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Background The introduction of locking plate technology has improved the feasibility of distal radius fracture fixation without the need for bone grafting, yet challenges persist in cases of severely comminuted fractures and small, unstable intra-articular fragments. This study aimed to assess the outcomes of bone grafting in severely comminuted distal radius fractures treated with locking plates. Methods We performed a retrospective analysis involving 450 patients who underwent distal radius fracture fixations. We evaluated wrist motion, grip strength, and radiographic parameters, including radial inclination, radial tilt, ulnar variance, articular step, and fracture union at standardized intervals. In addition, at the 12- and 24-month marks, we assessed the disabilities of the arm, shoulder, and hand (DASH) questionnaire score. Results Out of the 450 patients who underwent distal radius fracture fixation using volar locking plate systems, 59 individuals (13%) required either autologous bone graft (n = 24) or synthetic bone substitutes (n = 35). In the final follow-up, all fractures had successfully united, displaying an average volar tilt of 4°, radial inclination of 18.8°, and an articular step or gap of 0.1 mm. Conclusion There was no significant difference between the use of autologous or synthetic bone grafts on clinical or radiological outcomes in the long term. Bone grafts are useful in severe metaphyseal comminution and aid in the reduction of articular fragments and bi-cortical comminution.
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INTRODUCTION: ChatGPT (Chat Generative Pre-trained Transformer), developed by OpenAI (San Francisco, CA, USA), has gained attention in the medical field. It has the potential to enhance and simplify tasks, such as preoperative planning in orthopedic surgery. We aimed to test ChatGPT's accuracy in measuring the angle of correction for high tibial osteotomy for cases planned and performed at a tertiary teaching hospital in Singapore. MATERIALS AND METHODS: Peri-operative angular parameters from 114 consecutive patients who underwent medial opening wedge high tibial osteotomy (MOWHTO) were used to query ChatGPT 3.0. First ChatGPT 3.0 was queried on what information it required to plan a MOWHTO. Based on its response, pre-operative medial proximal tibial angle (MPTA) and joint line congruence angle (JLCA) were provided. ChatGPT 3.0 then responded with its recommended angle of correction. This was compared against the manually planned surgical correction by our fellowship-trained surgeon. A root mean square analysis was then performed to compare ChatGPT 3.0 and manual planning. RESULTS: The root mean square error (RMSE) of ChatGPT 3.0 in predicting correction angle in MWHTO was 2.96, suggesting a very poor model fit. CONCLUSION: Although ChatGPT 3.0 represents a significant breakthrough in large language models with extensive capabilities, it is not currently optimized to effectively perform complex pre-operative planning in orthopedic surgery, specifically in the context of MOWHTO. Further refinement and consideration of specific factors are necessary to enhance its accuracy and suitability for such applications.
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Osteoporosis reduces the skeletal strength and increases the risk for fracture. It is an underdiagnosed disease in men. Annatto tocotrienol has been shown to improve bone structural indices and increase expression of bone formation genes in orchidectomized rats. This study aimed to evaluate the effects of annatto tocotrienol on biomechanical strength and calcium content of the bone in orchidectomized rats. Thirty three-month-old male Sprague-Dawley rats were randomly assigned to five groups. The baseline control (BC) group was sacrificed at the onset of the study. The sham-operated group (SHAM) received olive oil (the vehicle of tocotrienol) orally daily and peanut oil (the vehicle of testosterone) intramuscularly weekly. The remaining rats were orchidectomized and treated with three different regimens, i.e., (1) daily oral olive oil plus weekly intramuscular peanut oil injection; (2) daily oral annatto tocotrienol at 60 mg/kg plus weekly intramuscular peanut oil injection; (3) daily oral olive oil plus weekly intramuscular testosterone enanthate injection at 7 mg/kg. Blood, femur and tibia of the rats were harvested at the end of the two-month treatment period for the evaluation of serum total calcium and inorganic phosphate levels, bone biomechanical strength test and bone calcium content. Annatto-tocotrienol treatment improved serum calcium level and tibial calcium content (p < 0.05) but it did not affect femoral biomechanical strength (p > 0.05). In conclusion, annatto-tocotrienol at 60 mg/kg augments bone calcium level by preventing calcium mobilization into the circulation. A longer treatment period is needed for annatto tocotrienol to exert its effects on bone strength.