Angioinvasive Mucormycosis Mimicking Mass and Pulmonary Thromboembolism in a Patient with Myelodysplastic Syndrome: A Case Report.

Mucormycosis encompasses a range of fungal infections that can impact various organs. Although pulmonary mucormycosis is relatively rare, it poses a significant threat, particularly to individuals with compromised immune systems. Pulmonary mucormycosis presents with various radiological manifestations. Notably, the involvement of the angioinvasive pulmonary artery in pulmonary mucormycosis cases has seldom been documented. In this report, we showcase the radiological characteristics of angioinvasive mucormycosis, which can mimic pulmonary thromboembolism or a pulmonary artery tumor, in a patient diagnosed with myelodysplastic syndrome.

Assessing the impact and implications of the revised Act on the Aggravated Punishment of Specific Crimes in preventing child traffic injuries in school zones: an interrupted time series analysis.

In 2019, a child's death in Korea led to stricter penalties for school zone traffic violations. We assessed the impact using 2017-2022 Traffic Accident Analysis System data. Adjusted analyses revealed a decline in severe injuries in school zones (11 → 8 cases per month, P=0.017). Legislation correlated with reduced risk of all child traffic injuries (RR=0.987, 95% CI, 0.977-0.997, P=0.002), indicating efficacy in curbing accidents.

Antenatal care inequalities in South Korea: An analysis of health insurance claims data (2013-2022) in a high-resource, high-use country.

OBJECTIVE: The aim of the present study was to explore inequalities in antenatal care (ANC) in South Korea. Based on the guidelines of the WHO, we categorized less than eight visits to an obstetrical facility as insufficient ANC. We examined ANC inequalities associated with age, disability, nationality, income, and geographic accessibility. METHODS: We extracted delivery event claimed from 2013 to 2022 from the National Health Insurance Service database. By tracing back 270 days from the delivery date, we counted the number of antenatal visits for each childbirth and calculated the proportion of women with insufficient ANC and assessed both absolute and relative inequalities for each population group. The logistic regression analysis for both underuse and overuse of ANC were conducted. RESULTS: Out of 3 416 517 childbirths, 104 109 women (3.0%) had fewer than eight ANC visits. Although the average number of ANC visits reached 18.7 in 2022, significant inequalities persisted across different population groups. The insufficient ANC rate was 28.1% for teenage women, 6.4% for disabled women, 10.7% for non-Korean women, and 15.2% for dependents of medical aid households. Women with low income and those living in obstetric care underserved areas also exhibited higher ANC insufficiency. From 2021 to 2022, sufficiency in ANC decreased for teenage, disabled, and non-Korean women, highlighting the effects of the COVID-19 pandemic. CONCLUSION: Antenatal care inequalities are evident in South Korea's well-resourced health system. There is a need for further investigation into these disparities and the qualitative aspects of maternity care services.

Connecting the S2 alar-iliac screw head to the satellite rod for surgical correction of degenerative sagittal imbalance.

PURPOSE: The S2AI screw technique has several advantages over the conventional iliac screw fixation technique. However, connecting the S2AI screw head to the main rod is difficult due to its medial entry point. We introduce a new technique for connecting the S2AI screw head to a satellite rod and compare it with the conventional method of connecting the S2AI screw to the main rod. METHODS: Seventy-four patients who underwent S2AI fixation for degenerative sagittal imbalance and were followed up for ≥ 2 years were included. All the patients underwent long fusion from T9 or T10 to the pelvis. The S2AI screw head was connected to the satellite rod (SS group) in 43 patients and the main rod (SM group) in 31 patients. In the SS group, the satellite rod was placed medial to the main rod and connected by the S2AI screw and domino connectors. In the SM group, the main rod was connected directly to the S2AI screw head and supported by accessory rods. Radiographic and clinical outcomes were evaluated in both groups. RESULTS: There were no significant differences in postoperative complications, including proximal junctional failure, proximal junctional kyphosis, rod breakage, screw loosening, wound problems, and infection between the two groups. Furthermore, the correction power of sagittal deformity and clinical results in the SS group were comparable to those in the SM group. CONCLUSION: Connecting the S2AI screw to the satellite rod is a convenient method comparable to the conventional S2AI connection method in terms of radiological and clinical outcomes.

Development and Validation of a Robust and Interpretable Early Triaging Support System for Patients Hospitalized With COVID-19: Predictive Algorithm Modeling and Interpretation Study.

BACKGROUND: Robust and accurate prediction of severity for patients with COVID-19 is crucial for patient triaging decisions. Many proposed models were prone to either high bias risk or low-to-moderate discrimination. Some also suffered from a lack of clinical interpretability and were developed based on early pandemic period data. Hence, there has been a compelling need for advancements in prediction models for better clinical applicability. OBJECTIVE: The primary objective of this study was to develop and validate a machine learning-based Robust and Interpretable Early Triaging Support (RIETS) system that predicts severity progression (involving any of the following events: intensive care unit admission, in-hospital death, mechanical ventilation required, or extracorporeal membrane oxygenation required) within 15 days upon hospitalization based on routinely available clinical and laboratory biomarkers. METHODS: We included data from 5945 hospitalized patients with COVID-19 from 19 hospitals in South Korea collected between January 2020 and August 2022. For model development and external validation, the whole data set was partitioned into 2 independent cohorts by stratified random cluster sampling according to hospital type (general and tertiary care) and geographical location (metropolitan and nonmetropolitan). Machine learning models were trained and internally validated through a cross-validation technique on the development cohort. They were externally validated using a bootstrapped sampling technique on the external validation cohort. The best-performing model was selected primarily based on the area under the receiver operating characteristic curve (AUROC), and its robustness was evaluated using bias risk assessment. For model interpretability, we used Shapley and patient clustering methods. RESULTS: Our final model, RIETS, was developed based on a deep neural network of 11 clinical and laboratory biomarkers that are readily available within the first day of hospitalization. The features predictive of severity included lactate dehydrogenase, age, absolute lymphocyte count, dyspnea, respiratory rate, diabetes mellitus, c-reactive protein, absolute neutrophil count, platelet count, white blood cell count, and saturation of peripheral oxygen. RIETS demonstrated excellent discrimination (AUROC=0.937; 95% CI 0.935-0.938) with high calibration (integrated calibration index=0.041), satisfied all the criteria of low bias risk in a risk assessment tool, and provided detailed interpretations of model parameters and patient clusters. In addition, RIETS showed potential for transportability across variant periods with its sustainable prediction on Omicron cases (AUROC=0.903, 95% CI 0.897-0.910). CONCLUSIONS: RIETS was developed and validated to assist early triaging by promptly predicting the severity of hospitalized patients with COVID-19. Its high performance with low bias risk ensures considerably reliable prediction. The use of a nationwide multicenter cohort in the model development and validation implicates generalizability. The use of routinely collected features may enable wide adaptability. Interpretations of model parameters and patients can promote clinical applicability. Together, we anticipate that RIETS will facilitate the patient triaging workflow and efficient resource allocation when incorporated into a routine clinical practice.

Comparison of Partial Versus Superficial or Total Parotidectomy for Superficial T1-2 Primary Parotid Cancers.

OBJECTIVES: This study aimed to compare the oncological outcomes of partial versus superficial or total parotidectomy for superficial T1 or T2 primary parotid cancers and investigate their prognostic factors and recurrence patterns. METHODS: The medical records of 77 patients with T1-2 primary parotid malignancies between May 2003 and March 2022 were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the prognostic factors associated with overall survival, disease-free survival, and local and distant recurrence. RESULTS: The average follow-up duration was 70.2 months (range, 12-202 months). The 5-year overall and disease-free survival rates were 88.7% and 77.1%, respectively. Twenty-two patients underwent partial parotidectomy, and 55 underwent superficial or total parotidectomy. There were no significant differences in the disease recurrence (P=0.320) and mortality rates (P=0.884) of the partial and superficial or total parotidectomy groups. The mean duration of surgery was shorter and the overall complication rates were significantly lower in the partial group than in the superficial or total parotidectomy group (P=0.049). Sixteen cases of recurrence occurred during the study period (20.8%). Univariate analyses showed that high-grade tumors (P=0.006), lymphovascular invasion (P=0.046), and regional lymph node metastasis (P=0.010) were significant risk factors for disease recurrence. Multivariate analysis identified regional lymph node metastasis as an independent prognostic factor for disease recurrence (P=0.027), and lymphovascular invasion as an independent prognostic factor for overall survival (P=0.033). CONCLUSION: The conservative surgical approach of partial parotidectomy can yield oncological outcomes comparable to those of superficial or total parotidectomy with careful patient selection in T1-2 parotid cancers.

Current Trends in Artificial Intelligence-Assisted Spine Surgery: A Systematic Review.

This systematic review summarizes existing evidence and outlines the benefits of artificial intelligence-assisted spine surgery. The popularity of artificial intelligence has grown significantly, demonstrating its benefits in computer-assisted surgery and advancements in spinal treatment. This study adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a set of reporting guidelines specifically designed for systematic reviews and meta-analyses. The search strategy used Medical Subject Headings (MeSH) terms, including "MeSH (Artificial intelligence)," "Spine" AND "Spinal" filters, in the last 10 years, and English- from January 1, 2013, to October 31, 2023. In total, 442 articles fulfilled the first screening criteria. A detailed analysis of those articles identified 220 that matched the criteria, of which 11 were considered appropriate for this analysis after applying the complete inclusion and exclusion criteria. In total, 11 studies met the eligibility criteria. Analysis of these studies revealed the types of artificial intelligence-assisted spine surgery. No evidence suggests the superiority of assisted spine surgery with or without artificial intelligence in terms of outcomes. In terms of feasibility, accuracy, safety, and facilitating lower patient radiation exposure compared with standard fluoroscopic guidance, artificial intelligence-assisted spine surgery produced satisfactory and superior outcomes. The incorporation of artificial intelligence with augmented and virtual reality appears promising, with the potential to enhance surgeon proficiency and overall surgical safety.

[Primary Malignant Peripheral Nerve Sheath Tumor of the Pulmonary Vein: A Case Report]. / íì •ë§¥ì˜ 원발성 ì• ì„± ë§ì´ˆì‹ ê²½ì´ˆì¢ : 증례 ë³´ê³ .

Primary masses rarely originate from the heart and great vessels, and a malignant peripheral nerve sheath tumor (MPNST) is extremely rare. A 76-year-old male with pleural effusion underwent contrast-enhanced computed tomography, which revealed a hypoattenuating mass involving the right pulmonary vein and left atrium. Ultrasonography showed that the mass originated from the right pulmonary vein. Surgical resection confirmed an MPNST that originated from the pulmonary vein. We report the first Korean case of a primary MPNST originating from the pulmonary vein. We have also described the radiologic findings suggestive of a pulmonary vein mass.

Insidious Onset Multifocal Chest Wall and Spinal Abscess Caused by Previous Candidemia: A Case Report.

Abscess formation due to Candida albicans infection is extremely rare. Radiological diagnosis of an atypical abscess at an uncommon site is challenging. In this study, we present a case of insidious onset multifocal chest wall and spinal abscess after candidemia in a young woman in the intensive care unit due to postpartum bleeding.

Erratum: Correction of Affiliations in the Article "Establishment of a Nationwide Korean Imaging Cohort of Coronavirus Disease 2019".

This corrects the article on p. e413 in vol. 35, PMID: 33258333.

Correction: Deep Learning With Chest Radiographs for Making Prognoses in Patients With COVID-19: Retrospective Cohort Study.

[This corrects the article DOI: 10.2196/42717.].

Enhanced Cholesterol-Lowering and Antioxidant Activities of Soymilk by Fermentation with Lactiplantibacillus plantarum KML06.

This study aimed to evaluate the cholesterol-lowering and antioxidant activities of soymilk fermented with probiotic Lactobacillaceae strains and to investigate the production of related bioactive compounds. Lactiplantibacillus plantarum KML06 (KML06) was selected for the fermentation of soymilk because it has the highest antioxidant, cholesterol-lowering, and ß-glucosidase activities among the 10 Lactobacillaceae strains isolated from kimchi. The genomic information of strain KML06 was analyzed. Moreover, soymilk fermented with KML06 was evaluated for growth kinetics, metabolism, and functional characteristics during the fermentation period. The number of viable cells, which was similar to the results of radical scavenging activities and cholesterol assimilation, as well as the amount of soy isoflavone aglycones, daidzein, and genistein, was the highest at 12 h of fermentation. These results indicate that soymilk fermented with KML06 can prevent oxidative stress and cholesterol-related problems through the production of soy isoflavone aglycones.

Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Myelopathy: Complications and Pitfalls.

OBJECTIVE: This retrospective cohort study has been aimed at evaluating the incidence of complications after vertebral body sliding osteotomy (VBSO) and analyzing some cases. Furthermore, the complications of VBSO were compared with those of anterior cervical corpectomy and fusion (ACCF). METHODS: This study included 154 patients who underwent VBSO (n = 109) or ACCF (n = 45) for cervical myelopathy and were followed up for > 2 years. Surgical complications, clinical and radiological outcomes were analyzed. RESULTS: The most common surgical complications after VBSO were dysphagia (n = 8, 7.3%) and significant subsidence (n = 6, 5.5%). There were 5 cases of C5 palsy (4.6%), followed by dysphonia (n = 4, 3.7%), implant failure (n = 3, 2.8%), pseudoarthrosis (n = 3, 2.8%), dural tears (n = 2, 1.8%), and reoperation (n = 2, 1.8%). C5 palsy and dysphagia did not require additional treatment and spontaneously resolved. The rates of reoperation (VBSO, 1.8%; ACCF, 11.1%; p = 0.02) and subsidence (VBSO, 5.5%; ACCF, 40%; p < 0.01) were significantly lower in VBSO than in ACCF. VBSO restored more C2-7 lordosis (VBSO, 13.9° ± 7.5°; ACCF, 10.1° ± 8.0°; p = 0.02) and segmental lordosis (VBSO, 15.7° ± 7.1°; ACCF, 6.6° ± 10.2°; p < 0.01) than ACCF. The clinical outcomes did not significantly differ between both groups. CONCLUSION: VBSO has advantages over ACCF in terms of low rate of surgical complications related to reoperation and significant subsidence. However, dural tears may still occur despite the lessened need for ossified posterior longitudinal ligament lesion manipulation in VBSO; hence, caution is warranted.

Network analysis of osteoporosis provides a global view of associated comorbidities and their temporal relationships.

We performed comorbidity-network analysis to obtain global view of comorbidity related with osteoporosis. We selected 10000-patients with osteoporosis registered in the National-Health-Insurance Service cohort-database. We found 45-significant disease-clusters. Of these, 14-disease-clusters were related to fra, while 10 were related to musculoskeletal diseases. Our findings will serve as basic data for further studies. PURPOSE: Osteoporosis causes devastating fractures; however, its exact etiology remains unknown. Elucidating associated comorbidities and their temporal relationships could provide better insights into its pathogenesis. Comorbidity-network analysis was performed to obtain global view of these associations. METHODS: We randomly selected 10000-patients with osteoporosis registered in the National-Health-Insurance Service cohort-database. These patients were identified using ICD-10 codes M81-M82, which represent osteoporosis without pathological fractures. Control group was created through propensity score matching. The comorbidities in each group were grouped into similar classifications to form "disease cluster"; 126 such clusters were identified. To create a comorbidity network, we selected disease clusters with high associations (i.e., odds ratios and relative risks ranked in the upper 50th percentile). To identify the temporal relationships between these clusters and osteoporosis, trajectories of directions were identified. RESULTS: Finally, we found 45 significant disease clusters. Of these, 14 disease clusters were related to fractures or injuries, while 10 were related to musculoskeletal diseases. Temporal analysis revealed that 15 disease clusters preceded osteoporosis; these included the following three with the strongest associations: "other fracture", "disorders of bone density and structure (M83-M85)", and "sequelae of injuries of neck and trunk (T91)". Thirty disease clusters followed osteoporosis; these included the following three with the strongest associations: "spine fracture," "spondylopathies (M45-M49)", and "pelvic region and thigh fracture,". CONCLUSION: We obtained a global view of the osteoporosis comorbidity network, which is otherwise difficult to achieve through study of individual diseases. Our findings will serve as the basic data for further studies.

Surgical complications and incomplete canal widening of the vertebral body sliding osteotomy to treat cervical myelopathy.

OBJECTIVE: Vertebral body sliding osteotomy (VBSO) is a surgical technique that anteriorly translates the vertebral body with compressive lesions and achieves cord decompression through canal widening. However, data on the surgical complications of VBSO are lacking. Furthermore, it has not been known whether VBSO could be a viable alternative in the treatment of cervical myelopathy even when the preoperative canal-occupying ratio (COR) is large, which seems to frequently result in incomplete canal widening. This study aimed to describe the incidence of VBSO-associated surgical complications and to evaluate the incidence and risk factors of incomplete canal widening. METHODS: A total of 109 patients who underwent VBSO to treat cervical myelopathy were retrospectively reviewed. Neck pain visual analog scale, Neck Disability Index, Japanese Orthopaedic Association (JOA) scores, and surgical complications were evaluated. For radiological evaluation, C2-7 lordosis, C2-7 sagittal vertical axis, and COR were measured. Patients with a preoperative COR < 50% (n = 60) and those with a COR ≥ 50% (n = 49) were compared and logistic regression analysis was performed to identify factors associated with incomplete canal widening. RESULTS: The most frequent complication in the patients was mild dysphagia (7.3%). Dural tears were observed during posterior longitudinal ligament resection (n = 1) and foraminotomy (n = 1). Two patients underwent reoperation due to radiculopathy from adjacent-segment disease. Incomplete canal widening occurred in 49 patients. According to logistic regression analysis, high preoperative COR was the only factor associated with incomplete canal widening. The amount of canal widening and JOA recovery rate in the COR ≥ 50% group were significantly higher than in the COR < 50% group. CONCLUSIONS: Mild dysphagia was the most common complication following VBSO. Although VBSO aims to decrease the complication rate of corpectomy, it was not free of dural tears. Special care would be required during the posterior longitudinal ligament resection. Incomplete canal widening occurred in 45.0% of patients, and high preoperative COR was the only risk factor for incomplete canal widening. However, high preoperative COR would not be a contraindication for VBSO, given that favorable clinical outcomes were presented in the COR ≥ 50% group.

CT-based three-dimensional invasiveness analysis of adenocarcinoma presenting as pure ground-glass nodules.

Background: We invest computed tomography (CT) image differences between non-invasive adenocarcinomas (NIAs) and invasive adenocarcinomas (IAs) presenting as pure ground glass nodules (GGNs). Methods: From 2013 to 2019, 48 pure GGNs were surgically resected in 45 patients. Of these, 40 were pathologically diagnosed as non-small cell lung cancers (NSCLCs). We assessed them using the Synapse Vincent (Fujifilm Co., Ltd., Tokyo, Japan) three-dimensional (3D) analysis system; we drew histograms of the CT densities. We calculated the maximum, minimum, means, and standard deviations of the densities. The proportions of GGNs of high CT density were compared between the two groups. The diagnostic performance was investigated via receiver operating curve (ROC) analysis. Results: Of the 40 pure GGNs, 20 were NIAs (4 adenocarcinomas in situ and 16 minimally IAs) and 20 IAs. Significant correlations were evident between histological invasiveness and the maximum and mean CT densities and the standard deviation. Neither the nodule volume nor the minimum CT density significantly predicted invasiveness. A CT volume density proportion >-300 Hounsfield units optimally predicted the invasiveness of pure GGNs; the cutoff was 5.41% with a sensitivity of 85% and a specificity of 95%. Conclusions: CT density reflected the invasiveness of pure GGNs. A CT volume proportion density >-300 Hounsfield units may significantly predict histological invasiveness.

Deep Learning With Chest Radiographs for Making Prognoses in Patients With COVID-19: Retrospective Cohort Study.

BACKGROUND: An artificial intelligence (AI) model using chest radiography (CXR) may provide good performance in making prognoses for COVID-19. OBJECTIVE: We aimed to develop and validate a prediction model using CXR based on an AI model and clinical variables to predict clinical outcomes in patients with COVID-19. METHODS: This retrospective longitudinal study included patients hospitalized for COVID-19 at multiple COVID-19 medical centers between February 2020 and October 2020. Patients at Boramae Medical Center were randomly classified into training, validation, and internal testing sets (at a ratio of 8:1:1, respectively). An AI model using initial CXR images as input, a logistic regression model using clinical information, and a combined model using the output of the AI model (as CXR score) and clinical information were developed and trained to predict hospital length of stay (LOS) ≤2 weeks, need for oxygen supplementation, and acute respiratory distress syndrome (ARDS). The models were externally validated in the Korean Imaging Cohort of COVID-19 data set for discrimination and calibration. RESULTS: The AI model using CXR and the logistic regression model using clinical variables were suboptimal to predict hospital LOS ≤2 weeks or the need for oxygen supplementation but performed acceptably in the prediction of ARDS (AI model area under the curve [AUC] 0.782, 95% CI 0.720-0.845; logistic regression model AUC 0.878, 95% CI 0.838-0.919). The combined model performed better in predicting the need for oxygen supplementation (AUC 0.704, 95% CI 0.646-0.762) and ARDS (AUC 0.890, 95% CI 0.853-0.928) compared to the CXR score alone. Both the AI and combined models showed good calibration for predicting ARDS (P=.079 and P=.859). CONCLUSIONS: The combined prediction model, comprising the CXR score and clinical information, was externally validated as having acceptable performance in predicting severe illness and excellent performance in predicting ARDS in patients with COVID-19.

Forensic authentication method for audio recordings generated by Voice Recorder application on Samsung Galaxy Watch4 series.

The number of smartwatch users has been rapidly increasing in recent years. A smartwatch is a wearable device that collects various types of data using sensors and provides basic functions, such as healthcare-related measurements and audio recording. In this study, we proposed the forensic authentication method for audio recordings from the Voice Recording application in the Samsung Galaxy Watch4 series. First, a total of 240 audio recordings from each of the four different models, paired with four different smartphones for synchronization via Bluetooth, were collected and verified. To analyze the characteristics of smartwatch audio recordings, we examined the transition of the audio latency, writable audio bandwidth, timestamps, and file structure between those generated in the smartwatches and those edited using the Voice Recording application of the paired smartphones. In addition, the devices with the audio recordings were examined via the Android Debug Bridge (ADB) tool and compared with the timestamps stored in the file system. The experimental results showed that the audio latency, writable audio bandwidth, and file structure of audio recordings generated by smartwatches differed from those generated by smartphones. Additionally, by analyzing the file structure, audio recordings can be classified as unmanipulated, manipulation has been attempted, or manipulated. Finally, we can forensically authenticate the audio recordings generated by the Voice Recorder application in the Samsung Galaxy Watch4 series by accessing the smartwatches and analyzing the timestamps related to the audio recordings in the file system.

Radiological Characteristics of Low-Grade Lytic Spondylolisthesis: Similarity to Dysplastic Spondylolisthesis.

STUDY DESIGN: Retrospective case-control study. PURPOSE: This study aimed to analyze the etiology of low-grade lytic spondylolisthesis based on the radiologic features of the vertebra. OVERVIEW OF LITERATURE: According to the Marchetti-Bartolozzi classification scheme, high-grade lytic spondylolisthesis (Meyerding grade 3-5) is classified as dysplastic. However, determination of the etiology for low-grade lytic spondylolisthesis as developmental or traumatic remains controversial. METHODS: Patients admitted and treated for one-level (L4/5 or L5/S1) low-grade spondylolisthesis were included in the study. A total of 135 patients were divided into the degenerative or lytic spondylolisthesis groups according to their condition (81 patients [degenerative group] vs. 54 patients [lytic group]). To assess the level of similarity in the radiological findings between low-grade lytic spondylolisthesis and dysplastic spondylolisthesis, the pedicle diameters and vertebral heights of the L4 and L5 vertebrae were measured on computed tomography images. Measurements were then converted to each vertebra's ratio to reduce confounding factors among individuals. RESULTS: The affected vertebra had a smaller sagittal pedicle diameter/transverse pedicle diameter ratio in the low-grade lytic spondylolisthesis group compared to the degenerative group, and the posterior vertebral height/anterior vertebral height ratio of L5 was smaller in the L5/S1 lytic spondylolisthesis group compared to the degenerative spondylolisthesis group. CONCLUSIONS: Low-grade lytic spondylolisthesis and dysplastic spondylolisthesis demonstrated similar radiological findings. Hence, surgeons should be attentive to the morphology of the vertebral body and posterior column during preoperative planning for the treatment of low-grade lytic spondylolisthesis.

Forearm bone mineral density as a predictor of reduction loss in distal radius fractures treated with cast immobilization.

Objective: Many potential predictors have been identified and proposed for predicting late reduction loss in distal radius fractures. However, no report exists on whether the bone mineral density (BMD) of the forearm correlates with the loss of reduction in distal radius fractures. This study aimed to investigate whether forearm BMD can be used as a predictor of reduction loss in distal radius fractures treated with cast immobilization. Methods: Ninety patients with distal radius fractures were divided into two groups according to the maintenance or loss of reduction evaluated from radiographs taken at least 6 weeks after their injury. Lumbar and forearm BMD (total and metaphysis) T-scores were measured and compared between the maintenance of reduction (MOR) group and the loss of reduction (LOR) group. Additionally, serologic markers (C-terminal telopeptide, osteocalcin, vitamin D) and radiologic risk factors (intra-articular fracture, ulnar fracture, dorsal comminuted fracture, volar hook) were evaluated and a logistic multiple regression analysis was performed to know the main risk factors of reduction loss. Results: Reduction loss was observed in 38 patients (42.2%). The total and metaphyseal BMD of the forearm was less in the LOR group than in the MOR group. However, the difference was not statistically significant [-2.9 vs. -2.5 for total (p = 0.18), -2.3 vs. -2.0 for metaphysis (p = 0.17)]. Multiple logistic regression analysis showed initial dorsal comminution (p = 0.008) and ulnar variance (p = 0.01) were the main risk factors for reduction loss. Conclusions: Forearm BMD was not a valuable prognostic factor for reduction loss in distal radius fractures. Initial dorsal comminution and ulnar variance rather than forearm BMD should be considered preferentially when predicting which patients are at high risk of reduction loss in distal radius fractures.