A fully bio-based soy protein wood adhesive modified by citric acid with high water tolerance.

Despite the widespread application prospect of soybean meal flour (SF) as a non-toxic and renewable wood adhesive, the practical application is limited by its poor mechanical properties and water resistance. In this work, a novel SF-based wood adhesive (CSP) was developed using citric acid (CA) as a modifier, which was further designated to produce plywood on a laboratory scale. Moreover, the effects of the mass ratio of CA/SF, hot-pressing temperature, and hot-pressing time on the bonding properties and water resistance of the resulting plywood were investigated in detail. As a result, under the optimal hot-pressing conditions (180 °C, 5 min), high-performance plywood bonded by CSP (CA/SF = 15/100) adhesive was fabricated, whose dry shear strength, cold-water wet shear strength (20 °C for 24 h), and hot-water wet shear strength (63 °C for 3 h) reached 1.65 MPa, 1.99 MPa, and 1.58 MPa, respectively. Due to the easy preparation process, sustainability, and favorable properties, the proposed fully bio-based CSP wood adhesive has great potential for the large-scale fabrication of eco-friendly wood panels in industry.

Mesenchymal stem cells can improve discogenic pain in patients with intervertebral disc degeneration: a systematic review and meta-analysis.

Background: The meta-analysis aimed to estimate the efficacy of mesenchymal stem cells on lumbar discogenic pain in patients with intervertebral disc degeneration. Methods: A comprehensive literature search was conducted in the PubMed, Web of Science, Embase and Cochrane Library databases with predetermined search strategy up to 18 September 2022. The clinical studies focusing on evaluating the efficacy and safety of mesenchymal stem cells in patients with intervertebral disc degeneration were identified. The primary outcomes were changes of pain score and Oswestry Disability Index. The Newcastle-Ottawa Scale for cohort studies was used for quality assessment. Review Manager was used to conduct the statistical analysis. Pooled risk ratios were calculated based on the random effect model. Heterogeneity, subgroup, and publication bias analyses were also performed. Results: There were 2,392 studies were identified in the initial search, and 9 eligible studies with 245 patients were eventually included in this review. The Visual Analogue Scale score was significantly lower in patients after receiving mesenchymal stem cells therapy (mean difference = 41.62; 95% confidence interval 24.32 to 58.93; Heterogeneity: I2 = 98%; p < 0.01). And the pooled mean difference of Oswestry Disability Index was 22.04 from baseline to final follow-up points (95% confidence interval 8.75 to 35.33; p = 0.001; Heterogeneity: I2 = 98%; p < 0.001). The pooled reoperation proportion was 0.074 (95% confidence interval 0.009 to 0.175; Heterogeneity: I2 = 72%; p < 0.01). There were no serious related adverse events associated with the therapy. Conclusion: The findings of this meta-analysis indicated that mesenchymal stem cells therapy may be effective in relieving pain and improving Oswestry Disability Index significantly in patients with lumbar discogenic pain. Mesenchymal stem cells therapy may also be associated with a lower risk of adverse events and reoperation rates.

Potential side effects of antibacterial coatings in orthopaedic implants: A systematic review of clinical studies.

Objective: The systematic review aimed to determine the potential side effects of antibacterial coatings in orthopaedic implants. Methods: Publications were searched in the databases of Embase, PubMed, Web of Science and Cochrane Library using predetermined keywords up to 31 October 2022. Clinical studies reporting side effects of the surface or coating materials were included. Results: A total of 23 studies (20 cohort studies and three case reports) reporting the concerns about the side effects of antibacterial coatings were identified. Three types of coating materials, silver, iodine and gentamicin were included. All of studies raised the concerns regarding safety of antibacterial coatings, and the occurrence of adverse events was observed in seven studies. The main side effect of silver coatings was the development of argyria. For iodine coatings, only one anaphylactic case was reported as an adverse event. No systemic or other general side effects were reported for gentamicin. Conclusion: Clinical studies on the side effects of antibacterial coatings were limited. Based on the available outcomes, the most reported side effects of antibacterial coatings in clinical use were argyria with silver coatings. However, researchers should always pay attention to the potential side effects of antibacterial materials, such as systematic or local toxicity and allergy.

Does computer-assisted orthopaedics system (ADAPT system) improve outcomes of intertrochanteric hip fractures?

INTRODUCTION: Intramedullary nailing (IMN) is a general treatment for intertrochanteric hip fractures. The computer-assisted orthopaedics system (CAOS), ADAPT system (Stryker, NJ), has been developed to facilitate lag screw insertion. When compared to the conventional freehand method, the efficacy of CAOS has not been clearly clarified. Therefore, we conducted this systematic review and meta-analysis to answer: does the CAOS performed better than freehand method in IMN. MATERIALS AND METHODS: Studies published up to January 2023 were searched in the PubMed, Embase, Web of Science and Cochrane Library databases with predetermined key words. Comparative clinical studies between CAOS (ADAPT system) and freehand method were included. The primary outcomes of interest were the tip-apex-distance (TAD) and positions of lag screw. Fluoroscopy use, operation duration and intraoperative/postoperative complications were also extracted. A meta-analysis was performed for pooled analysis. RESULTS: There were seven studies with 326 fractures in CAOS group and 325 fractures in Freehand group. All studies included presented high qualities. The CAOS group showed a statistically smaller TAD than Freehand group (weighted mean difference = -3.24 mm; 95% confidence interval [CI] -5.10 to -1.37 mm; p = 0.0007) and a better lag screw position (83/92 [90.2%] VS 64/92 [69.6%]; RR = 1.3; 95% CI 1.12 to 1.51; p = 0.0007). The operative time and radiation use revealed no difference between two groups. CONCLUSIONS: The current evidence indicated that ADAPT system could help to perform a more accurate lag screw than freehand manipulation while the operative time and radiation time was not reduced as expectations on such new technique. Long-term follow-up studies are appealed.

The Global Research Status and Trends in Ice and Snow Sports Injuries from 1995 to 2022: A Bibliometric and Visualized Analysis.

OBJECTIVE: The aim of the present study is to focus on the most popular winter sports programs, and to investigate the global research status and trends in sports-related injuries. METHODS: The Web of Science (WoS) Core Collection database was chosen as original data and used for extracting publications on ice and snow sports injuries on 18 February 2022. Articles published in English between 1995 to 2022 were selected for this study. RESULTS: Finally, for the topic search, a sum of 1605 articles were extracted and used for further analysis. The country and journal ranked first-in terms of total number, total citations and the highest H-index of publications-were the USA and American Journal of Sports Medicine, respectively. The affiliation with the most cited publications was the Norwegian School of Sport Sciences. The most influential first author with the most citations (2537 times), the greatest average citations per article (65.05 times) and the highest H-index (26) was Bahr R. Articles were divided into five main clusters based on keyword analysis: injuries study, head and neck damage study, risk study, therapy study and epidemiology study. Studies related to epidemiology and brain damage in ice and snow sports will continue to be research hot topics. CONCLUSIONS: In conclusion, our study indicates that the ice and snow sports injuries research domain is more prevalent in North America and Europe. This study contributes to a comprehensive understanding of ice and snow sports injuries and provides hotspot directions.

Tannin-based wood adhesive with good water resistance crosslinked by hexanediamine.

As a biomass material, tannins are used in the preparation of wood adhesives, but their poor strength and water resistance has greatly limited their application. Therefore, it is necessary to prepare tannin-based wood adhesives with good water resistance. In the present study, tannin and hexanediamine were simply mixed at room temperature to prepare tannin-hexanediamine (TH) adhesive and then used to prepare plywood. Effects of mass ratio of hexanediamine to tannin and pH value of TH adhesive are studied. The results indicating the effects of mass ratio and pH value are apparent on shear strength. When the mass ratio is above 25 % and the pH value is above 9, the plywood shows good water resistance. Fourier transform-infrared (FTIR), X-ray photoelectron spectroscopy (XPS), liquid chromatography-mass spectrometry (LCMS) and X-ray diffraction (XRD) are used to determine the structures of TH adhesive, confirmed the reaction between tannin and hexanediamine to form macromolecules. Simultaneous thermal analyzer (TG-DSC) and Dynamic mechanical analysis (DMA) are used to analyze the thermal properties, indicate TH resin contains a good storage module and heat resistance. Therefore, with its good shear strength and water resistance, this newly developed tannin-based adhesive has the potential to application in wood-based panel industry, as an alternative of formaldehyde-based adhesive.

Clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds: A meta-analysis of randomised controlled trials.

Negative pressure wound therapy (NPWT) with or without instillation has been extensively applied for patients with multiple wound types. Whether NPWT with instillation is superior to NPWT alone is not known. This study aims to compare the efficacy between negative pressure wound therapy with instillation (NPWTi) and standard negative pressure wound therapy for wounds. The authors searched for randomised controlled trials (RCTs) in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials investigating clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds. The registration number (protocol) on PROSPERO is CRD42022287178. Eight RCTs involved 564 patients met the inclusion criteria and were included finally. NPWTi showed a significant fewer surgeries and dressing changes (RR and 95% CI, -9.31 [-17.54, -1.08], P < 0.05), and smaller wound area after treatment (RR and 95% CI, -9.31 [-17.54, -1.08], P < 0.05) compared with NPWT. No significant difference was observed on healing rate, time to heal, length of stay, dehiscence, reinfection, reoperation and readmission between NPWTi and NPWT. The addition of instillation to NPWT could improve clinical outcomes regarding the number of surgeries and dressing changes, and wound area after treatment in patients with multiple wound types. However, because of the heterogeneity these conclusions still need to be further validated by more well-designed RCTs with large sample sizes.

Morphometric feature description of the proximal ulna based on quantitative measurement: a key consideration for implant design.

PURPOSE: To perform quantitative measurements of the anatomic morphology of the proximal ulna and establish the morphologic references based on Chinese for the surgical protocol and implant design. METHODS: The computed tomography data of 156 upper extremities were involved in this study. The ulna model was reconstructed in Mimics. Ten distance and 6 angle parameters were measured by 4 independent investigators with a new quantitative measurement method. The intraclass correlation coefficient was used to evaluate the measuring reliability. Gender and side differences of measured parameters were evaluated. RESULTS: Measurements showed a mean coronoid height of 15 mm, which was 42% of ulnar height with gender-specific differences (mean 16 mm in men and 14 mm in women, P < 0.001). A mean unsupported anteromedial facet width of 8 mm was 61% of the coronoid anteromedial facet. A larger opening angle correlates to a larger olecranon-diaphysis angle (P < 0.001) and larger coronoid height (P = 0.001). A mean proximal ulna dorsal angulation of 4.7° is present in 80% of models at an average of 52 mm distal to olecranon tip. The average proximal ulna varus angulation was 16° at a mean of 74 mm distal to the olecranon tip. Morphological features between the left and right sides were highly consistent. The ICC was between 0.789 and 0.978 for inter-observer and between 0.696 and 0.997 for intra-observer reliability. CONCLUSIONS: The proximal ulna features variable morphology but minor side differences among individuals. Over half of the anteromedial facet was not supported by the proximal ulnar diaphysis, making the coronoid vulnerable to elbow trauma. Preconditioning or customized design of the ulnar plate in the clinical setting with the help of contralateral morphology may be a good choice.

Finite element analysis of different medial fixation strategies in double-plate osteosynthesis for AO type 33-C2 Femoral fractures.

OBJECTIVES: In this study, we evaluated the biomechanical characteristics of different locations of medial fixation strategies in double-plate osteosynthesis for fixing AO/ASIF type 33-C2 femoral fractures by means of finite element analysis. METHODS: We used 3-matic software and UG-NX software to construct AO/ASIF type 33-C2 Femoral fractures and lateral less invasive stabilization system (LISS) plates, medial plates (MPs), and medial support pads (MSPs), respectively. Then, the LISS, MP and MSP were assembled into the fracture model separately to form three fixation models: MSP+LISS, anteromedial plate (AMP+LISS), and MP+LISS. In the next procedure, we performed finite element analysis using ANSYS software after meshing the elements of the models in HyperMesh 11.0 software. Loading conditions including lateral-medial four-point bending, anterior-posterior four-point bending, axial loading, and torsional loading were applied to evaluate the biomechanical advantages among the three fixation types. We observed the peak Von Mises Stress (VMS) value, maximum displacement, bending angle in the coronal plane of the fracture, and torsional angle of the fracture to assess the degree of plate deformation and fixation stability. RESULTS: Our results showed that in both lateral-medial four-point bending and anterior-posterior four-point bending, the calculations of MP+LISS were marginally better than those of AMP+LISS. However, with the action of axial loading and torsional loading, the deformation of MP+LISS was distinctly smaller than that of AMP+LISS, and the fixation stability of MP+LISS was also prominently better. Under lateral-medial four-point bending, the VMS on the lateral plate of MSP+LISS (59.977 MPa) was approximately half of the two double-plate models. Under anterior and posterior four-point bending, the 38.209 MPa peak VMS of MSP+LISS was still superior to the other two double-plate models. Under torsional loading, the peak VMS (347.75 MPa), the maximum torsional angle of the femoral head (7.852 °), and the torsional angle of fracture (0.036 °) of MSP+LISS preceded those of the other two models. However, under axial loading, the peak VMS (76.376 MPa) and the maximum displacement (3.1798 mm) of MSP+LISS were slightly higher than those of MP+LISS. CONCLUSION: The MSP+LISS model showed better biomechanical performance than the double-plate models, which might be an effective solution for the treatment of comminuted distal femur fractures.

Prophylactic tamsulosin can reduce the risk of urinary retention after surgery in male patients: A systematic review and meta-analysis.

Objective: The meta-analysis aimed to estimate the efficacy of prophylactic tamsulosin on postoperative urinary retention (POUR) in male patients. Methods: Papers were searched in the PubMed, Embase, Web of Science, and Cochrane Library databases with predetermined keywords up to March 1, 2022. The studies reporting the preventive efficacy of prophylactic tamsulosin on POUR among men were identified. Pooled risk ratios (RRs) were calculated based on the random-effects model. Meta-regression was performed to explore potential sources of heterogeneity. Results: There were 11 studies with 1,046 patients in the tamsulosin group and 1,113 patients in the control group. The risk of POUR was significantly lower in the tamsulosin group (123/1,046 [11.8%] vs. 238/1,119 [19.0%]; RR = 0.61; 95% confidence interval [CI] 0.43 to 0.87; P = 0.006; heterogeneity: I 2 = 57%; P = 0.009). Administration of tamsulosin was related to higher risk of adverse events (57/688 [8.3%] vs. 33/624 [5.3%]; RR = 1.68; 95% CI: 1.13 to 2.48; P = 0.010; heterogeneity: I 2 = 33%; P = 0.20). The level of evidence and mean age of the included patients were identified as the potential sources of heterogeneity. Conclusion: The present meta-analysis indicated that prophylactic tamsulosin helps in preventing POUR and younger patients might benefit more from this preventive regimen. Administrating tamsulosin was also associated with a possibly higher risk of adverse events.

3D Printing and Computer-Aided Design for Precision Osteotomy-Aided Modules in Bone Biomechanical Study.

Precise and shape-matching osteotomy models are determinants of the experimental homogeneity in the assessment of orthopedic biomechanical properties. At present, however, publications on detailed description of osteotomy in bone biomechanical study are scanty. The purposes of this study were to design a new method of osteotomy-aided module production for bone biomechanical study with the help of three-dimensional (3D) printing and computer-aided design (CAD) and to test the accuracy of osteotomy. Fourteen fourth-generation composite femurs were analyzed. The composite bone was scanned using computed tomography (CT) scanner and loaded in Mimics for reconstruction and, then, imported into 3-Matic software to design intertrochanteric region, distal femur, and rotation control lever models. 3D printer was used to print each component. After assembling Sawbones and osteotomy modules, a horizontal band-saw was used to create fracture models. The volume and mass of intermediate fragments were calculated and analyzed. Satisfactory osteotomies of all composite Sawbones were achieved. The mean volume and mass of intermediate fragments were 21.0 ± 1.5 mm3 and 19.0 ± 1.2 g, respectively. Range of deviation from average of volumes was -1.9 - 2.8 mm3 and most of these deviations fall within the range of -1.4 - 2.1 mm3. Range of deviation from average of mass was -2.0 - 1.6 g and most of these deviations fall within the range of -1.4 - 1.6 g. One-dimensional histogram of deviation from average shows the precise and stable osteotomy performed based on the modules accordingly. A new method of osteotomy-aided module production for bone biomechanical study with the help of 3D printing and CAD was designed and the accuracy of osteotomy was verified. This method is expected to achieve homogeneity and standardization of osteotomy in bone biomechanical study.

Investigation of Novel Thermosetting Copolymer-Based Monomethylolurea-Glyoxal for Wood Manufacturing.

The purpose of this investigation was to design novel alternating copolymers (monomethylolurea-glyoxal, MMU-G) as adhesives for wood manufacturing. MMU-G were synthesized under acid (pH = 5) conditions. After the 120-day storage period, the MMU-G resins were used for plywood production, which exhibited a wet shear strength of about 2.15 MPa, similar to the freshly prepared MMU-G resin. The excellent water resistance and long storage stability showed that MMU-G has particular characteristics and properties all of their own, which, in certain respects, are very different from those of urea-formaldehyde (UF) adhesives. The X-ray diffraction results showed that only a few crystallinities occurred in MMU-G resins, indicating the presence of long side chains in the MMU-G polymer structures, leading to better adhesion strength than UF resins. The structure characteristics of the MMU-G resin were studied by Fourier transform infrared and electrospray ionization mass spectrometry, and a possible molecular structure has been inferred, which is consistent with spectroscopic results.

Triangular Mechanical Structure of the Proximal Femur.

OBJECTIVE: The mechanical high modulus structure of the proximal femur could guide clinical surgical treatment and instrument design of proximal femoral fractures. The purpose of this study is to analyze and verify the mechanical structure of the proximal femur. METHODS: A total of 375 patients with intertrochanteric fractures were imaged using computed tomography (CT) scans. Patients were grouped according to age and sex. Cortical and medullary cavity parameters (cortical thickness [CTh], cortical mean density [CM], upper-lower diameter length [ULL], and medial-lateral diameter length [MLL]) were measured at eight planes. Six proximal femoral finite element models of different sexes and ages were constructed. To verify the measurement results, Abaqus was used to implement the force load to describe the von Mises stress distribution, and the maximum von Mises stress values of each wall of the proximal femur were compared. RESULTS: The CTh values of the lower and upper walls were higher than those of the anterior and posterior walls of the femoral neck (p < 0.05). The CM values of the lower and upper walls were higher than those of the anterior and posterior walls of the subcephalic and middle femoral neck (p < 0.05). The ULL value gradually increased from the subcephalic region to the bottom (p < 0.05). The CTh and CM values of the medial and lateral walls were higher than those of the anterior and posterior walls in the femoral trochanteric region (p < 0.05). The MLL value decreased gradually from the plane 20 mm above the upper edge to that 20 mm below the vertex of the femoral lesser trochanter (p < 0.05). The von Mises stress was concentrated on the upper and lower walls of the femoral neck and on the medial and lateral walls of the femoral trochanteric region. The maximum von Mises stress values of the upper and lower walls were higher than those of the anterior and posterior walls of the femoral neck. The maximum von Mises stress values of the medial and lateral walls were higher than those of the anterior and posterior walls in the femoral trochanteric region, except for the plane 20 mm above the upper edge of the femoral lesser trochanter. CONCLUSION: The bone mass of the proximal femur presented a triangular high-modulus distribution, which bore the main stress of the proximal femur. The triangular mechanical structure provides a guideline for the surgical strategy and instrument design of the proximal femur.

Classification of coronoid process fractures: A pending question.

Ulna coronoid fracture is a complicated elbow injury. Comprehensive classification of coronoid fracture can assist diagnosis, guide treatment, and improve prognosis. Existing coronoid fracture classifications are insufficient to interpret all fracture patterns. The coronoid fracture classification is associated with elbow-specific trauma patterns. Coronoid fractures are often associated with other elbow injuries, commonly with radial head fractures, which makes the clinical strategies inconsistent and prognosis poor. The current fracture classifications do not contain information about combined injuries. Preservation of ulnohumeral joint contact after trauma is critical to elbow mechanical and kinematic stability. Important fracture types for treatment include terrible-triad injuries and anteromedial facet fractures. Open reduction and internal fixation of these two fractures should be conducted when marked displacement of the fragment, elbow instability under stress, and complicated associated injuries. The current surgical tactics based on classifications are still controversial.

A Green Resin Wood Adhesive from Synthetic Polyamide Crosslinking with Glyoxal.

Glyoxal is considered to be the most likely substitute for formaldehyde to synthesize resin adhesives for wood bonding due to its reactivity, structural characteristics, being non-toxic, low volatility, and acceptable cost. Regrettably, the performance of the resin synthesized using glyoxal to directly replace all formaldehyde is not totally satisfactory, especially as it has almost no water resistance. This makes such a simple alternative fail to be suitable for industrial production. To prepare an environment-friendly glyoxal-based adhesive with good bonding performance, the work presented here relies first on reacting citric acid and hexamethylene diamine, producing a polyamide, with glyoxal, and then crosslinking it, thus synthesizing a thermosetting resin (namely CHG) adhesive and applying it for plywood bonding. The plywood prepared exhibits excellent dry and wet shear strength, which are better than GB/T9846-2015 standard requirements (≥0.7 MPa), and even after being soaked in hot water at 63 °C for 3 h, its strength is still as high as 1.35 MPa. The CHG resin is then potentially an adhesive for industrial application for replacing UF (urea-formaldehyde) and MUF (melamine-urea-formaldehyde) adhesives for wood composites.

The Global Status of Research in Ankle Fracture: A Bibliometric and Visualized Study.

Background: Ankle fractures are common lower extremity fractures that pose a significant economic and social burden. This study analyzed the ankle fracture research literature between 2000 and 2021 to clarify the current status of ankle fracture research and predict future research trends. Methods: Publications related to ankle fractures published between 2000 and 2021 were retrieved from the Web of Science Core Collection. Then Bibliometric analysis and Visualized Study were performed by VOSviewer software. Results: A total of 2656 publications were retrieved. The number of publications related to ankle fractures is increasing every year. The top countries and journals in terms of the total number of publications, number of citations, and H-index ranking were USA and foot and ankle int. Lorich DG had the most publications in this field. University of Amsterdam's research group had the biggest number of publications in this field. Co-occurrence analysis clustered the keywords into seven clusters: survival analysis and prognosis study, internal fixation treatment study, treatment study of combined deltoid ligament rupture, treatment study of combined inferior tibiofibular ligament injury, treatment study of posterior ankle fracture, treatment study of postoperative traumatic arthritis of ankle fracture, and treatment study of ankle injury in children. Conclusions: The importance of ankle fractures is increasing year by year with the aging process, and the number of publications related to ankle fractures will not continue to increase in the future. Survival and prognosis studies, internal fixation studies, combined deltoid ligament rupture studies, and combined inferior tibiofibular ligament injury studies may become the future research hotspots in the field of ankle fractures.

Evaluation of Ankle Fractures in 228 Patients From a Single Center Using Three-Dimensional Computed Tomography Mapping.

Purpose: The ankle joint has a complex anatomy structure with many causative factors and various injury mechanisms, and the clinical presentation of ankle fractures is diverse. This study aimed to analyze the characteristics of ankle fractures by applicating three-dimensional fracture line mapping technique. Methods: A retrospective study was conducted on 228 patients with ankle fractures. Three-dimensional reconstruction was performed by CT images and the fracture reconstruction model was superimposed onto a standard model of the tibiofibula for fracture line drawing. Then the fracture lines were converted into a three-dimensional coordinate point data set. And the fracture line maps as well as the fracture line heat maps were generated in 3-Matic software and Unigraphics NX software, respectively. Results: The dense area of the fibular fracture lines was located above the tibiofibular joint ligament and wrapped obliquely around the distal fibula from the anterior edge of the fibular neck. The fibular fracture line could be divided into three categories according to the degree of denseness. The dense area of the tibial fracture line is located within the anterior tibial fornix, the anterolateral corner, and the fibular notch. The tibial fracture lines can be classified into four categories according to the density of the fracture lines. The combined medial malleolus + posterior malleolar fracture line situation was found to be not encompassed by the existing AO and Lauge-Hansen (LH) classification systems according to this classification. Conclusion: The 3D fracture line mapping technique can better reflect the distribution of ankle fracture lines and could help to establish a new ankle fracture typing system in the future.

Prediction of osteoporosis from proximal femoral cortical bone thickness and Hounsfield unit value with clinical significance.

Background: Utilizing dual-energy x-ray absorptiometry (DXA) to assess bone mineral density (BMD) was not routine in many clinical scenarios, leading to missed diagnoses of osteoporosis. The objective of this study is to obtain effective parameters from hip computer tomography (CT) to screen patients with osteoporosis and predict their clinical outcomes. Methods: A total of 375 patients with hip CT scans for intertrochanteric fracture were included. Among them, 56 patients possessed the data of both hip CT scans and DXA and were settled as a training group. The cortical bone thickness (CTh) and Hounsfield unit (HU) values were abstracted from 31 regions of interest (ROIs) of the proximal femur. In the training group, the correlations between these parameters and BMD were investigated, and their diagnostic efficiency of osteoporosis was assessed. Finally, 375 patients were divided into osteoporotic and nonosteoporotic groups based on the optimal cut-off values, and the clinical difference between subgroups was evaluated. Results: The CTh value of ROI 21 and the HU value of ROI 14 were moderately correlated with the hip BMD [r = 0.475 and 0.445 (p < 0.001), respectively]. The best diagnostic effect could be obtained by defining osteoporosis as CTh value < 3.19 mm in ROI 21 or HU value < 424.97 HU in ROI 14, with accuracies of 0.821 and 0.883, sensitivities of 84% and 76%, and specificities of 71% and 87%, respectively. The clinical outcome of the nonosteoporotic group was better than that of the osteoporotic group regardless of the division criteria. Conclusion: The CTh and HU values of specific cortex sites in the proximal femur were positively correlated with BMD of DXA at the hip. Thresholds for osteoporosis based on CTh and HU values could be utilized to screen osteoporosis and predict clinical outcomes.

Comparative study of anatomical locking plate and reconstruction plate in treating acetabular fractures.

PURPOSE: This study aims to compare the effectiveness of anatomic locking plate and reconstruction plate used in treating acetabular fractures. METHODS: From January 2009 to January 2016, patients with acetabular fractures were included in this retrospective study. We grouped the patients into two groups based on the internal fixation: reconstruction plate group (RPG) and anatomic locking plate group (ALPG). The operation time, blood loss, intra-operative screw penetration, and plate breakage were compared between the two groups. The intra-operative fluoroscopic images were used to evaluate the fixation location. The quality of reduction and radiological grading were assessed according to the criteria developed by Matta. The clinical assessment was based on the Merle d'Aubigne-Postel score. RESULTS: Eighty-three patients were included in this study and were followed up for an average of 35 months (range, 25 to 42 months). Thirty-five patients were treated with the anatomical locking plate, and 48 patients were treated with the reconstruction plate. The mean surgical time was significantly shorter (P < 0.0001) in ALPG patients than in RPG patients, and the intra-operative blood loss was significantly lower (P = 0.008). The rates of intra-operative screw penetration or plate breakage in the ALPG (0/35) are significantly lower than that in the RPG (7/48) (P = 0.018). Post-operative Matta score (P = 0.905), Merle d'Aubigne-Postel score (P = 0.957), and overall complication rates (P = 0.391) were not significantly different among the groups. CONCLUSION: Patients treated by anatomical locking plate had shorter operation time, less bleeding, and lower rate screw perforation compared to patients treated by reconstruction plate. Anatomical locking plate is a better choice for acetabulum fractures, especially complicated fractures.