fracture healing, lowering the rate of delayed union and nonunion and shortening the fracture healing time.

Ex Vivo Treatment with Allogenic Mesenchymal Stem Cells of a Healthy Donor on Peripheral Blood Mononuclear Cells of Patients with Severe Alopecia Areata: Targeting Dysregulated T Cells and the Acquisition of Immunotolerance.

Alopecia areata (AA) is an autoimmune condition related to the collapse of the immune privilege of hair follicles. Certain AA populations present severe clinical manifestations, such as total scalp hair or body hair loss and a treatment refractory property. The aim of this study was to assess the effects of allogenic human mesenchymal stem cells (hMSCs) from healthy donors on the peripheral blood mononuclear cells (PBMCs) of severe AA patients, with a focus on the change in the cell fraction of Th1, Th17, and Treg cells and immunomodulatory functions. PBMCs of 10 AA patients and eight healthy controls were collected. Levels of Th17, Th1, and Treg subsets were determined via flow cytometry at baseline, activation status, and after co-culturing with hMSCs. All participants were severe AA patients with SALT > 50 and with a long disease duration. While the baseline Th1 and Treg levels of AA patients were comparable to those of healthy controls, their Th17 levels were significantly lower than those of the controls. When stimulated, the levels of CD4+IFN-γ+ T cells of the AA patients rose sharply compared to the baseline, which was not the case in those of healthy controls. The cell fraction of CD4+Foxp3+ regulatory T cells also abruptly increased in AA patients only. Co-culturing with allogenic hMSCs in activated AA PBMCs slightly suppressed the activation levels of CD4+INF-γ+ T cells, whereas it significantly induced the differentiation of CD4+Foxp3+ regulatory T cells. However, these changes were not prominent in the PBMCs of health controls. To examine the pathomechanisms, PBMCs of healthy donors were treated with IFN-γ to induce AA-like environment and then treated with allogenic grants and compared with ruxolitinib as a positive treatment control. hMSC treatment was shown to significantly inhibit the mRNA levels of proinflammatory cytokines, such as IFN-γ, TNF-α, IL-1α, IL-2R, IL-15, and IL-18, and chemokines, such as CCR7 and CCR10, in IFN-treated PBMCs. Interestingly, hMSCs suppressed the activation of JAK/STAT signaling by IFN in PBMCs with an effect that was comparable to that of ruxolitinib. Furthermore, the hMSC treatment showed stronger efficacy in inducing Foxp3, IL-10, and TGF-ß mRNA transcription than ruxolitinib in IFN-treated PBMCs. This study suggests that allogenic hMSC treatments have therapeutic potential to induce immune tolerance and anti-inflammatory effects in severe AA patients.

No association between telomere length and osteonecrosis of the femoral head.

BACKGROUND: Telemore length (TL) shortening has been found in many diseases. However, clinical characteristics of TL shortening in osteonecrosis of the femoral head (ONFH) has not been investigated. Therefore, we studied whether TL changes have clinicopathological values in ONFH. METHODS: The TL in the synovial tissues of 36 ONFH and 127 control patients (femoral neck fracture) was examined by quantitative real-time PCR as relative length, Δ Ct value. In addition, the correlation between TL and clinical features of ONFH and controls was analyzed. RESULTS: The average TL in the femoral tissues was 1.46 ± 3.12 (standard deviation). The average TL in the ONFH and control tissues was 1.92 ± 4.11 and 1.34 ± 2.78, respectively, however, the difference was absent (p = 0.324). Furthermore, a shorter TL was tended to be associated with erythrocyte sedimentation rate (100% vs. 61.5%, p = 0.073); however, the association was not statistically significant. CONCLUSIONS: In this study, we demonstrated that there is no association between the TL and clinicopathologic characteristics of ONFH patients. However, further studies considering the genetic factors are needed to be performed.

Highly Cross-Linked Polyethylene in Total Hip Arthroplasty in Patients Younger Than 50 Years With Osteonecrosis of the Femoral Head: A Minimum of 10 Years of Follow-Up.

BACKGROUND: Polyethylene wear and subsequent periprosthetic osteolysis remain a major concern of total hip arthroplasty (THA) failure in young, active patients with osteonecrosis of the femoral head (ONFH). The literature is lacking regarding the long-term performance of highly cross-linked polyethylene (HXLPE) in these patients. The purpose of this study is to evaluate long-term results for cementless THA using metal-on-HXLPE bearing couplings in patients younger than 50 years with ONFH. METHODS: We retrospectively evaluated the clinical and radiographic results of a consecutive series of 85 THAs (in 67 patients) performed with HXLPE liners (Durasul) in patients younger than 50 years who had ONFH. All procedures were performed at a single institution by a single surgeon using the same type of implants. The minimum duration of follow-up was 10 years (mean, 13.5 years; range, 10-17.3 years). Wear was measured using computer software. Osteolysis was evaluated with the use of radiography and computed tomography. RESULTS: The mean Harris hip score was 49.3 points (range, 26-68 points) before surgery, which improved to 93.6 points (range, 87-98 points) after surgery. Neither femoral nor acetabular components displayed mechanical loosening, and no components had been revised by the final follow-up evaluation. Radiographs and computed tomography scans did not demonstrate osteolysis. The mean liner wear was 0.037 mm/y (range, 0-0.099 mm/y). With the data available, univariate regression analysis did not demonstrate that age, sex, weight, activity level, underlying cause of osteonecrosis, liner thickness, or cup inclination had any influence on liner penetration. CONCLUSION: Although the long-term effects of HXLPE particles remain unknown, the implant survivorship rate and wear rate in our study are promising and support the continued use of metal-on-HXLPE bearing couplings in these high-risk patients because they do not produce any of the issues associated with hard-on-hard couplings. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Clinical Characteristics of Mitochondrial DNA Copy Number in Osteonecrosis of the Femoral Head.

Background and objectives: Alterations in mitochondrial DNA (mtDNA) have been observed and studied in various diseases. However, the clinical value of the mtDNA copy number (mtDNA-CN) alterations in osteonecrosis of the femoral head (ONFH) is poorly understood. In the present study, we investigated whether alterations in mtDNA-CNs are associated with clinicopathological parameters in ONFH. Materials and methods: MtDNA-CNs in the synovial tissue of 34 patients with ONFH and 123 control tissues (femoral neck fracture) were measured using quantitative real-time PCR. The present study then analyzed the correlation between the mtDNA-CN and the clinicopathological characteristics of ONFH and fracture patients. Results: The average mtDNA-CN (mean ± standard deviation) was 23.82 ± 22.37 and 25.04 ± 24.27 in ONFH and control tissues, respectively, and was not significantly different between the groups (p = 0.792). The mtDNA-CN was positively associated with age (27.7% vs. 45.9%, p = 0.018) and negatively associated with the erythrocyte sedimentation rate (ESR) (11.8% vs. 39.7%, p = 0.024) in all of the samples. The study also found further associations with age (22.2% vs. 68.8%, p = 0.014), gender (30.0% vs. 64.3%, p = 0.048), and ESR (0% vs. 57.7%, p = 0.043) in ONFH. Conclusions: in this study, we demonstrated that mtDNA-CN might be a significant marker for predicting clinical characteristics in ONFH.

Correction to: Spontaneous and repeat spontaneous abortion risk in relation to occupational characteristics among working Korean women: a cross-sectional analysis of nationally representative data from Korea.

It was highlighted that the original article [1] contained a mismatch between the result section of the abstract and Table 2. This Correction article shows the incorrect and correct result section of this article's Abstract.

Spontaneous and repeat spontaneous abortion risk in relation to occupational characteristics among working Korean women: a cross-sectional analysis of nationally representative data from Korea.

BACKGROUND: The association between spontaneous abortion (SA) and occupational characteristics among working women is not well-studied. This study aimed to assess the risk of SA and occupational factors such as occupational classification, working hours, and work schedules among working Korean women aged > 19 years. METHODS: In this cross-sectional study, 4078 working women were identified from among 25,534 workers in the Korea National Health and Nutrition Examination Surveys V (2010-2012) database, to obtain data on SA history and the number of SAs. Odds ratios (ORs) and 95% confidence intervals (CIs) for SA were calculated using multiple logistic regression models after adjusting for age, education, household income, cigarette smoking, alcohol consumption, and obesity status. The weighted prevalence for the number of SAs was calculated according to occupational characteristics to demonstrate the SA status among working Korean women. RESULTS: SA occurrence was reported in 5.7% of the study participants. The ORs (95% CIs) for SA were significantly higher in pink-, green-, and blue-collared workers than in white-collared workers. Regarding weekly working hours, compared with ≤50 h spent working, the ORs (95% CIs) for 51-60, 61-70, and > 70 h per week were 1.26 (0.87-1.84), 1.63 (1.04-2.56), and 1.73 (1.10-2.70), respectively. A significantly higher weighted prevalence of repeat SAs was observed in pink- and green-collared workers and in those who worked long hours. CONCLUSION: We found a significant association between SA, repeat SA, and occupational characteristics among working Korean women.

Periprosthetic femoral fracture as cause of early revision after short stem hip arthroplasty-a multicentric analysis.

BACKGROUND: The objective of this study was to analyze the prevalence and causes of early re-operation after hip replacement surgery using short bone-preserving stems in a large multicentre series. Specifically, we evaluated the clinical features of periprosthetic fractures occurring around short stems. METHODS: A total of 897 patients (1089 hips) who underwent primary total hip arthroplasty or bipolar hemiarthroplasty from January 2011 to February 2015 using short bone-preserving femoral stems were recruited. Mean patient age was 57.4 years (range, 18-97 years), with a male ratio of 49.7% (541/1089). Re-operation for any reason within two years was used as an endpoint. The incidence and clinical characteristics of the periprosthetic femoral fractures were also recorded. Mean follow-up period was 5.1 years (range, 2-7.9 years). RESULTS: Early re-operation for any reason was identified in 16 (1.5%) of 1089 hips. The main reason for re-operation was periprosthetic femoral fracture, which accounted for eight (50%) of the 16 re-operations. The overall incidence of periprosthetic femoral fracture at two years was 1.1% (12/1089). According to the Vancouver classification, two fractures were AG type and the other ten were B1 type. Advanced age, higher American Society of Anesthesiologist grade, femur morphology of Dorr type C, and the use of a calcar-loading stem increased the risk for periprosthetic femoral fracture. CONCLUSION: Periprosthetic femoral fracture was the major reason for re-operation after hip replacement surgery using short bone-preserving stems accounting for 50% (8/16) of re-operations two years post-operatively, but did not seem to deteriorate survivorship of implanted prostheses.

Outcomes are equivalent for two-column acetabular fractures either with or without posterior-wall fractures.

INTRODUCTION: It is likely that posterior-wall involvement in association with two-column fractures plays a pivotal role in outcomes because of the potential for hip instability if it is not anatomically reduced and fixed. Uncertainty remains about how this fracture is best treated, especially regarding how posterior-wall involvement may affect functional results. MATERIALS AND METHODS: To better understand the role that posterior-wall involvement may play in determining functional results, we compared data for outcomes for patients with posterior-wall involvement and for those without in a consecutive series of two-column fractures. Between 2000 and 2013, 42 patients who underwent surgical treatment for two-column acetabular fractures were evaluated after a minimum follow-up period of 1 year. Data were prospectively collected and retrospectively evaluated. Of the 42 patients, 25 had only a two-column fracture (group 1) and 17 had a two-column fracture with posterior-wall involvement (group 2). RESULTS: There were no differences between groups in terms of reduction accuracy, radiographic results, clinical results, or complication rates. All hips in patients with internal fixation for the associated posterior-wall fracture had anatomical reduction. At the latest follow-up evaluation, three patients from group 1 (without posterior-wall involvement) and three patients from group 2 (with posterior-wall involvement) had undergone total hip arthroplasty. CONCLUSION: These results suggest that a posterior-wall fracture in a two-column fracture does not compromise functional outcomes when the treatment algorithm discussed here is followed.

Efficient Depth Enhancement Using a Combination of Color and Depth Information.

Studies on depth images containing three-dimensional information have been performed for many practical applications. However, the depth images acquired from depth sensors have inherent problems, such as missing values and noisy boundaries. These problems significantly affect the performance of applications that use a depth image as their input. This paper describes a depth enhancement algorithm based on a combination of color and depth information. To fill depth holes and recover object shapes, asynchronous cellular automata with neighborhood distance maps are used. Image segmentation and a weighted linear combination of spatial filtering algorithms are applied to extract object regions and fill disocclusion in the object regions. Experimental results on both real-world and public datasets show that the proposed method enhances the quality of the depth image with low computational complexity, outperforming conventional methods on a number of metrics. Furthermore, to verify the performance of the proposed method, we present stereoscopic images generated by the enhanced depth image to illustrate the improvement in quality.

High incidence of stem loosening in association with periprosthetic femur fractures in previously well-fixed cementless grit-blasted tapered-wedge stems.

PURPOSE: Periprosthetic femur fracture is a potentially worrisome phenomenon for cementless stem fixation. The aim of this study was to document the incidence of stem loosening following periprosthetic femur fracture in previously well-fixed cementless grit-blasted tapered-wedge stems. METHODS: We identified 36 periprosthetic femur fractures of either Vancouver B1 or B2 following hip arthroplasties using cementless grit-blasted tapered-wedge titanium stems at three participating institutions (GB group). The control group consisted of 21 periprosthetic femur fractures of either Vancouver B1 or B2 following hip arthroplasties using cementless proximal porous-coated stems at the same institutions during the same period of study (PC group). All femoral stems had been in a well-fixed state before occurrence of fracture. All patients were treated surgically and femoral stem stability was assessed using preoperative radiographs and confirmed by intraoperative scrutinization. RESULTS: Seven (19.4%) of 36 fractures were Vancouver B1 and 29 (80.6%) were Vancouver B2 in the GB group, whereas 18 (85.7%) of 21 fractures were Vancouver B1 and 3 (14.3%) were Vancouver B2 in the PC group (P < 0.0001). The odds ratio for stem loosening was 24.86 (95% CI, 5.69-108.63) in the GB group versus the PC group. CONCLUSIONS: Hip arthroplasty using cementless grit-blasted tapered-wedge titanium stems showed higher incidence of stem loosening in association with periprosthetic femur fracture than hip arthroplasty conducted using proximal porous-coated stems. A high index of suspicion of stem loosening might be necessary in periprosthetic femur fracture following hip arthroplasty using this type of stems.

Korean speech-language pathologists' attitudes toward stuttering according to clinical experiences.

BACKGROUND: Negative attitudes toward stuttering and people who stutter (PWS) are found in various groups of people in many regions. However the results of previous studies examining the influence of fluency coursework and clinical certification on the attitudes of speech-language pathologists (SLPs) toward PWS are equivocal. Furthermore, there have been few empirical studies on the attitudes of Korean SLPs toward stuttering. AIMS: To determine whether the attitudes of Korean SLPs and speech-language pathology students toward stuttering would be different according to the status of clinical certification, stuttering coursework completion and clinical practicum in stuttering. METHODS & PROCEDURES: Survey data from 37 certified Korean SLPs and 70 undergraduate students majoring in speech-language pathology were analysed. All the participants completed the modified Clinician Attitudes Toward Stuttering (CATS) Inventory. OUTCOMES & RESULTS: Results showed that the diagnosogenic view was still accepted by many participants. Significant differences were found in seven out of 46 CATS Inventory items according to the certification status. In addition significant differences were also found in three items and one item according to stuttering coursework completion and clinical practicum experience in stuttering, respectively. CONCLUSIONS & IMPLICATIONS: Clinical and educational experience appears to have mixed influences on SLPs' and students' attitudes toward stuttering. While SLPs and students may demonstrate more appropriate understanding and knowledge in certain areas of stuttering, they may feel difficulty in their clinical experience, possibly resulting in low self-efficacy.

Cement Filling Technique to Prevent Greater Trochanter Displacement in Hip Arthroplasty for Femoral Intertrochanteric Fracture: A Technical Note.

With the increasing use of primary hip arthroplasty for management of intertrochanteric fractures, firm fixation and union of the greater trochanteric (GT) fragment are required during hip arthroplasty for management of intertrochanteric fractures. Various methods have been suggested to address this issue. However, displacement of the GT is a frequent occurrence. We have introduced a cement-filling technique for performance of hip arthroplasty of the proximal femur for achievement of immediate firm fixation of the GT. Cement filling during performance of hip arthroplasty for management of femoral intertrochanteric fractures is a valuable technique for preventing displacement of the GT and to encourage early mobilization.

Solution-Processed Thick Hole-Transport Layer for Reliable Quantum-Dot Light-Emitting Diodes Based on an Alternatingly Doped Structure.

The operating lifetime of quantum-dot light-emitting diodes (QLED) is a bottleneck for commercial display applications. To enhance the operational stability of QLEDs, we developed a robust solution-processed highly conductive hole-transport-layer (HTL) structure, which enables a thick HTL structure to mitigate the electric field. An alternating doping strategy, which involves multiple alternating stacks of N4,N4'-di(naphthalen-1-yl)-N4,N4'-bis(4-vinylphenyl)biphenyl-4,4'-diamine and phosphomolybdic acid layers, could provide significantly improved conductivity; more specifically, the 90 nm-thick alternatingly doped HTL exhibited higher conductivity than the 45 nm-thick undoped HTL. Therefore, when applied to a QLED, the increase in the thickness of the alternatingly doped HTL increased device reliability. As a result, the lifetime of the QLED with a thick, alternatingly doped HTL was 48-fold higher than that of the QLED with a thin undoped HTL. This alternating doping strategy provides a new paradigm for increasing the stability of solution-based optoelectronic devices in addition to QLEDs.

The impact of depression and anxiety on self-assessed pain, disability, and quality of life in patients scheduled for rotator cuff repair.

BACKGROUND: Psychological status may be an important predictor of outcome and patient satisfaction after treatment for rotator cuff disease. Few prior studies have considered these factors. The objective of the study was to investigate the prevalence of psychological distress and its effect on self-assessed pain, disability, and health-related quality of life in patients scheduled for rotator cuff repair. MATERIALS AND METHODS: We assessed 107 consecutive patients preoperatively using the Hospital Anxiety and Depression Scale (HADS); visual analog scale pain score; American Shoulder and Elbow Surgeons (ASES) scale; Korean Shoulder Scale (KSS); and World Health Organization Quality of Life Scale, Abbreviated Version (WHOQOL-BREF). Preoperative demographic, clinical, and radiologic parameters were also evaluated. RESULTS: Of the patients, 28 (26.2%) had depression and 25 (23.4%) had anxiety. The HADS depression score was positively correlated with the visual analog scale pain score (P = .048) and negatively correlated with the ASES, KSS, and WHOQOL-BREF scores (P = .005, P = .004, and P < .0001, respectively). The HADS anxiety score was negatively correlated with the ASES, KSS, and WHOQOL-BREF scores (P = .034, P = .037, and P < .0001, respectively). On multivariate analysis with a linear regression model, the HADS depression score was an independent predictor of ASES, KSS, and WHOQOL-BREF scores (P = .02, P = .005, and P = .001, respectively). CONCLUSION: Depression and anxiety had a negative impact on self-assessed outcome measurements in patients scheduled for rotator cuff repair. Depression was a strong predictor of functional disability and health-related quality of life. Our results suggest that preoperative psychological status may influence postoperative outcome after rotator cuff repair and thus is an essential part of preoperative assessment.

Inflammatory cytokines are overexpressed in the subacromial bursa of frozen shoulder.

BACKGROUND: Frozen shoulder is a debilitating condition characterized by gradual loss of glenohumeral motion with chronic inflammation and capsular fibrosis. Yet its pathogenesis remains largely unknown. We hypothesized that the subacromial bursa may be responsible for the pathogenesis of frozen shoulder by producing inflammatory cytokines. MATERIALS AND METHODS: We obtained joint capsules and subacromial bursae from 14 patients with idiopathic frozen shoulder and from 7 control subjects to determine the expression levels of interleukin (IL) 1α, IL-1ß, IL-6, tumor necrosis factor α (TNF-α), cyclooxygenase (COX) 1, and COX-2 by real-time reverse transcriptase-polymerase chain reaction, immunohistochemistry, and enzyme-linked immunosorbent assay. RESULTS: IL-1α, IL-1ß, TNF-α, COX-1, and COX-2 were expressed at significantly high levels in the joint capsules of the frozen shoulder group compared with those of the control group. Intriguingly, IL-1α, TNF-α, and COX-2 were also expressed at significantly high levels in the subacromial bursae of the frozen shoulder group compared with those of the control group. Immunohistochemical analysis showed increased expression of COX-2 in both the joint capsules and subacromial bursae of the frozen shoulder group. CONCLUSIONS: These findings imply that elevated levels of inflammatory cytokines in the subacromial bursa may be associated with the pathogenesis of inflammation evolving into fibrosis.

Highly cross-linked polyethylene in total hip arthroplasty for osteonecrosis of the femoral head: a minimum 5-year follow-up study.

We evaluated 162 hips with osteonecrosis of the femoral head that had undergone THA using highly cross-linked polyethylene liner after a minimum follow-up of 5 years. Neither femoral nor acetabular components displayed radiographic evidence of mechanical loosening or osteolysis, and no components had been revised at the latest follow-up. The mean rate of linear liner wear was 0.038 mm/year. Univariate regression analysis did not demonstrate that age, gender, weight, activity level or cup inclination had any influence on penetration. While the long term effects of altered mechanical properties of highly cross-linked PE remain unknown, the clinical and radiographic results at a minimum of 5 years are promising for this high-risk population.

Who Hurt You at Work? Results From a Nationwide Survey of Association Between Absenteeism and Workplace Violence, Stratified by Perpetrator.

OBJECTIVE: This study aimed to determine the association between workplace violence and sickness absenteeism. METHODS: We analyzed the data from the fifth and sixth waves of the Korean Working Conditions Surveys. Individuals younger than 18 years and self-employed or unpaid family workers were excluded. Descriptive statistics, χ 2 tests, and multiple logistic regression analysis were conducted. RESULTS: After adjusting for sociodemographic, occupational, and job-related characteristics, we found that the workers who had experienced workplace violence had higher rates of sickness absenteeism, especially when the perpetrator of violence was a coworker. CONCLUSIONS: Daily contact with the perpetrator at the workplace can cause distress and recollection of painful memories; thus, the aftermath of being harassed inside the workplace can be even more devastating than the event itself. A sensitive approach to recognizing the perpetrators of violence is needed.

The Validation of Two-Dimensional and Three-Dimensional Radiographic Measurements of Host Bone Coverage in Total Hip Arthroplasty for Hip Dysplasia: A Comparison with Intra-Operative Measurements.

Several methods have been introduced to measure the host bone coverage of the acetabular component after total hip arthroplasty (THA). The aims of this study were (1) to validate two-dimensional- and three-dimensional-based host bone coverage measurements by comparing intra-operative measurements, and (2) to determine the minimum host bone coverage for achieving stable cup fixation after THA in hip dysplasia. The clinical outcomes of each patient were evaluated during their final follow-up period using the Harris Hip score (HHS). The coverage of the host bone was analyzed by comparing 2D-based, 3D-based, and intraoperative assessments. The mean HHS was increased significantly from 60.84 ± 14.21 pre-operatively to 93.13 ± 4.59 (p < 0.0001). The host bone coverage ratio measured intraoperatively was 83.67 ± 3.40%, while the ratio measured by 3D CT reconstruction was 82.72 ± 3.59%. There was a strong positive correlation between the intra-operative host bone coverage and the 3D-based one (r = 0.826, p < 0.0001). It is recommended that 3D-based measurements are used to evaluate the host bone coverage after THA in patients with hip dysplasia. In addition, achieving a minimum host bone coverage of 75% is recommended for the attainment of stable cup fixation.

Is the Direct Fixation of Displaced Quadrilateral Plates in Acetabular Fractures Necessary?

Quadrilateral plate fractures represent a heterogeneous group of acetabular fractures. Accurate reduction is required to prevent post-traumatic arthritis. The purpose of this study is to determine the reduction effect of the direct fixation of quadrilateral plates in acetabular fractures, and to evaluate the strength of direct fixation compared to indirect fixation. Between 2005 and 2021, 49 patients underwent surgery for open reduction and internal fixation in acetabular fractures with severely displaced quadrilateral plates. Twenty-nine patients comprised the indirect fixation group, and twenty patients comprised the direct fixation group. In a comparison of primary outcome between two groups, 10 out of 29 indirect-group patients and 1 out of 20 direct-group patients developed post-traumatic osteoarthritis, wherein the difference between the two groups is statistically significant. In the assessment of postoperative Matta's radiological reduction status, 19 out of 20 patients in the direct group had achieved anatomical and congruent reduction. The treatment using a direct reduction and internal fixation improved the reduction quality of articular displacement and offered a better survivorship of the affected hip joint.