Epidemiologic characteristics of traumatic fractures in elderly patients during the outbreak of coronavirus disease 2019 in China.

PURPOSE: This study aimed to describe the epidemiologic characteristics of fracture in the elderly during the COVID-19. METHODS: This was a retrospective multi-centre study, which included patients who sustained fractures between 20 January and 19 February 2020. The collected data included patients' demographics (age and gender), injury-related (injury type, fracture location, injury mechanism, places where fracture occurred), and treatment modality. SPSS 23.0 was used to describe the data and perform some analysis. RESULTS: A total of 436 patients with 453 fractures were included; there were 153 males and 283 females, with an average age of 76.2 years (standard deviation, SD, 7.7 years; 65 to 105). For either males or females, 70-74 years was the most commonly involved age group. A total of 317 (72.7%) patients had their fractures occurring at home. Among 453 fractures, there were 264 (58.3%) hip fractures, accounting for 58.3%. Fall from standing height was the most common cause of fracture, making a proportion of 89.4% (405/453). Most fractures (95.8%, 434/453) were treated surgically, and 4.2% (19/453) were treated by plaster fixation or traction. Open reduction and internal fixation (ORIF) was the most used surgical method, taking a proportion of 49.2% (223/453). CONCLUSION: These findings highlighted the importance of primary prevention (home prevention) measures and could be used for references for individuals, health care providers, or health administrative department during the global pandemic of COVID-19.

Precise puncture combined with simplified percutaneous vertebroplasty to treat osteoporotic vertebral compression fractures: a comparative analysis with conventional percutaneous vertebroplasty.

OBJECTIVE: To investigate the feasibility and clinical efficacy of precise puncture combined with simplified percutaneous vertebroplasty (PVP) for treating osteoporotic vertebral compression fractures (OVCF). METHODS: A total of 82 patients with single-segment osteoporotic vertebral compression fractures (OVCF) treated with PVP from Dec. 2016 to Nov. 2018 were retrospectively analyzed. Among the patients, 45 cases in group A accepted precise puncture combined with simplified PVP, and 37 cases in group B underwent conventional PVP. The operative time, the number of intraoperative fluoroscopy, vertebral height restoration, postoperative bone cement distribution and bone cement leakage were observed and compared. The pain relief and improvement of quality of life (QOL) were assessed by visual analog score (VAS) and Oswestry disability index (ODI). RESULTS: There were no differences in injected cement volume and hospital stays in group A versus group B. The operative time, the number of intraoperative fluoroscopy and material cost were lower in group A compared with group B (P<0.05). After surgery, the VAS scores, ODI, the average vertebral height and Cobb angle were obviously improved and they were significantly different from those before operation (P<0.05). There was no statistically significant difference for VAS scores, ODI, average vertebral height and Cobb angle between groups at different time points. The proportion of patients with bone cement dispersion exceeding the midline of vertebra in group A was significantly higher than that in group B (82.2% vs. 62.1%, P<0.05), whereas the bone cement leakage rate in group A was lower than that in group B (8.9% vs. 27.0%, P<0.05). Patients were followed-up for 12-23 months (mean 17.6 months) after surgery. There were 3 cases (6.6%) of adjacent vertebral fractures in group A and 2 cases (5.4%) in group B. CONCLUSION: Precise puncture can improve the accuracy of puncture needle through pedicle to vertebral body. It is conducive to obtaining a better diffusion of bone cement across the midline with a lower bone cement leakage rate. Simplified PVP can not only reduce the surgery procedures, shorten the operative time, reduce the X-ray frequency, but also save material cost.

Comparison of image quality and lesion diagnosis in abdominopelvic unenhanced CT between reduced-dose CT using deep learning post-processing and standard-dose CT using iterative reconstruction: A prospective study.

PURPOSE: To compare image quality and lesion diagnosis between reduced-dose abdominopelvic unenhanced computed tomography (CT) using deep learning (DL) post-processing and standard-dose CT using iterative reconstruction (IR). METHOD: Totally 251 patients underwent two consecutive abdominopelvic unenhanced CT scans of the same range, including standard and reduced doses, respectively. In group A, standard-dose data were reconstructed by (blend 30 %) IR. In group B, reduced-dose data were reconstructed by filtered back projection reconstruction to obtain group B1 images, and post-processed using the DL algorithm (NeuAI denosing, Neusoft medical, Shenyang, China) with 50 % and 100 % weights to obtain group B2 and B3 images, respectively. Then, CT values of the liver, the second lumbar vertebral centrum, the erector spinae and abdominal subcutaneous fat were measured. CT values, noise levels, signal-to-noise ratios (SNRs), contrast-to-noise ratios (CNRs), radiation doses and subjective scores of image quality were compared. Subjective evaluations of low-density liver lesions were compared by diagnostic results from enhanced CT or Magnetic Resonance Imaging. RESULTS: Groups B3 and B1 showed the lowest and highest noise levels, respectively (P < 0.001). The SNR and CNR in group B3 were highest (P < 0.001). The radiation dose in group B was reduced by 71.5 % on average compared to group A. Subjective scores in groups A and B2 were highest (P < 0.001). Diagnostic sensitivity and confidence for liver metastases in groups A and B2 were highest (P < 0.001). CONCLUSIONS: Reduced-dose abdominopelvic unenhanced CT combined with DL post-processing could ensure image quality and satisfy diagnostic needs.

The association of inhibitor of Growth 4 with its prognostic value in osteogenic sarcoma.

BACKGROUND: Osteosarcoma is one of the first two cause of cancer-related death in children and young adolescents. Inhibitor of Growth 4 (ING4) is a member of the ING tumor suppressor family and play an important role in many cellular processes. The purpose of this study was to explore the correlation between ING4 expression and the prognosis of osteosarcoma patients. METHODS: ING4 mRNA and protein expressions in osteosarcoma and normal tissues were detected by quantitative real-time transcriptase polymerase chain reaction (qRT-PCR) and immunohistochemistry (IHC) method, respectively. Chi-square test was adopted to estimated the relationship of ING4 expression and clinical parameters of osteosarcoma patients. Besides, the overall survival of osteosarcoma patients was evaluated by Kaplan-Meier method. The potential of ING4 as a prognostic marker gene was addressed by Cox regression analysis. RESULTS: Down-regulated expression of ING4 mRNA and protein were observed in osteosarcoma tissues. ING4 expression was significantly associated with metastasis (P = 0.030) and recurrence (P = 0.008), but not other clinical features (P > 0.05). Cox regression analysis indicated that ING4 can be used as an independent prognotic biomarker for osteosarcoma, in univariate and multivariate analysis (P = 0.004, HR = 3.945, 95 % CI = 1.565-9.940; P = 0.001, HR = 4.213, 95 % CI = 1.747-10.161). CONCLUSION: Taken together, ING4 was down-regulated in osteosarcoma tissues. ING4 can act as an independent prognostic factor for osteosarcoma.

[Comparative study on closed reduction with elastic intramedullary nailing and open reduction with Kirschner wire fixations in treatment of radial neck fractures in children].

OBJECTIVE: To analyze and compare the effectiveness of the closed reduction with elastic intramedullary nailing and open reduction with Kirschner wire fixations in the treatment of O'Brien type III radial neck fractures in children. METHODS: Between November 2007 and November 2010, 31 children with O'Brien type III radial neck fractures were treated by the closed reduction with elastic intramedullary nailing fixation (closed reduction group, n=18) and by the open reduction with Kirschner wire fixation (open reduction group, n=13). There was no significant difference in age, gender, disease duration, and fracture classification between 2 groups (P > 0.05). RESULTS: The incisions of 2 groups healed primarily. All the patients were followed up 1-2 years (mean, 1.5 years). Limitation of the elbow extension occurred in 2 cases of the closed reduction group, limitations of the elbow extension, flexion, and forearm pronation in 6 cases of the open reduction group. There was no significant difference in elbow flexion, extension, pronation, and supination between affected side and normal side in the closed reduction group (P > 0.05). Except in supination (P > 0.05), there were significant differences in flexion, extension, and pronation between affected side and normal side in the open reduction group (P < 0.05). According to Metaizeau's grading criterion, excellent results were achieved in 16 cases and good in 2 cases in the closed reduction group; excellent results were achieved in 4 cases, good in 4 cases, fair in 3 cases, and poor in 2 case in the open reduction group; and there was significant difference between 2 groups (Z=3.435, P=0.001). The X-ray films showed anatomical reduction in 2 groups before removal of internal fixation; redisplacement occurred in 4 cases after removal of internal fixation in the open reduction group, no redisplacement occurred in the closed reduction group. There was no avascular necrosis of radial head and epiphyses during follow-up. CONCLUSION: Comparison with the open reduction with Kirschner wire fixation, the closed reduction with elastic intramedullary nailing fixation is a reliable and good treatment for O'Brien type III radial neck fractures in children, because it has the advantages of minimal invasion, easy operation, stable fixation, early mobilization, and less complication.

[Controlled clinical trials on different surgical methods for the treatment of acromioclavicular dislocation].

OBJECTIVE: To compare clinical effects of clavicular hook plate fixation, coracoid transplantation, and clavicular hook plate fixation combined with modified dynamic muscle transfer for the treatment of the complete acromioclavicular dislocation. METHODS: From January 2006 to November 2009, 65 patients with sustained complete acrominoclavicular dislocation were treated with clavicular hook plate fixation, coracoid transplantation,and clavicular hook plate fixation combined with modified dynamic muscle transfer. All the patients were divided into three groups: 22 patients in group A were treated with clavicular hook plate fixation, including 17 males and 5 females, with an average age of (31.0 +/- 10.0) years; 21 patient in group B were treated with coracoid transplantation, including 16 males and 5 females,with an average age of (33.0 +/- 6.4) years; 22 patients in group C were treated with clavicular hook plate fixation combined with modified dynamic muscle transfer,including 18 males and 4 females, with an average age of (30.0 +/- 5.3) years. Postoperative functional recovery was evaluated by Karlsson criteria. RESULTS: All the patients were followed up, and the duration ranged from half to three years (averaged 1.5 years). In group A, 8 patients got half re-dislocation, 2 patients got complete re-dislocation and arthritis of acromioclavicular joint after internal fixations removal, 1 patient had clavicular hook plate broken after operation. In group B, 7 patients got half re-dislocation, 1 patient got complete re-dislocation,and 5 patients had arthritis of acromioclavicular joint with acute pain and limited shoulder function after internal fixations removal. In group C,2 patients got half re-dislocation, no complete re-dislocation and arthritis of acromioclavicular joint occurred after internal fixations removal. According to Karlsson evaluation, in group A, 12 patients obtained an excellent result, 8 good and 2 poor; in group B, the data were 9, 7 and 5 respectively; in group C, they were 20, 2 and 0 respectively. There were remarkable differences of therapeutic effects between the clavicular hook plate fixation combined with modified dynamic muscle transfer and that with either of the former two treatment methods (P < 0.05). CONCLUSION: Clavicular hook plate combined with modified dynamic muscle transfer is a reliable and good treatment for the complete acrominoclavicular dislocation, with advantages such as easy to handle,stable fixation and early exercise.