Spine disorders affect 619 million people globally and are a leading cause of disability, yet AI-assisted diagnosis remains limited by the lack of level-aware, multimodal datasets. Clinical decision-making for spine disorders requires sophisticated reasoning across X-ray, CT, and MRI at specific vertebral levels. However, progress has been constrained by the absence of traceable, clinically-grounded instruction data and standardized, spine-specific benchmarks. To address this, we introduce SpineMed, an ecosystem co-designed with practicing spine surgeons. It features SpineMed-450k, the first large-scale dataset explicitly designed for vertebral-level reasoning across imaging modalities with over 450,000 instruction instances, and SpineBench, a clinically-grounded evaluation framework. SpineMed-450k is curated from diverse sources, including textbooks, guidelines, open datasets, and $\sim$1,000 de-identified hospital cases, using a clinician-in-the-loop pipeline with a two-stage LLM generation method (draft and revision) to ensure high-quality, traceable data for question-answering, multi-turn consultations, and report generation. SpineBench evaluates models on clinically salient axes, including level identification, pathology assessment, and surgical planning. Our comprehensive evaluation of several recently advanced large vision-language models (LVLMs) on SpineBench reveals systematic weaknesses in fine-grained, level-specific reasoning. In contrast, our model fine-tuned on SpineMed-450k demonstrates consistent and significant improvements across all tasks. Clinician assessments confirm the diagnostic clarity and practical utility of our model's outputs.

Background The aim of this study was to explore the relationship between perioperative bisphosphonate (BP) use and implant survival in total joint arthroplasty (TJA). Methods Literature in PubMed, EMBASE, and the Cochrane Library was systematically searched until May 2024, and studies were reviewed. Eligible studies are randomized controlled trials or cohort studies comparing BP with placebo or antiosteoporosis agents in TJA, reporting implant survival outcomes with full-text availability. The search identified 2,051 potentially relevant publications; 20 met the selection criteria. Results Our results revealed that perioperative BP use significantly reduced the incidence of all-cause revision surgery (ARS) after TJA (RR [risk ratio] 0.67 [95% CI (confidence interval) 0.54 to 0.83], P = 0.003). Preoperative BP use significantly increased the risk of developing ARS (RR 0.72 [95% CI 0.54 to 0.95], P < 0.00001) and periprosthetic fracture (PPF) (RR 1.33 [95% CI 1.21 to 1.46], P < 0.00001) after TJA. However, BP initiated after TJA reduced the risk of ARS (RR 0.57 [95% CI 0.43 to 0.74], P < 0.00001). In addition, perioperative BP use for at least six months was associated with a lower risk of ARS (RR 0.83 [95% CI 0.77 to 0.89], P < 0.00001), but a higher risk of PPF in patients who had TJA (RR 1.28 [95% CI 1.16 to 1.42], P = 0.0002). When initiated after total hip arthroplasty (THA), BP was associated with a lower incidence of PPF (RR 0.55 [95% CI 0.31 to 0.98], P = 0.04), and there was an increased risk of ARS following THA if perioperative BP was used for over one year (RR 1.10 [95% CI 1.01 to 1.21], P = 0.03). At last, perioperative BP use had no effect on aseptic loosening, periprosthetic joint infection, osteolysis, stress fracture, adverse events, or mortality after TJA. Conclusions Perioperative BP use significantly reduced the incidence of ARS after TJA. Preoperative use of BP significantly increased the risk of developing ARS and PPF after TJA. However, BP initiated after TJA reduced the risk of ARS, but had no effect on PPF. In addition, perioperative BP use for at least six months was associated with a lower risk of ARS, but a higher risk of PPF in patients who had TJA.

This systematic review synthesizes current evidence on the efficacy of internal fixation combined with pedicled bone grafting (IFPBG) for treating fresh Garden type III/IV femoral neck fractures in young people. Registered prospectively in PROSPERO (CRD42024584036), we systematically searched PubMed, EMBASE, Web of Science and Cochrane Library databases from inception through August 20, 2024. Two reviewers independently performed data extraction and assessed methodological quality using the Institute of Health Economics appraisal checklist. Treatment outcomes and complications were analyzed through pooled rate calculations and odds ratio (OR) comparisons. Three studies involving 353 patients met inclusion criteria, demonstrating generally robust methodological quality. The IFPBG group (Group A) showed superior fracture healing rates compared to internal fixation alone (Group B) (91.7

This study assesses clinical outcomes and quality of life (QoL) following surgical treatment of fragility ankle fractures in individuals aged over 80 years. We conducted a retrospective study involving 45 elderly patients who underwent surgery for fragility ankle fractures between 2015 and 2023. Pre-operative mobility was assessed using the Parker Mobility Score (PMS), and nutritional status was evaluated using a short-form mini-nutritional assessment (MNA-SF). The ASA classification and the age-adjusted Charlson Comorbidity Index (aCCI) were used to assess comorbidities affecting outcomes comprehensively. Primary outcomes included (1) Ankle function, measured by the Olerud-Molander Ankle Score (OMA-score), and (2) QoL, assessed through the EQ-5D-3 L index score, EQ-VAS, and Barthel Index. Any postoperative complications or mortality were considered secondary outcome. The cohort’s mean age was 83.8 ± 3.2 years. At the one-year follow-up, the OMA-score negatively correlated with pre-operative days (p = 0.035), length of hospital stay (p = 0.047), and time to weight-bearing initiation (p < 0.001). Time to weight-bearing initiation negatively impacted the EQ-5D-3 L index (p = 0.001) and EQ-VAS (p < 0.001), whereas the Barthel Index showed positive correlations with pre-operative PMS (p = 0.005) and MNA-SF (p = 0.002). Surgical and non-surgical complication rates were 28.9 % and 31.1 %, respectively. The one-year survival rate was 75.6 %. Deceased patients had higher aCCI scores (p = 0.005), lower PMS (p < 0.001), and lower MNA-SF scores (p = 0.005); however, the ASA grade showed no significant difference (p = 0.066). The timing of weight-bearing initiation after ankle surgery may significantly influence ankle function and QoL in octogenarians and nonagenarians. Geriatric assessments, such as the PMS, MNA-SF, and aCCI, effectively assess mortality risk, whereas the ASA classification is less predictive.

Vertebral vertex detection is a fundamental step for subsequent spine image analysis and X-ray image- based spine disease diagnosis. Existing CNN-based frameworks for landmark detection can be directly used for automatic vertebral vertex detection. However, challenges such as overlapping vertebrae and vertebrae misalignment often arise when applying existing methods to vertebral vertex detection. To address the issues, we propose a sequential vertebral vertex detection network (SVVD-Net) that fully utilizes the regularity of vertebral alignment to generate vertebral vertices with relative positional constraints. Leveraging information about previously predicted vertebrae to identify the next one, the SVVD-Net could make sequential predictions and effectively avoid vertebrae overlapping and misalignment. We design an anatomy-aware encoder based on external attention mechanism, to address the anatomical information regarding the similarities in shape and alignment of vertebrae among samples. Structured mask is used in the decoder to reduce the direct influence of one vertebra upon its immediate neighbor and accordingly accommodate occasional subtle misalignment between two adjacent vertebrae. We evaluate the performance of SVVD-Net on two datasets of X-ray images of the spine. The results indicate that the proposed SVVD-Net consistently outperforms state-of-the-art methods. Ablation experiments further support the effectiveness of involved sequential landmark generation, anatomy- aware encoder and structured mask. Accordingly, this study presents a successful attempt to incorporate anatomical priors into medical image analysis.

腰椎管狭窄症(lumbar spinal stenosis,LSS)是一种常见的脊柱退行性疾病,其主要临床表现是腰腿痛和间歇性跛行[1-2].随着人口老龄化的加剧,其发病率逐年增加,成为影响老年人生活质量的主要疾病之一[3].

BACKGROUND:This study evaluates the outcomes of fibular intramedullary nails (IMNs) compared to traditional plates and screws (PS) in the surgical treatment of unstable ankle injuries in patients aged ≥65 years. METHOD:We conducted a retrospective study involving 32 elderly patients with unstable ankle fractures treated with IMNs from 2010 to 2022. A comparison was made with 125 case-control patients treated with PS during the same period. Outcomes compared included postoperative wound and nonwound complications, surgical reduction, union rates, implant removal rates, and the Olerud Molander Ankle Score (OMAS) at a minimum follow-up of 2 years. RESULTS:The IMN group had a higher incidence of high-energy injuries, open fractures, concomitant surgery, and perioperative transfusion requirements than the PS group. Additionally, the IMN group developed fewer wound-related (3.1% vs 20% in the PS group, P = .043) and non-wound-related complications (18.8% vs 39.2% in the PS group, P = .030). Both groups had similar initial weightbearing restrictions, fracture union times, mean OMAS scores, rates of malunion or nonunion, and delayed implant removal times. Notably, there were significant differences in the quality and adequacy of mortise alignment between the groups (good: 53.1% in IMN group vs 79.2% in PS group, fair: 46.9% in IMN group vs 20.8% in PS group, P = .006). CONCLUSION:Although the IMN group had an inferior outcome in the quality and adequacy of mortise reduction compared with the PS group, elderly patients with ankle fractures treated with IMN showed comparable functional outcomes to those treated with PS but with lower complication rates. Future research in this area will provide vital information for developing optimal treatment strategies, thereby improving the overall care of elderly patients with ankle fractures.

Autogenous bone grafts have long been considered the "gold standard" and most effective material in bone regeneration procedures.[1] Autogenous bone grafts are used to repair bone defects caused by nonunion, infection, tumor resection, and spinal and joint fusion.[2] It has been reported that more than 200,000 autologous bone grafts are performed in the United States each year.[3] Although there are no specific statistics on the annual number of bone grafts performed in China, autologous bone grafting is the most common surgical technique in orthopedics. The iliac crest remains the most common donor site, along with the fibula, ribs, tibial metaphysis, proximal humerus, distal radius, and greater trochanter.[4,5] Various bone-graft options provide different amounts and qualities of cortical, cancellous, and corticocancellous bone.[6,7] Autogenous bone graft is osteogenic, histocompatible, provides structural support, and has no risk of disease transmission. The disadvantages of autogenous bone grafting are its limited supply and the increase in the magnitude of surgery owing to the need to harvest bone graft material, which increases the operative time, blood loss, and risk of complications. There are no clinical guidelines or consensus report focused on autogenous bone-grafting indications, techniques, and complication.[8] The Trauma Orthopedic Branch of the Chinese Orthopedic Association and National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation developed clinical practice guidelines for indications, techniques, and complications of autogenous bone grafting (detailed information is listed in the Supplementary File, https://links.lww.com/CM9/B551). Definition of autogenous bone grafting Autogenous bone grafting is defined as the transplantation of bone tissue obtained from a donor site into a bone defect, nonunion, or arthrodesis. Cortical bone is osteoconductive, provides functional support, and is suitable for structural defects. Cancellous bone graft has a viable cell and pore structure, which makes it easy to reconstruct blood vessels. Cancellous bone provides an osteoinductive, osteoconductive, and osteogenic substrate, but is not suitable for structural defects that require immediate mechanical stability. The vascularized bone graft (VBG) is categorized into pedicled and free grafts. A pedicled VBG is transferred from the donor site to the recipient site with its native vasculature preserved. A free VBG has its vascular pedicle divided, permitting transfer to virtually any location. Recommended strength The recommendation strength is based on a combination of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and the characteristics of clinical practice in China. Using the weighted value of each characteristic, the experts who wrote the guidelines scored the recommendations individually using a grading system [Supplementary Tables 1–3, https://links.lww.com/CM9/B551]. Types of autogenous bone grafts Autogenous bone is considered the gold standard for most applications in orthopedics because of the physiologic properties of autogenous bone as biocompatible, bioresorbable, osteoconductive, osteoinductive, and structurally supportive. When selecting the graft donor area, clinicians must consider the location of the bone defect, the position of the patient during surgery, and the required amount of graft material. The most common site for bone harvesting is the anterior iliac crest, along with the posterior iliac crest, ribs, fibula, tibial metaphysis, distal radius, and greater trochanter of the femur. Different donor areas have different indications, techniques, and complications. The most common complications are donor site pain, nerve injury, infection, fracture, an extended surgical time, increased blood loss, and limited bone graft material (grade IA). Autologous bone grafts comprise non-vascularized and VBGs. Non-vascularized autogenous bone is divided into cortical, cancellous, and corticocancellous bone. The most common vascularized bone flaps are harvested from the iliac crest with the deep circumflex iliac artery, the fibula with branches of the peroneal artery, the ribs with the posterior intercostal artery, and the distal end of the radius with the supraretinacular artery (grade IIA). Indications, techniques, and complications of non-vascularized bone grafts Anterior iliac crest bone grafting The anterior iliac crest is the most common donor site for autologous bone grafting (grade IA) and is suitable for treating severe open fractures, bone defects, delayed union, nonunion, tumor bone defects, joint fusion, and interbody fusion. The techniques for anterior iliac crest bone grafting include the curettage technique, bicortical or tricortical technique, trapdoor technique, trephine technique, and acetabular reamer technique (grade IIIA). The anterior iliac crest provides a large amount of cancellous, unicortical, bicortical, and tricortical bone. The complications of anterior iliac crest grafting are pain, nerve injury, hematoma formation, infection, incisional hernia, vascular injury, and donor site fracture (grade IA). Posterior iliac crest bone grafting The posterior superior iliac spine is the most common source of autogenous bone graft material during posterior spine fusion or procedures that require a large amount of bone graft material. The trapdoor technique is recommended to protect the integrity of the iliac crest and internal plate, and the depth of resection is limited to 4 to 6 cm to prevent damage to the sacroiliac joint and superior gluteus artery. Complications at the posterior iliac crest donor site are pain, neurovascular injury, avulsion fracture, hematoma, infection, incisional hernia, gait disturbance, sacroiliac joint invasion, and ureteral injury. Injury to the sacroiliac joint and superior gluteal artery can be avoided (grade IA). Autologous rib bone grafting An autologous rib bone graft is suitable for the reconstruction of defects in the spine, maxillofacial region, or limbs. In situ rib split transplantation is recommended, in which the rib is split in the coronal plane, the deep cortex is preserved in situ, and the superficial half of the rib cortex and cancellous bone are removed. This method is technically simple, requires a short operation time, does not damage the pleura, and reduces donor site complications. The complications of autologous rib bone grafting are pneumonia, persistent atelectasis, superficial wound dehiscence, pneumothorax, intercostal neuralgia, and chronic chest wall pain (grade IB). Tibial metaphyseal bone grafting The ipsilateral proximal and distal tibia provide adequate amounts of bone graft material for use in foot and ankle surgery. The tibia is easily accessible and can provide large quantities of cancellous and cortical bone. Tibial bone is commonly harvested using an osteotome, curette, or trephine. The main postoperative complications are pain at the donor site, hematoma, deep infection, and stress fracture (grade IB). Distal radius bone grafting The distal radius is usually used for nonunion or bone defects in the ipsilateral hand and wrist requiring a small amount of bone graft material. The cancellous or corticocancellous bone can be harvested by fenestration through the dorsal first and second compartments or through the palmar approach. The recurrent branch of the radial artery is anatomically constant, and a vascularized free bone flap can be used to repair scaphoid fracture nonunion and lunate osteonecrosis to obtain mechanical support and improve local blood supply. The main complications are donor site pain, tenosynovitis, infection, fracture, and nerve injury (grade IB). Greater trochanter bone grafting The greater trochanter of the femur is mainly composed of cancellous bone, which is suitable for ipsilateral lower limb defects, foot and ankle surgery, femoral neck nonunion, and femoral head necrosis. The greater trochanter free bone graft can be obtained by trephine or fenestration, providing a bone volume of 5–10 cm3. Common complications are donor site pain and stress fracture of the femoral neck due to excessive bone harvesting (grade IB). Reamer irrigator aspirator technique The reamer irrigator aspirator (RIA) is a relatively recent device that is placed in the femoral or tibial medullary canal to harvest a large volume of bone and is supposed to be less invasive than previous methods, allowing the harvest of a greater graft volume. The RIA device allows intramedullary reaming with simultaneous irrigation and aspiration to harvest large amounts of autologous bone from the medullary canal of long bones. The complications of the RIA technique are hemodynamic instability, iatrogenic fracture, pain, hematoma, and deep infection (grade IIIB). Indications, techniques, and complications of vascularized bone grafting Free vascularized fibular grafting Free vascularized fibular grafting (FVFG) is indicated for the reconstruction of upper extremity skeletal defects larger than 6 cm caused by oncologic resection, trauma, osteomyelitis, nonunion, or congenital malformation. Furthermore, FVFG is another important hip-preserving approach for the treatment of osteonecrosis. The most common FVFG technique is Wood's modified method in which the fibula is resected between the peroneus longus and soleus muscles. Complications at the donor site are ipsilateral tibial stress fracture, flexor pollicis longus tendon contracture, peroneal nerve palsy, and compartment syndrome (grade II-B). Vascularized iliac bone grafting The vascularized iliac bone graft based on deep circumflex iliac vessels provides a large concave segment of bone suitable for reconstruction of the extremities and spine. Both pedicled iliac bone flap transfer and FVFG are effective methods for the treatment of femoral head necrosis. Several donor site complications are reported after vascularized iliac bone grafting, namely injury to the lateral cutaneous femoral nerve, gait disturbance, bowel obstruction, and herniation (grade III-B). Vascularized rib bone grafting The vascularized rib graft is suitable for use in adjacent spinal fusion or long bone defects of the extremities that require strong biomechanical support. Vascularized rib grafting can be used in complex cases with a high risk of nonunion, infection, and pseudoarthrosis of the bone defect. There are few donor site complications, namely pneumothorax and hemothorax (grade IIIB). Surgical techniques related to autogenous bone grafting In vitro storage of autogenous bone graft material The common preservation methods after autologous bone harvesting are dry preservation and solvent preservation. Saline or 5% glucose solution is recommended as it better preserves the osteoinduction and osteogenic ability of autologous bone than dry preservation (grade IIIC). Antibiotic-impregnated autogenous bone grafts Antibiotic-impregnated bone grafts have become popular and seem to be effective and safe in the treatment of infected bone and joint defects. Infectious bone defects are common and need to be addressed before a new implant is inserted. A major advantage of antibiotic-impregnated bone grafts is the possibility of impregnating various antibiotics depending on the sensitivity profile of the causative organism (grade IB). Autogenous cancellous bone grafting using the induced membranes treatment technique The induced membranes technique is a common clinical technique that comprises a two-stage procedure. The iliac crest is the most common donor site in clinical practice, and bone can be harvested from the anterior or posterior iliac crest in accordance with the surgical position and the patient's condition. The acquisition of autologous bone by the RIA device obtains relatively more bone mass, reduces the time required for bone harvesting, and reduces donor site complications (grade IIIB). Acknowledgments We thank Kelly Zammit, BVSc, from Liwen Bianji (Edanz) (www.liwenbianji.cn/), for editing the English text of a draft of this manuscript. Funding This work was supported by the grant from the Special Project Program of the National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation (No. 2022-NCRC-000000) and the Beijing Municipal Natural Science Foundation (No. 7232165). Conflicts of interest None.

Inflammation may play a role in the mechanism of postoperative delirium (POD), a severe complication among older postoperative patients. The purpose of this study was to investigate the risk factors of POD in postoperative patients with hip fracture, especially the inflammation marker– neutrophil–lymphocyte ratio (NLR). This retrospective investigation utilized data from the Seventh Medical Center of People’s Liberation Army. 1,242 Eligible patients with hip fracture (829 females), median age 81 years, mean neutrophil-lymphocyte ratio (NLR) 5.28, were enrolled. Receiver operating characteristic (ROC) curve was performed to identify the optimal cut point of NLR for POD. The relationship between NLR and POD occurrence, NLR and POD duration were analyzed by multivariable analysis. ROC curve showed that the optimal cut point of NLR for POD was NLR ≥ 7.6. Multivariate logistic regression analysis showed that NLR ≥ 7.6 (odds ratio [OR] 2.75, [95

There are few histological studies on multifidus after lumbar surgery, and it is not clear whether multifidus changes affect the clinical outcome after lumbar surgery. The aim of this study was to investigate the relationship between multifidus changes and clinical outcomes after lumbar surgery. Patients underwent internal fixation removal after lumbar posterior surgery were enrolled. Patients were divided into a low back pain (LBP) group (n = 15) and a non-low back pain (non-LBP) group (n = 10).The Oswestry disability index (ODI) and visual analog scale (VAS) were completed. 18 patients with lumbar fracture surgery were included as the control group. Multifidus morphological changes were observed by hematoxylin and eosin and Masson staining. The expression of TGF-β1 was observed by immunohistochemistry, immunofluorescence and Western blot. The cross-sectional area (CSA) of the multifidus in the non-LBP group and the control group were greater than those in the LBP group. TGF-β1 expression and gray value ratio in the non-LBP group and the control group were lower than those in the LBP group. The multifidus CSA and TGF-β1 expression in multifidus were strongly correlated with ODI and VAS. Patients with LBP after posterior lumbar surgery suffered from atrophy and fibrosis lesions in the multifidus, and the degree of multifidus lesions was closely related to dysfunction and pain, which might be one of the causes of LBP after posterior lumbar surgery.

ObjectiveAs the population ages and technology advances, lateral lumbar intervertebral fusion (LLIF) is gaining popularity for the treatment of degenerative lumbar scoliosis (DLS). This study investigated the feasibility, minimally invasive concept, and benefits of LLIF for the treatment of DLS by observing and assessing the clinical efficacy, imaging changes, and complications following the procedure.MethodsA retrospective analysis was performed for 52 DLS patients (12 men and 40 women, aged 65.84 ± 9.873 years) who underwent LLIF from January 2019 to January 2023. The operation time, blood loss, complications, clinical efficacy indicators (visual analogue scale [VAS], Oswestry disability index [ODI], and 36‐Item Short Form Survey), and imaging indicators (coronal position: Cobb angle and center sacral vertical line–C7 plumbline [CSVL–C7PL]; and sagittal position: sagittal vertical axis [SVA], lumbar lordosis [LL], pelvic incidence angle [PI], and thoracic kyphosis angle [TK] were measured). All patients were followed up. The above clinical evaluation indexes and imaging outcomes of patients postoperatively and at last follow‐up were compared to their preoperative results.ResultsCompared to the preoperative values, the Cobb angle and LL angle were significantly improved after surgery (p < 0.001). Meanwhile, CSVL–C7PL, SVA, and TK did not change much after surgery (p > 0.05) but improved significantly at follow‐up (p < 0.001). There was no significant change in PI at either the postoperative or follow‐up timepoint. The operation took 283.90 ± 81.62 min and resulted in a total blood loss of 257.27 ± 213.44 mL. No significant complications occurred. Patients were followed up for to 21.7 ± 9.8 months. VAS, ODI, and SF‐36 scores improved considerably at postoperative and final follow‐up compared to preoperative levels (p < 0.001). After surgery, the Cobb angle and LL angle had improved significantly compared to preoperative values (p < 0.001). CSVL–C7PL, SVA, and TK were stable after surgery (p > 0.05) but considerably improved during follow‐up (p < 0.001). PI showed no significant change at either the postoperative or follow‐up timepoints.ConclusionLateral lumbar intervertebral fusion treatment of DLS significantly improved sagittal and coronal balance of the lumbar spine, as well as compensatory thoracic scoliosis, with good clinical and radiological findings. Furthermore, there was less blood, less trauma, and quicker recovery from surgery.

Hip fracture is the most common type of injury in elderly people and is associated with a high incidence of complications and risk of mortality. In these patients, subsequent pulmonary infection can contribute to the development of an acute lung injury, a consequence of the systemic inflammatory response induced by hip fracture. Although the crucial role of microRNAs (miRNAs) in inflammatory responses has been established, the functions of miRNAs in the inflammatory responses associated with lung injury after hip fracture remain poorly understood. In this study, we explored the potential role of miR-205-5p in lung injury after hip fracture in an in vivo hip fracture model and in vitro cultures of human pulmonary alveolar epithelial cells (HPAEpiC). An analysis of clinical serum samples revealed increased levels of miR-205-5p and high mobility group box 1 (HMGB1) after hip fracture. A bioinformatics analysis and dual-luciferase reporter assay identified HMGB1 as a potential target of miR-205-5p. The overexpression of miR-205-5p clearly reduced the expression of HMGB1 and inhibited NF-κB signaling, apoptosis, and proinflammatory cytokine production while enabling continued cell proliferation. Our results demonstrate that the upregulation of miR-205-5p suppresses inflammatory responses and promotes cell viability and proliferation by selectively targeting HMGB1 in the context of lung injury after hip fracture. Therefore, miR-205-5p may be an alternative target of therapeutic strategies for lung injury after hip fracture.

Hip fractures in nonagenarians is one of the great challenges for patients of this age, the family and the larger society. The purpose of this study was to investigate the risk factors and prognosis of postoperative delirium in nonagenarians with hip fracture. 199 Eligible patients were enrolled. Confusion Assessment Method (CAM) were used to identify the delirium. Logistic regressions were used to investigate the effect of 18 pre-existing conditions on postoperative delirium. Prognosis of postoperative delirium in nonagenarians with hip fracture were also be evaluated. The results indicated the following: (1) the prevalence of postoperative delirium among nonagenarians with hip fracture was 28.1% (56 of 199); (2) coexisting disease ≥ 4 (OR = 5.355, 95% CI = 1.394–9.074, P = 0.007), longer admission to operating time (OR = 1.514, 95% CI = 1.247–1.837, P = 0.000), and general anesthesia (OR = 2.086, 95% CI = 1.804–7.968, P = 0.032) were independent risk factors for postoperative delirium in nonagenarians with hip fracture; (3) nonagenarians with postoperative delirium had a predominantly high burden of perioperative complications, long length of stay, and postoperative mortality at 30 days follow-up and 1 year follow-up than the patients without postoperative delirium. The results could enable clinicians to improve outcome after operation in nonagenarians with hip fracture.

Abstract Purpose Postoperative delirium (POD) is an independent risk factor not only for mortality but also for institutionalization and dementia. The purpose of this study was to investigate the risk factors, which is related to the pathogenesis of POD, in geriatric patients with hip fracture.Methods 1,242 Eligible patients with hip fracture were enrolled. Receiver operating characteristic (ROC) curve was performed to identify the optimal cut point of NLR for POD. The relationship between NLR and POD occurrence, NLR and POD duration were analyzed by multivariable analysis.Results ROC curve showed that the optimal cut point of NLR for POD was NLR ≥ 7.6. Multivariate logistic regression analysis showed that NLR ≥ 7.6 (odds ratio [OR] 2.75, [95% confidence interval [CI] 1.51 to 5.02], p = 0.001), stroke (OR 1.05, [95% CI 1.02 to 1.09], p = 0.005), complications, general anesthesia, long length of stay were risk factors of POD, with the largest effect for NLR ≥ 7.6. NLR ≥ 7.6 (OR 0.59, [95% CI 0.209 to 0.886], p = 0.038), older age (OR 0.054, [95% CI 0.009 to 0.099], p = 0.019), previous stroke (OR 0.908, [95% CI 0.085 to 1.731], p = 0.031), and previous heart failure (OR 1.679, [95% CI 0.448 to 2.910], p = 0.008) suggested long POD duration.Conclusions NLR could be used as a potential marker for prediction of POD and POD duration in geriatric patients with hip fracture.

Objective:To explore the risk factors of heart failure within 1 year after surgery for hip fracture in the elderly.Methods:A retrospective cohort study was conducted to analyze the clinical data of 476 elderly patients with hip fracture admitted to No.7 Medical Center, Chinese PLA General Hospital from January 2018 to December 2019, including 171 males and 305 females, at age of 60-104 years [(82.5±8.1)years]. There were 271 patients with intertrochanteric fractures and 205 with femoral neck fractures. The patients were divided into heart failure group ( n=111) and non-heart failure group ( n=365) based on the presence of heart failure within 1 year after surgery. The following items were recorded: gender, age, fracture type (intertrochanteric fractures and femoral neck fractures), comorbidities [hypertension, coronary heart disease, arrhythmia, pulmonary infection, chronic obstructive pulmonary disease (COPD), renal insufficiency and diabetes], use of anticoagulants before injury, walking ability and self-care ability before injury, hematological indicators (white blood cell count, hemoglobin, albumin), time from injury to surgery, types of anesthesia (general anesthesia and regional anesthesia), types of surgery (intramedullary nails, dynamic hip screws, cannulated screw and arthroplasty), blood transfusion, length of hospital stay, sorts of perioperative complications (cerebrovascular disease, delirium, pulmonary infection, acute myocardial infarction, malignant arrhythmia, urinary tract infection, venous thromboembolism, acute cholecystitis and intestinal obstruction), and number of perioperative complications. Univariate analysis was used to evaluate the relationship between the above indicators and heart failure within 1 year after surgery in the elderly patients with hip fracture. Multiple Logistic stepwise regression analysis was used to determine the independent risk factors for the heart failure. Results:Univariate analysis showed that age, coronary heart disease, arrhythmia, use of anticoagulants before injury, albumin, blood transfusion, length of hospital stay, and number of perioperative complications≥2 were correlated with heart failure within 1 year after surgery in elderly patients with hip fracture ( P<0.05 or 0.01). Multivariate Logistic stepwise regression analysis showed that coronary heart disease ( OR=1.50, 95% CI 1.10, 2.51, P<0.05), blood transfusion≥2 U ( OR=2.01, 95% CI 1.23, 3.29, P<0.01) and number of perioperative complications≥2 ( OR=2.12, 95% CI 1.27, 3.53, P<0.01) were significantly associated with heart failure within 1 year after surgery in elderly patients with hip fracture. Conclusion:Complications of coronary heart disease, blood transfusion≥2 U and number of perioperative complications≥2 are independent risk factors for heart failure within 1 year after surgery in elderly patients with hip fracture.

BackgroundFragility fractures of the pelvis (FFPs) are osteoporotic pelvic fractures or insufficiency pelvic fractures caused by the low energy injury or stress fracture in daily livings in the elderly more than 60 years, which the incidence is increasing with the aging population in our country. FFPs result in considerable morbidity and mortality and as well as massive financial burden on the already strained health systems throughout the world.MethodsThis clinical guideline was initiated by the Trauma Orthopedic Branch of Chinese Orthopedic Association; the External Fixation and Limb Reconstruction Branch of Chinese Orthopedic Association; the National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation; Senior Department of Orthopedics of Chinese PLA general hospital; the Third Hospital of Hebei Medical University. The grading of recommendations assessment, development and evaluation (GRADE) approach and the reporting items for practice guidelines in healthcare (RIGHT) checklist were adopted.Results22 evidence based recommendations were formulated based on 22 most concerned clinical problems among orthopedic surgeons in China.ConclusionUnderstanding these trends through this guideline will facilitate better clinical care of FFP patients by medical providers and better allocation of resources by policy makers.

OBJECTIVE:To study the clinical manifestations and treatment of intervertebral space infection after percutaneous lumbar radiofrequency ablation of nucleus pulposus.METHODS:A retrospective analysis was performed of 496 patients who underwent percutaneous lumbar disc decompression using low-temperature plasma radiofrequency ablation nucleus pulposus from June 2009 to June 2019. Six patients had lumbar infection, and the infection rate was 1.21%. All patients were male, ranging in age from 20 to 61 years old. Three patients underwent single segment radiofrequency ablation, two patients underwent dual segments ablation;and one patient underwent three segment ablation, totaling 10 intervertebral discs. One patient was complicated with type 2 diabetes before operation. The interval between infection occurrence ranged from 21 to 65 days.RESULTS:All 6 patients were followed up, and the duration ranged from 18 to 40 months, with an average of 24 months. Among them, 2 patients presented with symptoms of low back pain accompanied by fever, and imaging examination showed intervertebral space infection accompanied by abscess. In addition, 4 patients experienced low back pain but no fever, and MRI showed abnormal signals of the infected intervertebral endplate or vertebral body. One patient showed staphylococcus aureus in blood culture, while the remaining 5 patients showed negative bacterial culture. All the patients were treated with antibiotics after diagnosis. Four patients were treated with conservative management to control infection;1 patient was treated with debridement of posterior lumbar infection focus, and 1 patient was treated with debridement of posterior lumbar infection focus combined with interbody fusion and internal fixation.CONCLUSION:The occurrence of intervertebral space infection during lumbar radiofrequency ablation nucleoplasty should be given sufficient attention. Strict aseptic technique, avoiding repeated multi segment puncture, realizing early detection and treatment, and selecting appropriate treatment methods according to the severity of infection is the guarantee of achieving curative effect.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

OBJECTIVE:To explore incidence, risk factors and the relationship between preoperative heart failure and prognosis in elderly patients with hip fracture.METHODS:A retrospective analysis was performed on 1 569 elderly patients with hip fracture treated from January 2012 to December 2019, including 522 males and 1 047 females, aged 81.00 (75.00, 90.00) years old;896 intertrochanteric fractures and 673 femoral neck fractures. Patients were divided into heart failure and non-heart failure groups according to whether they developed heart failure before surgery, and heart failure was set as the dependent variable, with independent variables including age, gender, fracture type, comorbidities and hematological indicators, etc. Univariate analysis was performed at first, and independent variables with statistical differences were included in multivariate Logistic regression analysis. Independent risk factors for preoperative heart failure were obtained. The length of hospital stay, perioperative complications, mortality at 30 days and 1 year after surgery were compared between heart failure and non-heart failure groups.RESULTS:There were 91 patients in heart failure group, including 40 males and 51 females, aged 82.00 (79.00, 87.00) years old;55 patients with intertrochanteric fracture and 36 patients with femoral neck fracture. There were 1 478 patients in non-heart failure groups, including 482 males and 996 females, aged 81.00(75.00, 86.00) years old;841 patients with intertrochanteric fracture and 637 patients with femoral neck fracture. There were significant differences in age, sex, coronary heart disease, arrhythmia and dementia between two groups(P<0.05). Multivariate Logistic analysis of statistically significant factors showed that males(OR=1.609, P=0.032), age(OR=1.032, P=0.031), arrhythmia(OR=2.045, P=0.006), dementia (OR=2.106, P=0.014) were independent risk factor for preoperative heart failure. The 30-day and 1-year mortality rates were 9.9% and 26.4% in heart failure group and 3.6% and 13.8% in non-heart failure group, respectively;and had statistical significance between two groups (P<0.05). There were significant differences in pulmonary infection, cerebrovascular complications and cardiovascular complications between two groups (P<0.05). The duration of hospitalization in heart failure group was (16.21±10.64) d compared with that in non-heart failure group (13.26±8.00) d, and the difference was statistically significant (t=2.513, P=0.012).CONCLUSION:Male, old age, arrhythmia and dementia are independent risk factors for heart failure after hip fracture in elderly patients. Patients with preoperative heart failure have a higher incidence of postoperative pulmonary infection, cerebrovascular and cardiovascular complications, higher mortality at 30 d and 1 year after surgery, and longer hospital stay.