Comparison of above elbow and below elbow immobilisation for conservative treatment of distal end radius fracture in adults: A systematic review and meta-analysis of randomized clinical trials.

PURPOSE: The aim of this study was to analyze if any difference exists on the type of immobilisation (above elbow vs. below elbow) in the conservative treatment of distal end radius fractures in adults. METHODS: The study was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses. An electronic literature search was performed up to 1st October 2021 in Medline, Embase, Ovid and Cochrane database using the search terms, "distal end radius fractures OR fracture of distal radius", "conservative treatment OR non-surgical treatment", "above elbow immobilisation" and "below elbow immobilisation". Randomized clinical trials written in English, describing outcome of distal end radius fractures in adults by conservative or non-surgical means using above elbow immobilisation or below elbow immobilisation were included and assessed according to the risk of bias assessment (RoB2) tool by Cochrane collaboration. Non-randomized clinical trials, observational studies, retrospective studies, review articles, commentaries, editorials, conference presentations, operative techniques and articles without availability of full text were excluded from this review. The meta-analysis was performed using Review Manager version 5.4.1 (The Cochrane Collaboration, Copenhagen, Denmark). RESULTS: Six randomized clinical trials were included for quantitative review. High heterogeneity (I2 > 75%) was noted among all the studies. The standard mean difference (MD) between the disability of the arm, shoulder and hand scores in both the groups was 0.52 (95% CI: -0.28 to 1.32) which was statistically non-significant. There was no statistical difference in the radial height (MD = 0.10, 95% CI: -0.91 to 1.12), radial inclination (MD = 0.5, 95% CI: -1.88 to 2.87, palmar tilt (MD =1.06, 95% CI: -0.31 to 2.43) and ulnar variance (MD = 0.05, 95% CI: -0.74 to 0.64). It was observed that shoulder pain occurred more commonly as a complication in above elbow immobilisation and the values were statistically significant (above elbow: 38/92, 41.3%; below elbow: 19/94, 20.2%). CONCLUSION: This two-armed systematic review on the above elbow or below elbow immobilisation to be used for conservative treatment of the distal end radius fracture in adults resulted in non-significant differences in terms of functional and radiological scores among the 2 groups but significant increase in the complication rates in the above elbow group.

What has changed in total hip arthroplasty in patients of juvenile idiopathic arthritis since 2000? A systematic review and pooled data analysis.

PURPOSE: The prevalence of juvenile idiopathic arthritis (JIA) is estimated to be 16-150 per 100,000 children worldwide. The hip joint may be involved in over 50% of children leading to significant morbidity which may require surgical intervention in the form of arthroplasty. The literature lacks a concise overview of the outcomes, including complication and implant survival of total hip arthroplasty (THA) in juvenile idiopathic arthritis (JIA). The aim of this study is to systematically analyze the literature and report the outcomes of THA in JIA. METHODS: Search was conducted in the online databases PubMed, Embase and Cochrane database. It included all original studies which evaluated clinical and/or radiological outcomes of THA in JIA with a minimum sample size of 5 patients and published in English. The level of evidence of the included studies was graded according to the Oxford Centre for Evidence Based Medicine. The Institute of Health Economics checklist was used to assess the quality of the studies included. RESULTS: The nine studies included were retrospective in nature with all being Level IV according to Oxford Centre for Evidence Based Medicine. 475 hips in 304 patients with majority of them being females (241/304, 79.2%) were included in this review. All the studies reported the outcome objectively using various scores. The proportion of revision surgeries (92/378), either femoral or acetabular, noted was 22% (95% CI 10-33%). The proportion of acetabular revisions (72/378) was 16% (95% CI 8-25%) as compared to 4% (95% CI 1-6%) for femoral revisions (20/378). There was no difference in survivorship when cemented and uncemented implants were compared. CONCLUSION: JIA patients with advanced hip disease represent a unique population with need for extra-long implant longevity. THA in patients of JIA leads to improved pain relief as well as mobility but the conversion of the same outcomes to functional activity is not proportionally improved. The current trend is the use of uncemented and ceramic-on-ceramic implants. Acetabular implants require earlier revision as compared to femoral implants. Age at surgery can be delayed by early institution of methotrexate which indirectly improves implant survival. LEVEL OF EVIDENCE: IV.

Classification of Lung Diseases Using an Attention-Based Modified DenseNet Model.

Lung diseases represent a significant global health threat, impacting both well-being and mortality rates. Diagnostic procedures such as Computed Tomography (CT) scans and X-ray imaging play a pivotal role in identifying these conditions. X-rays, due to their easy accessibility and affordability, serve as a convenient and cost-effective option for diagnosing lung diseases. Our proposed method utilized the Contrast-Limited Adaptive Histogram Equalization (CLAHE) enhancement technique on X-ray images to highlight the key feature maps related to lung diseases using DenseNet201. We have augmented the existing Densenet201 model with a hybrid pooling and channel attention mechanism. The experimental results demonstrate the superiority of our model over well-known pre-trained models, such as VGG16, VGG19, InceptionV3, Xception, ResNet50, ResNet152, ResNet50V2, ResNet152V2, MobileNetV2, DenseNet121, DenseNet169, and DenseNet201. Our model achieves impressive accuracy, precision, recall, and F1-scores of 95.34%, 97%, 96%, and 96%, respectively. We also provide visual insights into our model's decision-making process using Gradient-weighted Class Activation Mapping (Grad-CAM) to identify normal, pneumothorax, and atelectasis cases. The experimental results of our model in terms of heatmap may help radiologists improve their diagnostic abilities and labelling processes.

A systematic review and meta-analysis of long-term outcomes of femoral derotation surgery for intoeing gait in cerebral palsy.

BACKGROUND: Femoral derotation osteotomy is treatment of choice in intoeing gait secondary to cerebral palsy (CP). RESEARCH QUESTION: The aim of this study was to critically appraise the literature regarding the long-term outcomes of femoral derotation surgery in CP. METHODS: Electronic databases of PubMed and Scopus was used for the literature review by two researchers independently (SB, SC). The study population included patients of cerebral palsy undergoing femoral derotation surgery. The keywords used were "cerebral palsy", "intoeing gait", "femur anteversion", "hip anteversion", "femur derotation" and "femur osteotomy". RESULTS: Nine studies which included 657 limbs in 407 patients were selected for this study of which eight were retrospective in nature. The improvement in hip rotation at stance at last follow up (more than five years) maintained a statistical significance (SMD 1.67 95 %CI 1.12-2.22). Similar statistically significant outcomes were noted for foot progression angle (SMD 1.19 95 %CI 0.92-1.47), anteversion (SMD 2.75 95 %CI 1.49-4.01) and total passive internal rotation (SMD 1.71 95 %CI 1.19-2.22). SIGNIFICANCE: Femoral derotation surgery is the procedure of choice for correction of intoeing gait in CP. Even though, there is deterioration of results on long-term as compared to short term, majority of the patients shall maintain overall correction without recurrence of an intoeing gait. Future studies with uniform criteria for defining recurrence on the basis of functional limitations shall provide better idea about the natural course of this procedure.

Comparison of bone health among pre-menopausal and post-menopausal females in rural Eastern India: A pilot study.

PURPOSE: The aim of this study was to identify the at-risk female population (pre- and post-menopausal), identify the risk factors for low bone mineral density (BMD) and assess the knowledge of the subjects regarding osteoporosis by Osteoporosis Knowledge Assessment Tool (OKAT) in both the groups and to determine areas for early intervention in a predominantly rural and tribal area of Eastern India. STUDY DESIGN: This was a cross-sectional hospital-based study conducted in a predominant tribal and rural area of Eastern India. Females who were pre- and post-menopausal without a prior diagnosis of osteoporosis were included in the study. MAIN OUTCOME MEASURES: Factors affecting osteoporosis and quantified knowledge regarding the disease. RESULTS: A total of 388 females were included in the study (pre-menopausal = 190 and post-menopausal = 198). Although no significant difference was noted in the age at menarche between both the groups, a gradual significant shift in the age at menarche was noted in the younger females (p = .031). The mean OKAT score in the pre-menopausal and post-menopausal group was 9.5 ± 3.4 and 9.2 ± 3.5, respectively. 80% of females in the pre-menopausal group had normal T-scores whereas only 25% of the females in the post-menopausal group had normal T-scores. CONCLUSION: Targeted educational programs which influence the preventive health behaviour in general and osteoporosis knowledge in particular would bridge this gap. Peer-led community intervention programs which focus on behaviour change with respect to lifestyle and diet modification in the younger population should be the step ahead to reduce the prevalence of the disease.

Attention to the Bone Health of a Neglected Rural-Tribal Population in India: A Pilot Study.

Objective: The aim of this pilot study was to analyze the need and feasibility of conducting prospective research on the epidemiological factors of bone mineral density (BMD) in the at-risk population in a rural and tribal-dominated area based on a screening test. Methods: This community-based retrospective cross-sectional study was based on data from the medical records from July 2021 to September 2021 at community camps organized in a rural area of Deoghar district of Jharkhand, India, and the at-risk patients who had undergone ultrasound-based BMD measurement were included in this study. Results: The mean age of the patients (N = 216) was 68.2 ± 10.2 years (range 35-73 years) with a mean T-score of -0.83 ± 0.09 (range -2.78-0.3, 95% CI 0.19). 70.3% (n = 152) of the patients were diagnosed as either osteopenic or osteoporotic based on the T-score. 14.8% (n = 32) of the patients had a comorbidity making them susceptible for low BMD. BMD was significantly low in patients above 60 years of age (t - 3.36, P - 0.0005), presence of comorbidity (t - 3.12, P - 0.001), and urban population (t - -1.93, P - 0.02). Conclusion: Although DEXA remains the study of choice, QUS can be used in primary healthcare systems in the developing world for the purposes of screening. Females, elderly, and urban residence have an increased chance of low BMD. This pilot study shows that a large-scale prospective study analyzing various aspects of bone health including dietary and lifestyle practices is the need of the hour.

Prevention of "bygone futures" due to road traffic injuries in children.

Road traffic injuries remain one of the common and leading causes of death among children and adolescents till the age of 19 years. Road safety is important for children since their physical activity, active travel, independence and development are largely affected by it. Solutions for road safety with benefits for people as well as an economy exist which should be implemented effectively and efficiently. These solutions which combine engineering, legislation and behavioural interventions should be implemented in an integrated Safe Systems Approach. The future of the children must be safeguarded from these injuries and every effort towards it being converted into "bygone figures" must be done diligently and honestly. The various risk factors and interventions possibly explained in this review article shall help in better understanding of the causes and possible guidelines at a policy level to prevent road traffic injuries in children.

Posterior Instrumentation of Cervical Spine: A Bibliometric Analysis of Trends in Publication.

Aim The aim of this study was to perform a bibliometric analysis of the articles published on posterior instrumentation of cervical spine and to study the general publishing trends over the years in this topic in terms of journals, authors, topics, keywords, collaborating countries, etc. Material and Methods Articles were searched on the web of science using appropriate keywords. A bibliometric analysis was performed using Bibliometrix R package Results A total of 1,953 studies were identified between 1991 and 2023 including 1,782 articles and 171 reviews from 198 sources. A total of 3,421 author's keywords were used by 6,725 authors. Thirty-four documents are single authored. The average co-author per document is 5.63. The average citation per document is 22.62. There is international co-authorship in 13.11% documents. RM Xu and Sonntag VKH have maximum publications ( n = 28). The "Spine" journal has the maximum number of publications ( n = 335) and best H index of 64. United States has maximum number of publications ( n = 1,720) and citations ( n = 19,573). Publication by Harms et al in the "Spine" in 2001 has the highest global ( n = 956) & local ( n = 272) citations. Three-dimensional printing and atlantoaxial fixation are emerging trends. Conclusion The findings of this study enhance the knowledge on the topic of posterior instrumentation of cervical spine and shall guide the trends and directions of future research and innovation.