An Automatic Method for Elbow Joint Recognition, Segmentation and Reconstruction.

Elbow computerized tomography (CT) scans have been widely applied for describing elbow morphology. To enhance the objectivity and efficiency of clinical diagnosis, an automatic method to recognize, segment, and reconstruct elbow joint bones is proposed in this study. The method involves three steps: initially, the humerus, ulna, and radius are automatically recognized based on the anatomical features of the elbow joint, and the prompt boxes are generated. Subsequently, elbow MedSAM is obtained through transfer learning, which accurately segments the CT images by integrating the prompt boxes. After that, hole-filling and object reclassification steps are executed to refine the mask. Finally, three-dimensional (3D) reconstruction is conducted seamlessly using the marching cube algorithm. To validate the reliability and accuracy of the method, the images were compared to the masks labeled by senior surgeons. Quantitative evaluation of segmentation results revealed median intersection over union (IoU) values of 0.963, 0.959, and 0.950 for the humerus, ulna, and radius, respectively. Additionally, the reconstructed surface errors were measured at 1.127, 1.523, and 2.062 mm, respectively. Consequently, the automatic elbow reconstruction method demonstrates promising capabilities in clinical diagnosis, preoperative planning, and intraoperative navigation for elbow joint diseases.

Clinical outcomes of olecranon sled fixation in patients with Mayo type II olecranon fractures.

Background: Tension band wiring and plate fixation are common internal fixation methods used for olecranon fractures, but complications and reoperations are common. The purpose of this study is to investigate the clinical outcomes of displaced olecranon fractures treated with olecranon sled internal fixation. Methods: The data of 39 patients with olecranon fractures treated with olecranon sled in the Department of Traumatology of Beijing Jishuitan Hospital between May 2018 and April 2020 were retrospectively analyzed. There were 17 males and 22 females; the mean age was 44.0 ± 15.8 (range, 18-68 years). Preoperative olecranon fractures were classified according to the Mayo classification: 24 cases were type IIA and 15 cases were type IIB. Elbow range of motion (extension and flexion) and forearm rotation (protonation and supination) were observed at the last follow-up. The Mayo elbow performance score (MEPS), Disabilities of the arm, shoulder and hand (DASH) and visual analogue scale (VAS) scores were used to evaluate elbow function and pain, and complications were also recorded. Results: Thirty-nine patients were followed up for 33.6 ± 8.3 months (range, 25-51 months) after the operation. At the last follow-up, the mean flexion-extension arc was 137° ± 15° (range, 60°-160°), and the mean pronation-supination arc was 178° ± 4° (range, 160°-180°). The mean MEPS was 94.9 ± 9.9 (range, 50.0-100.0). The mean DASH score was 5.4 ± 4.3 (range, 0-18.3). The mean VAS score was 0.4 ± 0.8 (range, 0-3). Seven patients developed olecranon skin irritation, and 3 of them had the internal fixation device removed. Two patients developed heterotopic ossification, of whom 1 patient suffered elbow stiffness. Conclusion: Olecranon sled internal fixation has good clinical outcomes in the treatment of Mayo type II olecranon fractures with a low rate of reoperations.

Effects of ozone exposure on lipid metabolism in Huh-7 human hepatoma cells.

Ozone pollution is a major environmental concern. According to recent epidemiological studies, ozone exposure increases the risk of metabolic liver disease. However, studies on the mechanisms underlying the effects of ozone exposure on hepatic oxidative damage, lipid synthesis, and catabolism are limited. In this study, Huh-7 human hepatocellular carcinoma cells were randomly divided into five groups and exposed to 200 ppb O3 for 0, 1, 2, 4, and 8 h. We measured the levels of oxidative stress and analyzed the changes in molecules related to lipid metabolism. The levels of oxidative stress were found to be significantly elevated in Huh-7 hepatocellular carcinoma cells after O3 exposure. Moreover, the expression levels of intracellular lipid synthases, including SREBP1, FASN, SCD1, and ACC1, were enhanced. Lipolytic enzymes, including ATGL and HSL, and the mitochondrial fatty acid oxidase, CPT1α, were inhibited after O3 exposure. In addition, short O3 exposure enhanced the expression of the intracellular peroxisomal fatty acid ß-oxidase, ACOX1; however, its expression decreased adaptively with longer exposure times. Overall, O3 exposure induces an increase in intracellular oxidative stress and disrupts the normal metabolism of lipids in hepatocytes, leading to intracellular lipid accumulation.

Anxiety and depression are associated with poor outcomes in open elbow arthrolysis.

BACKGROUND: Open elbow arthrolysis (OEA) is an established treatment for posttraumatic elbow stiffness (PTES); however, its efficacy is debatable for some patients. Poor surgical outcomes have been associated with anxiety and depression in other orthopedic conditions, but no studies have examined this association in OEA. In this study, we aimed to determine whether a high preoperative anxiety and depression score is associated with a worse functional outcome in OEA for PTES. METHODS: A retrospective review of prospectively collected data was carried out in patients undergoing OEA between April 2021 and March 2022. Mental state evaluated by Hospital Anxiety and Depression Scale (HADS), subjective elbow function valued by Disabilities of the Arm, Shoulder, and Hand (DASH) score, objective elbow function valued by Mayo Elbow Performance Score (MEPS), pain score measured by visual analog scale (VAS) and the flexion-extension range of motion (ROM) of the affected elbow were collected before and after surgery in outpatient clinic follow-up at 3 months and 6 months. Patient satisfaction was only recorded 6 months postoperatively. All patients were divided into 2 groups based on the preoperative HADS score for analysis: Group A was the nonanxiety-depression group, and Group B was the anxiety-depression group. RESULTS: A total of 49 patients were included. Both groups improved in DASH, MEPS and ROM at 3 months and at 6 months. The HADS score in Group B decreased significantly at 6 months, showing that the mental state of patients in Group B improved after surgery. Group A had a lower DASH at 3 months and 6 months, larger 6-month ROM and higher satisfaction rate than Group B. Comparing the differences between preoperative and postoperative measurements, Group A improved more in ROM at 6 months. There was no significant difference in other outcome measures between the two groups. CONCLUSIONS: OEA is a safe and effective treatment for PTES, and can achieve good clinical outcomes in the short-term follow-up, regardless of whether the patients suffer from anxiety or depression. Patients with a HADS score ≥11 before OEA, however, have worse outcomes than those with a HADS score <11. LEVEL OF EVIDENCE: Level II; Retrospective Design; Prognosis Study.

Risk of ozone exposure-induced fracture.

Introduction: Ozone (O3) is known to induce oxidative stress that influences various cells and tissues, which may further lead to diminished bone mineral density. Nevertheless, few studies have investigated the association between O3 exposure and fractures. Considering the similar growing trends of O3 concentrations and fracture morbidity in recent years, in the present study, we aimed to examine whether O3 exposure is associated with the fracture morbidity. Methods: Using a retrospective cohort study design, we analyzed the records of 8,075 patients with fracture admitted in the warm season to Beijing Jishuitan Hospital from 2014 to 2019 and matched them to the corresponding exposure time and concentration of O3. Results: The results showed that increased odds of fracture were associated with increased O3 concentrations, presumably because O3 induces oxidative stress (OS) that leads to bone mineral density (BMD) loss. Discussion: Our findings suggest that O3 exposure is a risk factor for fractures, providing new evidence of the adverse health effect induced by air pollution. We can conclude that more intensive air pollution control is needed for the prevention of fracture occurrence.

Short-term effect of apparent temperature on daily hospitalizations for osteoporotic fractures in Beijing, China: A retrospective observational study.

BACKGROUND: Studies on the associations between temperature and osteoporotic fractures (OF) hospitalizations are limited. This study aimed to assess the short-term effect of apparent temperature (AT) on the risk of OF hospitalizations. METHODS: This retrospective observational study was conducted in Beijing Jishuitan Hospital from 2004 to 2021. Daily OF hospitalizations, meteorological variables and fine particulate matter were collected. A Poisson generalized linear regression model combined with a distributed lag non-linear model was applied to analyze the lag-exposure-response relationship between AT and the number of OF hospitalizations. Subgroup analysis by gender, age and fracture type was also conducted. RESULTS: Total daily hospitalization visits for OF during the studied period were 35,595. The exposure-response curve of AT and OF presented a non-linear relationship, with optimum apparent temperature (OAT) at 28.40 °C. Taking OAT as the reference, the cold effect (-10.58 °C, 2.5th percentage) on single lag day had statistical significance from the current day of exposure (RR = 1.18, 95 % CI: 1.08-1.28) to lag 4 day (RR = 1.04, 95 % CI: 1.01-1.08), while the cumulative cold effect increased the risk of OF hospitalization visits from lag 0 to 14 days, with the maximum RR over lag 0-14 days (RR = 1.84, 95 % CI: 1.21-2.79). There were no significant risks of OF hospitalizations for warm effects (32.53 °C, 97.5th percentage) on single or cumulative lag days. The cold effect might be more evident among females, patients aged 80 years or older, and patients with hip fractures. CONCLUSION: Exposure to cold temperatures is associated with an increased risk of OF hospitalizations. Females, patients aged 80 years or older and patients with hip fractures might be more vulnerable to the cold effect of AT.

Biomechanical comparison of three internal fixation configurations for low transcondylar fractures of the distal humerus.

BACKGROUND: We aimed to evaluate the biomechanical stiffness and strength of different internal fixation configurations and find suitable treatment strategies for low transcondylar fractures of the distal humerus. METHODS AND MATERIALS: Thirty 4th generation composite humeri were used to create low transcondylar fracture models that were fixed by orthogonal and parallel double plates as well as posterolateral plate and medial screw (PPMS) configurations (n=10 in each group) using an anatomical locking compression plate-screw system and fully threaded medial cortical screws. Posterior bending (maximum 50 N), axial loading (maximum 200 N) and internal rotation (maximum 10 N·m) were tested, in that order, for each specimen. Stiffness under different biomechanical settings among different configurations were compared. Another 18 sets of fracture models were created using these three configurations (n=6 in each group) and the load to failure under axial loading among different configurations was compared. RESULTS: Under posterior bending, the stiffness of parallel group was higher than orthogonal group (P<0.001), and orthogonal group was higher than PPMS group (P<0.001). Under axial loading, the stiffness of parallel group was higher than orthogonal group (P=0.001) and PPMS group (P<0.001); however, the difference between orthogonal and PPMS group was not statistically significant (P>0.05). Under internal rotation, the stiffness of parallel group was higher than orthogonal group (P=0.044), and orthogonal group was higher than PPMS group (P=0.029). In failure test under axial loading, the load to failure in the orthogonal group was lower than parallel group (P=0.009) and PPMS group (P=0.021), but the difference between parallel group and PPMS group was not statistically significant (P>0.05). All specimens in orthogonal group demonstrated "distal medial failure"; most specimens had "distal medial and trochlear failure" in the parallel group; most specimens exhibited "contact failure" in the PPMS group. CONCLUSION: For treating low transcondylar fractures, the overall stiffness and strength of the parallel configuration were superior to those of the orthogonal and PPMS configurations. Nevertheless, the PPMS configuration can provide adequate stability and stiffness comparable to double-plate configurations under axial loading. Therefore, the PPMS construct may have certain clinical value.

Relationship between measurements of ipsilateral capitellum and prosthetic radial head size.

BACKGROUND: Selecting the correct size of head component is challenging in radial head arthroplasty, particularly in comminuted fractures. This study aimed to investigate the relationship between measurements of the ipsilateral capitellum and the prosthetic radial head size, which may be used to predict the size of the radial head prosthesis preoperatively. METHODS: Our study enrolled all patients who underwent radial head arthroplasty at Beijing Jishuitan Hospital. Demographic, injury-related and radiographic data were collected. The prosthetic radial head size was recorded from the surgical notes. Three-dimensional models of preoperative CT scans were reconstructed, on which the lateral capitellar diameter, the capitellar width and the width between the capitellum and trochlea were measured. The correlations between measurements of the ipsilateral capitellum and the prosthetic radial head size were evaluated, and linear regression equations were established. RESULTS: The study enrolled 37 patients, with an average age of 42.8 ± 11.5 years and a male-female ratio of 20:17. The median diameter of the radial head prostheses was 22 (20, 22) mm. The average lateral capitellar diameter was 20.71 ± 1.93 mm, the mean capitellar width was 14.90 ± 1.40 mm, and the mean width between the capitellum and trochlea was 19.29 ± 1.78 mm. The lateral capitellar diameter (R = 0.820, P < 0.001), the capitellar width (R = 0.726, P < 0.001) and the width between the capitellum and trochlea (R = 0.626, P < 0.001) were significantly positively correlated with the size of the radial head prosthesis. The linear regression equation between the lateral capitellar diameter and the size of the radial head prosthesis was calculated and defined as follows: D = 7.44 + 0.67*d (D: diameter of radial head prosthesis; d: lateral capitellar diameter; and adjusted R2 = 0.719, P < 0.001). CONCLUSIONS: There are positive correlations between the anatomical parameters of the ipsilateral capitellum and the prosthetic radial head size. The lateral capitellar diameter can be measured on three-dimensional CT preoperatively to predict the size of the radial head prosthesis intraoperatively.

Comparative study of the functional outcomes of combined medial-lateral approach arthrolysis with or without external fixation for severe elbow stiffness.

BACKGROUND: To evaluate and compare the functional outcomes of combined medial-lateral approach open arthrolysis with and without hinged external fixation. METHODS: We retrospectively collected and analyzed the clinical data of patients with severe elbow stiffness who were treated in our institution from January 2018 to January 2019. All of them were treated with combined medial-lateral approach arthrolysis. There were 20 patients who had the hinged external fixation placed and 29 patients without the placement of the external fixation. Their baseline characteristics and functional outcomes were evaluated and compared. RESULTS: The average follow-up time was 28.4 ± 3.7 months. There were no significant differences in the ROM of the elbow, MEPS, VAS, DASH, or complications between the two groups. The operation time and treatment cost of the patients without external fixation were significantly lower than patients with external fixation. CONCLUSION: Combined medial-lateral approach open elbow arthrolysis without external fixation is a safe and effective way to treat elbow stiffness. LEVEL OF EVIDENCE: Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

Comparative study of functional outcomes between OTA/AO type C, Gustilo type I/II open fractures and closed fractures of the distal humerus treated by open reduction and internal fixation.

BACKGROUND: To evaluate the difference of functional outcomes between OTA/AO type C, Gustilo type I/II open fractures and closed fractures of the distal humerus after open reduction and internal fixation. METHODS: We retrospectively analyzed the clinical data of patients with OTA/AO-C distal humerus fractures who were treated in our department from January 2014 to December 2016. The patients were divided into an open fracture group and a closed fracture group. Their baseline characteristics and functional outcomes were analyzed and compared. RESULTS: A total of 64 patients treated by operative fixation were identified (25 open and 39 closed injuries), and the average follow-up time was 35.1 ± 13.6 months. There were no significant differences in the range of motion (ROM) of the elbow, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, complications, hospitalization time, operation time, intraoperative blood loss, or medical costs between the two groups (P > 0.05). CONCLUSION: OTA/AO type C, Gustilo I/II distal humeral open fractures can yield satisfactory clinical results similar to those of closed distal humeral fractures after open reduction and internal fixation. LEVEL OF EVIDENCE: Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

Lateral minimal approach to the terrible triad of the elbow: a treatment protocol in Beijing Jishuitan Hospital.

BACKGROUND: This study aimed to report the surgical techniques and results of treating coronoid process and radial head fracture combined with dislocation of the elbow (terrible triad of the elbow) using a single lateral incision, known as the extensor digitorum communis (EDC) split approach. METHODS: A retrospective analysis was performed of 109 patients with terrible triad of the elbow who had been treated by the authors from January 2013 to December 2019. The participants included 67 males and 42 females, with a mean age of 42.2 years (14-71 years). All participants were treated via a single lateral approach. The coronoid process was fixated with Kirschner wires combined with anterior capsule suture lasso fixation. For the radial head fracture, 58 cases were fixated by AO headless cannulated screw (AO HCS) and 51 cases by acumed radial head replacement. In repair of the lateral collateral ligament (LCL) complex and the common extensor tendon, 28 cases used ETHIBOND suture through bone holes at the humeral lateral epicondyle, and the other 81 cases used suture anchors. No medial collateral ligament was repaired. A total of 46 participants were fixated with a Stryker dynamic joint distractor (DJD) II hinged external fixator to protect the bone and soft tissue. RESULTS: All participants were followed up from 6 to 60 months (mean, 36.1 months). Their elbow range of flexion and extension averaged 123.4°±20.7°, forearm rotation 151.0°±25.6°, and Mayo elbow performance score (MEPS) 92.3±8.8. There were 22 participants (19.5%) with ulnar nerve symptoms, 16 (14.7%) who had elbow stiffness, and 7 underwent secondary surgery, including 6 removals of internal fixation, 5 arthrolyses of the elbow, and 2 ulnar neurolyses. CONCLUSIONS: Coronoid fractures, radial head fractures, and LCL injuries of the terrible triad of the elbow can be treated satisfactorily through a lateral minimal incision, combined with a hinged external fixation if necessary.

Chronic type C3 distal humeral fracture associated with massive bone defects treated by open reduction and internal fixation with iliac crest autografts: a case report.

BACKGROUND: Chronic intercondylar fractures of the distal humerus with massive bone defects and severe comminution in the metaphysis are rare and complex injuries that are challenging for surgeons to treat, as reconstructing the triangular structure of the distal humerus is difficult and may have a severe impact on functional outcomes, especially in young patients, for whom total elbow arthroplasty is usually not a suitable option due to significant impairment in upper limb strength. Here, we report a patient in such scenario who was young and active and was treated by structural iliac bone autografting and internal fixation. CASE PRESENTATION: A 26-year-old male patient experienced a major car accident and was diagnosed with an open fracture (Gustilo-Anderson type IIIB) of the right distal humerus with massive bone defects and severe intra-articular involvement, without neurovascular injuries or other associated injuries. Surgical debridement, negative pressure vacuum sealing drainage, and immobilization by braces were initially performed, and the wound was closed after 15 days. When the wound had finally healed and the soft tissue was in good condition without infection or effusion 45 days later, this young and active patient was diagnosed with a chronic type C3 distal humeral fracture associated with massive bone defects at the supracondylar level in both columns and severe comminution at the trochlear groove. We performed surgical debridement and arthrolysis around the fracture site, and then, we successfully reconstructed the triangular structure of the distal humerus using structural iliac crest autografts in both columns as well as in the defective trochlear groove. Finally, internal fixation via a parallel double-plate configuration was performed. Over a follow-up period of 3 years, the patient achieved almost full recovery of range of motion and an excellent functional score, without minor or major postoperative complications. CONCLUSION: In this study, we proposed a surgical reconstruction strategy for complex chronic distal humeral fractures associated with massive bone defects and severe articular involvement in young and active patients using metaphyseal shortening and structural iliac crest bone autografting together with open reduction and internal fixation via a parallel configuration.

Olecranon osteotomy vs. triceps-sparing for open reduction and internal fixation in treatment of distal humerus intercondylar fracture: a systematic review and meta-analysis.

BACKGROUND: The open reduction and internal fixation (ORIF) was a standard treatment approach for fracture at distal humerus intercondylar, whereas the optimal way before ORIF remains inconclusive. We, therefore, performed a systematic review and meta-analysis to assess the efficacy and safety of olecranon osteotomy vs. triceps-sparing approach for patients with distal humerus intercondylar fracture. METHODS: The electronic searches were systematically performed in PubMed, EmBase, Cochrane library, and Chinese National Knowledge Infrastructure from initial inception till December 2019. The primary endpoint was the incidence of excellent/good elbow function, and the secondary endpoints included Mayo elbow performance score, duration of operation, blood loss, and complications. RESULTS: Nine studies involving a total of 637 patients were selected for meta-analysis. There were no significant differences between olecranon osteotomy and triceps-sparing approach for the incidence of excellent/good elbow function (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 0.69-2.75; P = 0.371), Mayo elbow performance score (weight mean difference [WMD]: 0.17; 95% CI: -2.56 to 2.89; P = 0.904), duration of operation (WMD: 4.04; 95% CI: -28.60 to 36.69; P = 0.808), blood loss (WMD: 33.61; 95% CI: -18.35 to 85.58; P = 0.205), and complications (OR: 1.93; 95% CI: 0.49-7.60; P = 0.349). Sensitivity analyses found olecranon osteotomy might be associated with higher incidence of excellent/good elbow function, longer duration of operation, greater blood loss, and higher incidence of complications as compared with triceps-sparing approach. CONCLUSIONS: This study found olecranon osteotomy did not yield additional benefit on the incidence of excellent/good elbow function, while the duration of operation, blood loss, and complications in patients treated with olecranon osteotomy might be inferior than triceps-sparing approach.

Symptomatic primary hyperparathyroidism in a young woman presenting with multiple skeletal destructions: a case report and review of literature.

BACKGROUND: Multiple pathological manifestations are rarely present in patients with primary hyperparathyroidism (PHPT). Here we described a case of a young woman who presented with multiple skeletal destructions and received an unclear diagnosis at several hospitals. CASE PRESENTATION: A 30-year-old woman was admitted to our hospital due to pain in both knees and walking difficulty that lasted for 6 and 2 years, respectively. Her laboratory test results revealed a high parathyroid hormone level (822 pg/ml) and hypercalcemia (2.52 mmol/L) in the blood. Parathyroid imaging revealed a lumpy concentration of radioactive uptake detected at the lower pole in the right lobe of the thyroid, and was nearly 2.2 cm * 2.4 cm in size. Next, the patient was treated with parathyroidectomy that resulted in a significant improvement in physiological and clinical symptoms. Moreover, the skeletal destruction and bone mineral density were significantly improved after a 5-years follow-up period. CONCLUSIONS: Multiple skeletal destructions can be caused by PHPT that should be taken into consideration in young patients with complex bone lesions.

Changes in bone mineral density after parathyroidectomy in patients with moderate to severe primary hyperparathyroidism.

OBJECTIVE: Primary hyperparathyroidism (PHPT) is relatively common in China and results in severe damage to the skeletal system. This study aimed to investigate changes in bone mineral density (BMD) over 2 years in patients with PHPT after parathyroidectomy. METHODS: This retrospective cohort study included patients with PHPT who underwent parathyroidectomy between January 2010 and December 2015. BMD and T-scores and Z-scores of the lumbar spine (L1, L2, L3, and L4) and total hip (femoral neck, great trochanter, and Ward's triangle) at baseline and 2 years after surgery were measured by dual-energy X-ray absorptiometry. RESULTS: Thirty patients with moderate to severe PHPT (17 men and 13 women) aged 38.90±15.48 years were included. BMD, and T-score and Z-score values at the lumbar spine and total hip at 6 months, 1 year, and 2 years after parathyroidectomy were significantly improved compared with preoperative values. Improvement in BMD was largest at L4 (46.7%) and smallest at L1 (37.4%) in the lumbar spine 2 years after parathyroidectomy. For the total hip, the increase in BMD was largest at Ward's triangle (42.6%) and smallest at the femoral neck (37.5%). CONCLUSIONS: BMD of the lumbar spine and total hip is improved after parathyroidectomy in patients with PHPT.

Identification of independent factors affecting bone mineral density after successful parathyroidectomy for symptomatic hyperparathyroidism.

BACKGROUND: Studies have shown that the response of bone mineral density (BMD) to parathyroidectomy for symptomatic primary hyperparathyroidism (PHPT) is heterogeneous and difficult to predict. However, the independent factors affecting BMD in PHPT patients after parathyroidectomy remains limited and inconclusive. This study aimed to explore the independent factors affecting BMD changes in symptomatic PHPT patients after parathyroidectomy. METHODS: This study retrospectively analyzed 105 patients with symptomatic PHPT treated at Beijing Jishuitan Hospital between January 2010 and December 2015. The primary outcome was a > 10% increase in BMD at 3 years after parathyroidectomy compared with the preoperative value, whereas the secondary outcomes were BMD changes at various measurement sites. RESULTS: A total of 105 patients with a mean age of 46.37 years were included in this study. Univariate logistic regression analysis indicated that hypertension (odds ratio [OR[: 0.032; 95% confidence interval [CI]: 0.001-0.475; P = 0.012), and parathyroid hormone level (OR: 1.006; 95% CI: 1.004-1.009; P = 0.044) were associated with the > 10% BMD increase. However, these results were not significant after adjustments for potential confounders. Moreover, the BMD values at the lumbar spine, femoral neck, femoral trochanter, Ward's triangle, and whole body after parathyroidectomy were significantly greater than those before the operation (P < 0.05). CONCLUSIONS: This study suggests that patient characteristics were not associated with the > 10% BMD increase. However, the BMD values of the femur and lumbar spine were significantly increased in symptomatic PHPT patients after parathyroidectomy.

Correlation between modified trochleocapitellar index and post-traumatic elbow stiffness in type C2-3 distal humeral fractures among adults.

BACKGROUND: The purpose of this study was to propose the modified trochleocapitellar index (mTCI), assess its reliability, and evaluate its correlation with post-traumatic elbow stiffness in type C2-3 distal humeral fractures among adults. METHODS: From January 2013 to June 2017, a total of 141 patients with type C2-3 distal humeral fractures were included. The mTCI was calculated as the ratio between the modified trochlear and capitellar angles relative to the humeral axis (mTCI-HA), lateral humeral line (mTCI-LHL), and medial humeral line (mTCI-MHL) from anteroposterior radiographs taken immediately after the operation. The patients were divided into group A (with elbow stiffness) and group B (without elbow stiffness) based on follow-up results. To determine risk factors for elbow stiffness, univariate and logistic regression analyses were performed on each radiographic parameter separately, together with other clinical variables. Interrater reliability was assessed for all measurements. RESULTS: Specific optimal ranges of value were identified for mTCI-HA (0.750-0.875), mTCI-LHL (0.640-1.060), and mTCI-MHL (0.740-0.900), beyond which the likelihood of elbow stiffness significantly increased (P < .001). By multivariate analysis, mTCI-HA (odds ratio [OR] 26.22, 95% confidence interval [CI] 3.39-203.07, P = .002), mTCI-LHL (OR 5.37, 95% CI 2.17-13.28, P < .001), and mTCI-MHL (OR 5.95, 95% CI 1.91-18.56, P = .002) values beyond the optimal ranges were identified as the independent risk factors for elbow stiffness. The interrater reliability of mTCI-HA, mTCI-LHL, and mTCI-MHL was 0.986, 0.983, and 0.987, respectively. CONCLUSION: The mTCI measurement method is reliable. Either too small or too large mTCI values were associated with post-traumatic elbow stiffness among adult patients with type C2-3 distal humeral fractures. The mTCI-HA showed a better predictive value than mTCI-LHL and mTCI-MHL.

[Progress on diagnosis and treatment of low transcondylar fractures of distal humerus].

Low transcondylar fractures of the distal humerus in adults is rarely seen and reported in literatures. It has a bimodal distribution in terms of age, affecting the elderly and younger patients. The fracture is characterized by a very low transverse intra-capsular and extra-articular fracture lines extending from the level of lateral epicondyle to medial epicondyle. Standard elbow plain films and CT scans are crucial and indispensable for diagnosis. Conservative treatment is suitable for undisplaced fractures, patients who are intolerant of anesthesia, or people with advanced dementia. Open reduction and internal fixation (ORIF) is preferred. Parallel and orthogonal plate fixation are widely adopted while some researchers preferred crisscross-type screw fixation or bicolumnar 90-90 plating. In addition, some customized posterolateral plates are specially designed to be able to insert a transverse screw, functioning as lateral support. However, most of the recent researches conducted on low transcondylar fractures of the distal humerus are retrospective studies with relatively lower level of evidence compared to prospective and randomized controlled ones which remain a vacancy in this field. Therefore, further studies comparing the biomechanical properties and clinical prognosis of different configurations of internal fixation or total elbow arthroplasty for the treatment of low transcondylar fractures are needed in the future.

Retrospective analysis of 514 cases of tibial plateau fractures based on morphology and injury mechanism.

BACKGROUND: Tibial plateau fractures remain a clinical challenge due to the complexity of the fracture patterns which have been repeatedly categorized by many researchers. However, limitations do exist in some respects. So we aimed to reclassify tibial plateau fractures based on injury mechanism and morphological characteristics. METHODS: Five hundred fourteen cases of tibial plateau fractures were enrolled. The X-rays and CT scans were analyzed. RESULTS: According to our observation and analysis, tibial plateau fractures can be categorized into the following six types: (1) Lateral condylar fractures (axial force applied while knee extending in valgus position). Two hundred fifty-one cases were included (48.83%). (2) Fracture dislocation (multiple forces especially rotational stress while knee extending). Fifty-five out of 514 cases belong to this pattern (10.70%). Correction of the subluxation remains primary and crucial during surgical procedures. (3) Simple medial condylar fractures (axial force applied while knee extending in varus position). One third of which were associated with an avulsion fracture of fibular head. Fifteen cases were included (2.92%). (4) Bicondylar fractures (axial forces applied while knee extending). One hundred twelve cases were included (21.79%). Surgical algorithm greatly depends on soft tissue conditions. (5) Posterior condylar fractures (axial stress applied while knee flexing). Sixty-five cases were seen in our study (12.65%), most of which were associated with an avulsion fracture of the intercondylar eminence (49/65, 75.38%). The fracture of posteromedial part, posterolateral part, and intercondylar eminence forms a unique pattern of injury defined as "Posterior Condylar Triad." (6) Anterior condylar compression fractures (axial, varus, or valgus forces applied while knee overextending). Posterior structural complexes, crucial ligaments, or even popliteal arteries are prone to be damaged. Sixteen cases were identified (3.11%). CONCLUSION: Our classification system has instructive significance in overall preoperative evaluation of fracture features and soft tissue problems as well as guiding clinical management for better functional outcomes.

[Is anterior transposition of ulnar nerve beneficial during open reduction and internal fixation for intercondylar humerus fractures].

OBJECTIVE: To compare activity, function and postoperative ulnar nerve function of elbow joint by anterior transposition of ulnar nerve or not during open reduction and internal fixation for intercondylar humerus fractures. METHODS: From January 2013 to May 2017, 168 patients with intercondylar humerus fractures were treated surgically with open reduction and internal fixation (ORIF). The patients were divided into anterior subcutaneous transposition group and simple decompression group according to handling method of ulnar nerve. There were 48 patients in transposition group, including 23 males and 25 females with an average age of (42.5±15.7) years old ranging from 14 to 77 years old, and ulnar nerve treated enough free and anterior subcutaneous transpostion after reduction of intercondylar humerus fractures; while there were 120 patients in simple decompression group, including 62 males and 58 females with an average age of (43.4±17.3) years old ranging from 14 to 81 years old, ulnar nerve returned to sulci nervi ulnaris. Activity of flexion and extension of elbow joint, range of rotation of forearm were recorded at the latest following-up, Mayo score of elbow joint was used to evaluate clinical effect, McGowan grading was used to assess dysfunction of unlnar nerve. RESULTS: There was 1 patient delayed union, and 2 patients occurred joint stiffness in transposition group; while 1 patient suffered from incision infection, 1 fracture nonunion, and 4 joint stiffness in simple decompression group; and there was no statistical difference between two groups(P>0.05). Forty-eight patients in transposition group were followed-up from 12 to 59 months with an average of (32.2±14.2) months, activity of flexion and extension of elbow joint was (116±28)°, range of rotation of forearm was (152±12)°, MEPS score was 88.6±11.6; and 28 patients got excellent results, 16 good, 3 moderate and 1 poor. There were 17 patients occurred injury of ulnar nerve, and 7 patients still occurred dysfunction of ulnar nerve, and 6 patients were grade I, 1 patient was grade II according to McGowan grading. In simple decompression group, there were 120 patients were followed-up from 13 to 61 months with an average of (32.0±14.9) months, activity of flexion and extension of elbow joint was (119±27)°, range of rotation of forearm was (154±16)°, MEPS score was 88.9±12.5; and 67 patients got excellent results, 44 good, 7 moderate and 2 poor. There were 42 patients occurred injury of ulnar nerve, and 22 patients still occurred dysfunction of ulnar nerve, and 18 patients were grade I, 4 patients were grade II according to McGowan grading. There were no statistical differences in following time, activity of flexion and extension of elbow joint, range of rotation of forearm, MEPS score and dysfunction of ulnar nerve. CONCLUSIONS: Whether anterior transposition of ulnar nerve or not has no clarified effects for open reduction and internal fixation for intercondylar humerus fractures.