Use of deep learning methods for hand fracture detection from plain hand radiographs.

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.

Dissociation of bipolar components following bipolar hemiarthroplasty: A report of two different cases and review of the literature.

In elder patients, the treatment for femoral neck fracture generally involves bipolar hip hemiarthroplasty. Hip dislocation is one of the most common complications of bipolar hip hemiarthroplasty. In many studies, hemiarthroplasty dislocation frequency ranged from 1.2% to 8.4%. However, dissociation between femoral head and femoral components is an extremely rare complication in bipolar hemiarthroplasty. Component dissociation was reported following polyethylene break after Bateman bipolar hemiarthroplasty which has been used since 1985. Self-centering systems have been developed to varus positioning of femoral head within in bipolar plate. In a self-centering system, normal forces on articular surface between acetabulum and femoral head should rotate femoral head into valgus position. However, dissociation of acetabular components was also reported with self-centering systems. In the literature, the largest case series reporting dissociation between components after bipolar hemiarthroplasty was reported in 2014 by Hasegawa et al., which included seven cases. Other larger studies were reported by Uruç et al. in 2017 (5 cases) and by Georgiou et al. in 2016 (5 cases). In this study, two different cases are reported dissociation between components after bipolar hemiarthroplasty. In conclusion, dissociation between components is a rare complication following bipolar hemiarthroplasty; however, it results in revision surgery in almost all cases. As spontaneous or traumatic dissociation can occur during maneuvers of closed reduction after hip dislocation, one should be careful during closed reduction of hip dislocation.

The effect of the angle between fracture line and Kirschner wires on stability in supracondylar humerus fractures treated with Kirschner wire fixation: A finite element analysis.

OBJECTIVES: This study aims to investigate the effects of the angles created by the Kirschner wires (K-wires), which are applied in the percutaneous fixation of supracondylar humerus fractures with cross K-wire, with the fracture line on fracture stabilization. PATIENTS AND METHODS: The study was conducted on distal humerus fracture models. Medial and lateral K-wires were placed in the fracture models. The angle between the fracture line and the K-wire inserted from medial was represented by alpha (α), while the angle between the fracture line and the K-wires inserted from lateral was represented by beta (ß). A combination of various angles (30°, 45°, and 60°) was used in each model, where no two models had the same combination of α and ß, resulting in nine different wire configurations. The simulation program was used to simulate the effects of forces, which were applied on rotation, flexion and extension directions, on these models. We measured and compared the stress on the wires and the displacement of fractures under different force configurations. RESULTS: When the force was applied in the counterclockwise direction, the stresses were 58 megapascal (MPa) on medial K-wire, 24 MPa on lower lateral K-wire, and 45 MPa on upper lateral K-wire in (45°, 45°) wire configuration. When the force was applied in the clockwise direction, the stresses were 57 MPa on medial K-wire, 23 MPa on lower lateral K-wire, and 45 MPa on upper lateral K-wire in (45°, 45°) wire configuration. In all models, the increased α and ß angles were translated into the decreased stress on K-wires at the fracture level and decreased displacement under rotational deforming forces. Despite having generally lower fracture displacement, the increased α and ß angles led to variable changes in the stress on K-wires against flexion and extension forces. CONCLUSION: In supracondylar humerus fractures, increasing the insertion angle of both medial and lateral K-wires augments stabilization and reduces displacement, particularly against rotational deforming forces.

Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures.

BACKGROUND: We aimed to compare clinical and functional outcomes between patients treated with Dynamic hip screw (DHS) and Proximal Femoral Nail-Antirotation (PFN-A) implants. METHODS: This study included 122 patients (66 men [54.1%] and 56 women [45.9%]) who underwent surgery with DHS and PFN-A for an intertrochanteric femur fracture and had at least 12 months follow-up. Reduction assessment, femoral neck-shaft angle and tip-apex distance measurements were performed in early postoperative radiographs. On control visits in months 1, 3, 6 and 12, range of motion, thigh or hip pain, and Trendelenburg positivity were assessed in clinical examination and reduction assessment, femoral neck-shaft angle and tip-apex distance measurements were performed on radiographs after the union. Patients were assessed using Hip Harris Score after the union. RESULTS: Regardless of implant type used, mean tip-apex distance measured at the immediate postoperative period was 27.6 in patients with implant failure, whereas 21.6 in patients without, indicating a significant difference. Again, mean femoral neck-shaft angle measured at the immediate postoperative period was 123 degree in patients with implant failure, whereas 130 degree in those without, indicating a significant difference. It was found that the femoral neck-shaft angle was <128 degree in all patients with implant failure whereas it was >128 degree in 94% of patients without implant failure at immediate postoperative period. CONCLUSION: The findings regarding femur neck-shaft angle at the immediate postoperative period was <128 degree in all patients with implant failure and that it was ≥128 degree in 94% of patients without implant failure emphasize the importance of anatomic restoration in femur neck-shaft angle during surgery. The finding that mean tip-apex distance was 27.6 mm in patients with implant failure and 21.6 mm in patients without implant failure indicates that the technique is as important as implant type selected for treatment success of the implantation.

A neglected case of giant synovial chondromatosis in knee joint.

Synovial chondromatosis is a rare benign condition arising from the synovial membrane of the joints, synovial sheaths or bursae around the joints. Primary synovial chondromatosis typically affects the large joints in the third to fifth decade of life. The purpose of this case report is to document this rare synovial pathology, which required open synovectomy and debridement to eradicate it. In our case, the biggest sized SOC was 20x19x6 cm, although there were many joint mice. Our case had the biggest SOC ever extracted, which to the best of my knowledge has not been reported earlier.