Deep learning-assisted diagnosis of femoral trochlear dysplasia based on magnetic resonance imaging measurements.

BACKGROUND: Femoral trochlear dysplasia (FTD) is an important risk factor for patellar instability. Dejour classification is widely used at present and relies on standard lateral X-rays, which are not common in clinical work. Therefore, magnetic resonance imaging (MRI) has become the first choice for the diagnosis of FTD. However, manually measuring is tedious, time-consuming, and easily produces great variability. AIM: To use artificial intelligence (AI) to assist diagnosing FTD on MRI images and to evaluate its reliability. METHODS: We searched 464 knee MRI cases between January 2019 and December 2020, including FTD (n = 202) and normal trochlea (n = 252). This paper adopts the heatmap regression method to detect the key points network. For the final evaluation, several metrics (accuracy, sensitivity, specificity, etc.) were calculated. RESULTS: The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the AI model ranged from 0.74-0.96. All values were superior to junior doctors and intermediate doctors, similar to senior doctors. However, diagnostic time was much lower than that of junior doctors and intermediate doctors. CONCLUSION: The diagnosis of FTD on knee MRI can be aided by AI and can be achieved with a high level of accuracy.

Research Advances in the Application of AI for Preoperative Measurements in Total Knee Arthroplasty.

Total knee arthroplasty (TKA) is widely used in clinical practice as an effective treatment for end-stage knee joint lesions. It can effectively correct joint deformities, relieve painful symptoms, and improve joint function. The reconstruction of lower extremity joint lines and soft tissue balance are important factors related to the durability of the implant; therefore, it is especially important to measure the joint lines and associated angles before TKA. In this article, we review the technological progress in the preoperative measurement of TKA.

A preliminary study of proximal realignment combination surgery in the treatment of adolescent habitual patellar dislocation.

OBJECTIVE: A combination of lateral soft tissue release, medial soft tissue contraction, vastus medialis anterior placement, medial patellofemoral ligament reconstruction, and rectus femoris insertion reconstruction are introduced in the treatment of habitual patellar dislocation in adolescents. METHODS: A retrospective analysis was performed on 12 patients (17 knees) with habitual patellar dislocation and unclosed epiphyses who underwent surgical treatment at the First Hospital of Jilin University from May 2017 to November 2021. The Lysholm scores and Q angle were collected preoperatively and at final follow-up and were compared. RESULTS: Twelve patients (4 boys and 8 girls) aged 10-15 years were retrospectively analysed, who followed up for an average of 21 months (5-48 months). The range of motion of the knee joint returned to normal in all patients, and no cases of complications including surgical site infection, joint stiffness, or patellar re-dislocation occurred. The mean Lysholm scores and Q angles improved from 73.9, and 19.6° preoperatively to 91.7, and 13.9° at the final follow-up, respectively. CONCLUSION: The preliminary effect of the combination surgery for habitual patellar dislocation in adolescents was satisfactory.

Modified treatment of knee osteoarthritis complicated with femoral varus deformity: A case report.

BACKGROUND: Surgical treatment of knee osteoarthritis (KOA) complicated by extra-articular deformity has always been controversial regardless of whether it is simultaneous or staged. Simultaneous total knee arthroplasty (TKA) combined with supracondylar osteotomy without plate for treatment of KOA complicated by femoral varus deformity has not been reported in the literature. CASE SUMMARY: A 53-year-old Chinese woman complained of left knee pain for 6 years that worsened for 4 mo during her visit on April 3, 2020, accompanied by instability in walking, which seriously affected quality of life. According to her medical history and preoperative imaging, the patient was diagnosed with left KOA with varus deformity. We used the angular center of rotation principle for osteotomy of the femur deformity and placed a poststabilized femur prosthesis into the knee joint. At the same time, a 13 mm × 130 mm femur extension rod was used instead of a steel plate to fix the end of the femur osteotomy, reducing the possible complications caused by steel plate implantation and reducing the economic burden on patients. The operation successfully solved two major problems of KOA and varus deformity, and the clinical and imaging evaluation of postoperative follow-up were satisfactory. CONCLUSION: TKA and supracondylar femoral osteotomy can be used for simultaneous KOA treatment and deformity correction.

Whole-exome sequencing and genome-wide association studies identify novel sarcopenia risk genes in Han Chinese.

Sarcopenia is a complex polygenic disease, and its molecular mechanism is still unclear. Whole lean body mass (WLBM) is a heritable trait predicting sarcopenia. To identify genomic loci underlying, we performed a whole-exome sequencing (WES) of WLBM variation with high sequencing depth (more than 40*) in 101 Chinese subjects. We then replicated in the major findings in the large-scale UK Biobank (UKB) cohort (N = 217,822) for WLBM. The results of four single-nucleotide polymorphisms (SNPs) were significant both in the discovery stage and replication stage: SNP rs740681 (discovery p = 1.66 × 10-6 , replication p = .05), rs2272303 (discovery p = 3.20 × 10-4 , replication p = 3.10 × 10-4 ), rs11170413 (discovery p = 3.99 × 10-4 , replication p = 2.90 × 10-4 ), and rs2272302 (discovery p = 9.13 × 10-4 , replication p = 3.10 × 10-4 ). We combined p values of the significant SNPs. Functional annotations highlighted two candidate genes, including FZR1 and SOAT2, that may exert pleiotropic effects to the development of body mass. Our findings provide useful insights that further enhance our understanding of genetic interplay in sarcopenia.

Protrusion of a ceramic femoral head through the acetabular metallic cup in total-hip arthroplasty: A case report.

RATIONALE: Dislocation, wear, metallosis, and implant loosening are well-known complications of a failed total-hip arthroplasty (THA), and acetabular liner dissociation is an uncommon but catastrophic complication. To our knowledge, this is the first description of metallosis due to acetabular liner dissociation, but not presenting as a result of wear of a metal-on-metal articulation and a polyethylene liner of other articulation. PATIENT CONCERNS: We described a 61-year-old man who had a 2-year history of pain in the right groin region after THA. Postoperative period of primary THA was uneventful. However, he did not undergo postoperative follow-up, and often participated in strenuous sports activities including mountain climbing and long-distance running. DIAGNOSIS: Radiographs demonstrated superior subluxation of the femoral head and direct articulation and abrasion wear of the ceramic femoral head on the cup. Preoperative laboratory data revealed no signs of infection. INTERVENTIONS: We performed revision THA using a direct lateral approach with ceramic-on-ceramic hip prosthesis. OUTCOMES: Postoperatively, the patient wore a hip orthosis for 6 weeks to prevent dislocation but was allowed full weight bearing. At 1-year follow-up, there was no recurrence of hip pain. LESSONS: Wear of THA components can result in catastrophic failure of the implants and significant soft-tissue metallosis. Therefore, regular postoperative follow-up is necessary for early intervention, even in those with asymptomatic hips.

Replication of FTO Gene associated with lean mass in a Meta-Analysis of Genome-Wide Association Studies.

Sarcopenia is characterized by low skeletal muscle, a complex trait with high heritability. With the dramatically increasing prevalence of obesity, obesity and sarcopenia occur simultaneously, a condition known as sarcopenic obesity. Fat mass and obesity-associated (FTO) gene is a candidate gene of obesity. To identify associations between lean mass and FTO gene, we performed a genome-wide association study (GWAS) of lean mass index (LMI) in 2207 unrelated Caucasian subjects and replicated major findings in two replication samples including 6,004 unrelated Caucasian and 38,292 unrelated Caucasian. We found 29 single nucleotide polymorphisms (SNPs) in FTO significantly associated with sarcopenia (combined p-values ranging from 5.92 × 10-12 to 1.69 × 10-9). Potential biological functions of SNPs were analyzed by HaploReg v4.1, RegulomeDB, GTEx, IMPC and STRING. Our results provide suggestive evidence that FTO gene is associated with lean mass.

Uncontacted tire explosion causing trauma to bilateral lower extremities: A case report.

It is uncommon for tire explosion related injuries on the lower extremity. The bilateral lower extremities were injured by tire explosion when the patient was seated in a bus. She sustained an open fracture with partial bone loss in the right calcaneus (a comminuted fracture in the right ankle joint) and a closed comminuted fracture in the left tibia and fibula. This damage was caused by uncontacted tire explosion, thanks to a thick floor between the exploded tire and the patient's feet. This type of injury on lower extremity caused by uncontacted tire explosion was uncommon.

[Particle impaction bone graft and plate internal fixation for the treatment of proximal femoral bone tumor or tumor lesion].

OBJECTIVE: To evaluate the clinical feasibility of particle impaction bone graft and plate internal fixation for the treatment of proximal femoral bone tumors or tumor disease. METHODS: From January 2013 to January 2016 a total of 26 cases of the proximal femur bone tumors or tumor lesions, neither pathological fracture, were retrospectively analyzed, including 12 males and 14 females with an average age of 34.2 years old ranging from 8 to 62 years old. The pathologic result involved fibrous dysplasia in 11 cases, bone isolation bone cyst in 7 cases, giant cell tumors of bone in 3 cases, aneurysm sample bone cyst in 3 cases, non ossifying fibroma in 1 case, benign fibrous histiocytoma in 1 case. No biopsy of the lesion was performed before the operation. Postoperative lesions were sent to pathology. The operation was treated by particle impaction bone graft and plate internal fixation. RESULTS: All patients were followed up to resume normal life for 8 to 42 months with an average of 25 months. The function assessment referenced to the bone and soft tissue tumor association (MSTS). At the end of the last examination, the positive and lateral X-ray films of the femur showed no low density shadow in the margin of bone graft and bone graft, and the bone healing in the bone graft area was good. No recurrence or metastasis was found in all patients, and no loosening or deformation of the internal fixator occurred. The hip function was well restored and no fracture or deformity progressed in all patients. CONCLUSIONS: The tumor recurrence in the proximal femur is related to curettage and bone grafting. After the curettage, the residual tumor cells were treated by chemical and physical methods. By this method, the disease can be cured for a long time, and it can reduce the recurrence and resume the function of the hip joint.

[Causes of perioperative pain and the pain management in total knee arthroplasty].

Total knee arthroplasty has become one of the effective operation methods on end-stage knee osteoarthritis. However,the postoperative pain has been plaguing the clinicians. The cause of postoperative pain can be divided into iatrogenic, prosthesis and patient. Pain treatment in perioperative period includes preoperative education, analgesia in advance, and the selection and design of reinforcement; during operation mainly includes the appropriate surgical approach, keep the balance of soft tissue around the knee joint, cocktail analgesia pain around the knee joint; after operation mainly includes oral analgesic drugs, femoral nerve tissue and patient controlled analgesia. And the multimodal analgesi.a which is the analgesic methods combined application in perioperative period raised in resent years fully intervene the pain in perioperative period,so that it can effectively reduce the pain of patients after knee replacement, promote the patients do functional exercise more better and get better operation result.

Twenty-seven-year nonunion of a Hoffa fracture in a 46-year-old patient.

A Hoffa fracture is an uncommon clinical entity typically seen in adults after high-energy trauma. Nonunion of a Hoffa fracture appears to be even more uncommon. To our knowledge, only three cases of nonunion of a Hoffa fracture have been documented in the literature to date, including two children and one adult. This article presents a case of an adult who had nonunion of a Hoffa fracture for 27 years and was treated by open reduction and internal fixation, and the varus deformity corrected with xenogenous bone graft. An excellent result has been achieved to date. This unusual case reminds us that we cannot neglect the possibility of nonunion of a cancellous bone fracture, especially the Hoffa fractures of the medial femoral condyle if they are treated nonoperatively. It also demonstrates that internal fixation with bone graft is effective, even for the 27-year Hoffa fracture.

An anthropometry study of the shoulder region in a chinese population and its correlation with shoulder disease / Estudio antropométrico de la región del hombro en una población china y su relación con enfermedad del hombro

Purpose: There is a paucity of data which reflected the relationship between morphology and incidence of shoulder disorders with respect to the ethnic Chinese population. We used anteroposterior radiographs to measure the Acromion Index (AI) and Acromioglenoid Angle (AA) of Chinese patients. The baseline was defined as the line that connected the superior and inferior osseous margins of the glenoid cavity. In order to calculate the AI, the distance from the baseline to the lateral margin of the acromion was measured and then divided by the distance from the baseline to the lateral aspect of the humeral head. The AA was defined as the angle formed by the intersecting line drawn tangent to the sclerotic line of the acromion undersurface and the baseline point. The AI and AA were determined in three groups: 165 patients (average age, 60.2 years) with chronic shoulder symptoms; in an age and gender-matched acute injury group of 61 patients (average age, 44.3 years); and in an age and gender-matched control group of 63 volunteers (average age, 37.3 years).The average AI and standard deviation was 0.72 +/- 0.06 in shoulders with subacromial impingement syndrome, 0.59 +/- 0.06 in those with acute injury, and 0.66 ± 0.06 in normal shoulders. The average AA and standard deviation was 76.8°+/-7.02 in shoulders with subacromial impingement syndrome, 84.2°+/-7.81 in those with acute injury, and 80.0°+/- 7.33 in normal shoulders. The AI and AA varied between patients with acute and chronic shoulder problems.

Hay escasez de datos que reflejen la relación entre la morfología y la incidencia de los trastornos de hombro con respecto a la población de origen chino. Se utilizó radiografías anteroposteriores para medir el índice acromial (IA) y ángulo acromioglenoido (AA) de los pacientes chinos. La línea de base se define como la que conecta los márgenes óseos superior e inferior de la cavidad glenoidea. Con el fin de calcular el IA, se midió la distancia desde la línea base hasta el margen lateral del acromion y luego se dividió por la distancia desde la línea base hasta la cara lateral de la cabeza humeral. El AA se define como el ángulo formado por la línea de intersección dibujada tangente a la línea esclerótica de la superficie inferior del acromion y el punto de línea base. El AI y AA se determinaron en tres grupos: 165 pacientes (edad media, 60,2 años) con síntomas crónicos en el hombro; en un grupo de 61 pacientes (edad media, 44,3 años) con herida aguda, y en un grupo control de 63 voluntarios (edad media, 37,3 años). La IA promedio fue de 0,72 +/- 0,06 en los hombros con el síndrome de pinzamiento subacromial, 0,59 +/- 0,06 en los pacientes con lesión aguda, y 0,66 +/- 0,06 en los hombros normales. El AA promedio fue de 76,8 ° +/- 7,02 en los hombros con el síndrome de pinzamiento subacromial, 84,2 ° +/- 7,81 en los pacientes con lesión aguda, y 80,0 ° +/- 7,33 en los hombros normales. La IA y AA variaron entre los pacientes con problemas en el hombro agudos y crónicos.

Bipolar hemiarthroplasty with a two-step osteotomy technique for unstable intertrochanteric fracture in senile patients.

OBJECTIVE: To introduce bipolar hemiarthroplasty with a two-step osteotomy technique and observe its clinical result for unstable intertrochanteric fractures in senile patients. METHODS: Fifteen consecutive patients with unstable intertrochanteric fractures aged from 81 to 92 years with a mean of 85 years were treated in our hospital from August 2006 to October 2011 (Evans type III in 4 cases, Evans type IV in 11 cases), who received bipolar hemiarthroplasty with a two-step osteotomy technique performed by a senior orthopedic surgeon through posterior approach under general anesthesia. All cases were evaluated by Zuckerman functional recovery score (FRS) and operative risk assessment software 1, based on the patients' physical and laboratory examinations preoperatively. The duration and blood loss have been recorded. There were 4 male cases (4 hips) and 11 female cases (11 hips). All prostheses consisted of Link SP II femoral stem and bipolar femoral head. All patients were followed up for more than 1 year. RESULTS: The average preoperative FRS, predictive value of operative morbidity and mortality were 83.7 (81.7-85.9), 9.3% (7.3%-15.0%) and 3.5% (2.3%-4.2%), respectively. The average operation time was 50 minutes with a mean intraoperative blood loss of 310 ml. There were no operative or anesthetic complications or deaths within 30 days after operation. Sitting up was permitted 3 to 4 days, and partial weight bearing was allowed 5 to 7 days after operation. The average FRS was 79.3 at 30 days and 84.9 at 1 year postoperatively. Three patients died of unrelated causes (one due to myocardial infarction and the others due to cerebral hemorrhage during at least one-year follow-up). CONCLUSION: Bipolar hemiarthroplasty with a two-step osteotomy technique for unstable intertrochanteric fractures in the senile patients is a good choice for early ambulation and good hip function.

Causes of death after hip fracture in senile patients.

Hip trauma has been a leading cause of death in senile patients for more than a centenary. Although the mortality decreased due to the advanced technique in medication, surgery and nursing, the increasing mortality should not be neglected in elders after orthopedic operation nowadays. Many factors are considered to influence the causes of death after trauma, such as age, gender, personal customs, comorbidities, types of fracture, timing of surgery, procedure, anesthesia, complications, medical treatment, activity of daily living, or even marriage status. This article reviews these causes from the aspects of patient's own factors, iatrogenic factors, medical treatment and other factors and provides some clues for further clinical application according to the recent foreign and domestic researches. According to the present research, it is essential for surgeons to perform a comprehensive estimation for patients suffering from hip trauma.