The evaluation of three-dimensional fracture mapping may offer significant benefits for clinicians, as well as for engineers involved in the design of advanced implants. The specific objectives of this study were to perform three-dimensional mapping of mandibular fractures based on the unique fracture morphologies of a defined cohort and to assess fracture distribution according to demographic variables, etiological factors, mandibular third molar impaction status, and fracture characteristics. This retrospective single-center cohort study included patients with mandibular fractures who were admitted to the Department of Oral and Maxillofacial Surgery at a tertiary healthcare center between January 2018 and February 2025. The primary outcome was the three-dimensional mapping of mandibular fracture distribution, visualized as fracture line density using color-coded heat maps. Covariates included demographic, etiological, mandibular third molar-related, and fracture-related variables. Fracture mapping was performed at the fracture level, whereas statistical analyses evaluating the association between impacted third molars and fracture location were conducted at the patient level. One hundred fifty eight patients with mandibular fractures were analyzed, including 103 males (65.2

Understanding dimensions of both sinus tarsi (ST) and tarsal canal (TC) in normal and flatfeet may influence the design, usage and possible control of postoperative complications of arthroereisis. This study was to assess 3D features of the tarsal sinus and canal complex (TSCC) in both normal control and flatfeet in children under non-weightbearing and weightbearing conditions. Three-dimensional (3D) computer-aided design modeling from WBCT scans of 22 children with flexible flatfeet (age 9–14) and 14 with normal control feet (age 9–15) were used to evaluate volume and dimensions of TSCC. Correlations between Meary’s angle, hindfoot alignment, and volume of TSCC were calculated on non-weightbearing and weightbearing CT scans. The volume of TSCC was smaller in the flatfoot group compared with the control group both under weightbearing and non-weightbearing conditions. From non-weightbearing to weightbearing the volume of TSCC decreased by 19.1

In recent years, the incidence of calcaneal fractures, a complex and common type of foot trauma, has risen sharply due to an increase in traffic accidents, falls from heights, and other injuries. However, research in computer-aided diagnosis of such fractures remains limited, primarily due to the lack of a precisely annotated dataset for training and validating segmentation algorithms. To address this gap, we have developed a new dataset, CalFrac, which includes CT scan data from 140 calcaneal fracture patients at Ruijin Hospital in Shanghai. The data is stored in the widely-used DICOM format, and under the guidance of expert clinicians, all cases were meticulously annotated using 3D Slicer software. This process yielded high-resolution 3D mask images that accurately capture the fracture regions in shape and extent. We further analyzed and evaluated the CalFrac dataset by testing six classical and advanced medical image segmentation models. The results highlighted the limitations of these models and validated the dataset's value for improving segmentation accuracy in calcaneal fracture diagnosis.

The amount of digital rock samples is crucial for studying pore properties. However, it is currently challenging due to equipment limitations or cost considerations. To address this issue, we propose sorts of reconstruction solutions under Data-Scarce Scenarios based on latent inversion predictions from the proposed generative model. Firstly, a novel underlying feature distribution learning model called ResNet-VGG Inversion Optimization Network (RVION) is proposed to infer the latent codes of the real rock images. During inversion, the latent codes predicted by RVION are prepared to interpolate into latent space learned by the generative model. To stably generate high-quality images, the Adaptive Data Augmentation Progressive Growing Generative Adversarial Network (ADA-PGGAN) is proposed, which includes a mechanism to supervise discriminator’s overfitting and automatically adjust levels of data augmentation. Subsequently, interpolated latent codes are input into the generator to progressively increase image resolution and reconstruct large-scale 3D digital rocks. Finally, evaluations using various metrics were conducted in both 2D and 3D on our results. The Sliced Wasserstein Distance (SWD) was used to assess our proposed data augmentation operation. The majority of SWD values remained below 0.01, and further decreased as the resolution increased. Furthermore, generated images accurately exhibited core characteristics. We also evaluated our results in 3D with corresponding metrics, structural properties to indicate consistency with given samples.

Approximately 20% of diabetic foot ulcers (DFUs) patients require lower extremity amputation, and postoperative reulceration and reamputation remains common. To clarify the biomechanical consequences and reulceration risk of different ray amputations (RAs), we built finite-element models and simulated various RAs. During the simulated gait cycle, amputation of the first ray or first two rays (1 RA and 1-2 RA) exhibited higher von Mises stress and strain values. These two RAs also generated larger plantar “danger areas” for reulceration, suggesting that 1 RA and 1-2 RA may substantially increase reulceration risk. Conversely, preserving the first ray or first two rays mitigates reulceration risk. Two clinical case examples aligned with the modelling results. This study concludes that, when feasible, preserving the first ray or first two rays helps maintain foot biomechanics and reduces reulceration risk; if 1 RA or 1-2 RA is unavoidable, transmetatarsal amputation might be more suitable.

Reduction is a crucial stage in the surgical treatment of bone fractures. The detailed fracture information of the patient can be obtained from computed tomography (CT) scans before surgery and enable physicians to plan preoperative reduction, to reduce the operation time and thus increase the probability of getting satisfactory results. The primary purpose of this paper is to design a computer-aided automatic registration method of frac-ture point cloud data, so as to simplify the fracture reduction process. In this paper, we propose an integrated fracture reduction system was introduced. The system enables direct semi-automatic processing from CT im-ages to fracture reduction. First, a 3D fracture models is reconstructed from CT images by using the modified Marching Cube (MC) algorithm and is discretized to generate a point cloud. Second, the K-dimensional (KD) tree algorithm is used to cluster and segment the point clouds to identify different fracture fragments. Last, through the combination algorithm of Normal Distributions Transform (NDT) and modified Iterative Closest Point (ICP), the coarse alignment and fine registration of point clouds are achieved step by step. This method has been successfully applied to the reduction of tibial fracture. In the tests performed, the processing time of each step, the point cloud and the 3D model after registration are displayed. The semi-automatic integrated system based on preoperative CT scanning is used to realize fracture reduction, which provides a feasible foun-dation for minimally invasive and accurate fracture reduction surgery

This article has been corrected: The authors found an error in Figure 5G, which depicts transwell migration assays assessing the effects of miR-15a-3p inhibition on HUVEC cells. The central panel, illustrating migration of HUVECs treated with exosomes derived from DFU individuals (Dia-Exos), was replaced with the appropriate image from the original set of experiments. This inadvertent error does not in any way compromise the validity or integrity of the study's findings. The authors take full responsibility for this oversight and sincerely apologize for any inconvenience caused.

The objective of this study was to measure how much of the superolateral femoral neck should be removed to reduce the incidence of wedge effect. Simulating surgery: Computed Tomography images of 131 intertrochanteric fracture patients were included, three-dimensionally reconstructed, virtually reduced and implanted with Proximal Femoral Nail Antirotation blade-II(PFNA-II) nail. The antero-posterior length and media-lateral width of the intersection between superolateral femoral neck and PFNA-II nail were measured. Retrospective study: The pre- and postoperative CT of 30 patients were collected. The average varus angle of the neck-shaft angle and the correlation between the angles and the difference in the actual and estimated width of the fragments removed were measured. Models of 108 patient were selected for analysis. The average antero-posterior length and media-lateral width were 14.46 mm (14.00-14.93 mm) and 9.33 mm (8.79-9.87 mm), respectively. The AO/OTA classification was not significantly associated with the outcome, but the gender was. In the retrospective study, the mean value of the varus angles was -4.58 degrees (SE = 6.85 degrees), and the difference of width was strongly positively correlated with the varus angle with a correlation coefficient of 0.698. Results obtained in this study can improve the understanding of this region and help surgeons to make appropriate preoperative planning to reduce the incidence of wedge effect. Retrospective study provided effective proof of the reliability of this study.

Deep learning models have demonstrated promising results in the early and accurate diagnosis of osteonecrosis of the femoral head (ONFH), enabling early detection and informed surgical decision-making. The objective of this review is to summarize the applications of deep learning models on the medical images of ONFH. English papers were searched from CINAHL via EBSCOhost, Embase, IEEE Xplore® Digital Library, PubMed, Scopus, and Web of Science. Sixteen studies (n = 16) were eligible for data synthesis. Among these, five studies (n = 5) focusing on radiographs, ten studies (n = 10) focusing on magnetic resonance imaging, and one study (n = 1) focusing on computed tomographic images. The applications of these studies included identifying ONFH from normal or other hip pathologies, classifying severity, segmenting, and detecting femoral head and necrotic regions, predicting signs and symptoms of ONFH, and predicting potential ONFH after fracture fixation. Generally, the models demonstrated good to excellent classification performance and excellent discriminatory power; and generally comparable to that of experienced physicians and superior to that of less experienced physicians. However, the external validity of these studies demonstrated only moderate, as evidenced by the performance on the external testing set and might be attributed to the relatively small data size used during model training. we observed a shift from CNN-based models to U-Net based models (i.e., with encoder-decoder architecture). In addition to streamlining the segmentation, detection, and classification procedures, future studies will explore multimodal attention, self-supervised learning, explainable models, and data augmentation through generative models.

Purpose To evaluate the importance of computed tomography (CT) in the assessment of distal radius fractures. Methods Fifty distal radius fractures were randomly included in this study. In the first part, preoperative CT images were reconstructed for all patients. After reconstructing the bony structures, 50 fracture lines were plotted on standardized bony structures of the distal radius using 3-matic software. A heat map was created based on the frequency of fracture lines to investigate the overall distribution of distal radius fractures through CT image superimposition. In the second part, all patients' imaging data, including preoperative and postoperative X-rays, were compared with preoperative and postoperative CT scans. Two independent observers analyzed the data to compare the disclosure of important details and to investigate the significance of CT for individual distal radius fractures. Results The overall pattern of fracture lines in distal radius fractures is clearly demonstrated by CT. In the distal radial epiphyseal region, an annular band with a width of 4.52 mm is located in the area of primitive epiphyseal cartilage development below the watershed. Fractures below this annular band were rare. The distribution of volar fracture lines above the annular band was significantly less than that of dorsal fracture lines, which were more concentrated around Lister's tubercle and more frequently involved the distal radial joint. For individuals, preoperative CT and reconstruction techniques revealed 100% of the fracture details, especially in assessing articular surfaces. Postoperative CT provided a more accurate assessment of distal radius fracture repositioning and fixation, such as screw implantation and penetration, and articular surface flattening. However, overall fracture parameters (radial styloid height, radial inclination, palmar tilt) were measured more clearly by X-ray than by CT. Conclusions CT and X-rays are essential for both preoperative and postoperative evaluations of distal radius fractures. However, CT offers a more detailed understanding of fracture characteristics and serves as a more effective guide for preoperative assessment and postoperative monitoring. Therefore, CT should be used as a routine examination.

[This retracts the article DOI: 10.1155/2020/8428407.].

Background The “In–Out–In” (IOI) posterosuperior screw was common in screw fixations of femoral neck fractures. The impacts of the IOI screw on the blood supply of the femoral head have not yet been clarified. The nutrient foramen was damaged when the screw was present in their corresponding cortex surface. This study aimed to evaluate the damage degrees of the nutrient foramina in the femoral neck as the IOI posterosuperior screw was placed in different posterosuperior locations. Methods One hundred and eight unpaired dry human cadaveric proximal femurs were scanned by a three-dimensional scanner. Digital data obtained from the proximal femur surface were employed for subsequent analysis. All nutrient foramina in the femoral neck were identified and marked in each subject. A simulation of the anteroposterior, lateral, and axial views was then performed, and regions of interest (ROIs) for IOI posterosuperior screws, with 6.5 mm diameter, were determined in the posterosuperior femoral neck on the axial graphs. Nutrient foramina were counted and analyzed in ROIs and femoral neck, and its damage from the IOI posterosuperior screw was also calculated in different conditions of screw placement. Paired t -tests were used for comparative analyses before and after damage. Results Most nutrient foramina were located in the subcapital region and the least in the basicervical region in the femoral neck, while the most were located in the transcervical and the least in the subcapital in the ROIs. In addition, most nutrient foramina in ROIs were located in the superior–posterior area of the femoral neck. There were four main locations of IOI posterosuperior screws where the decrease in the nutrient foramina was statistically significant ( P < 0.01). The risk zone determined by these locations was located in a posterosuperior square of ROIs with an edge length of 9.75 mm. Conclusion To minimize iatrogenic damage to the blood supply of the femoral head, screw positions could be assessed in anteroposterior and lateral radiographs using a risk zone. The IOI posterosuperior screw in ROIs can be applied to fix femoral neck fractures when feasible in clinical practice. This study could provide surgeons with more alternatives for screw placement in the posterosuperior femoral neck.

BACKGROUND:Existing state-of-the-art "safe zone" prediction methods are statistics-based methods, image-matching techniques, and machine learning methods. Yet, those methods bring a tension between accuracy and interpretability.PURPOSE:To explore the model explanations and estimator consensus for "safe zone" prediction.MATERIAL AND METHODS:We collected the pelvic datasets from Orthopaedic Hospital, and a novel acetabular cup detection method is proposed for automatic ROI segmentation. Hybrid priors comprising both specific priors from data and general priors from experts are constructed. Specifically, specific priors are constructed based on the fine-tuned ResNet-101 convolutional neural networks (CNN) model, and general priors are constructed based on expert knowledge. Our method considers the model explanations and dynamic consensus through appending a SHapley Additive exPlanations (SHAP) module and a dynamic estimator stacking.RESULTS:The proposed method achieves an accuracy of 99.40% and an area under the curve of 0.9998. Experimental results show that our model achieves superior results to the state-of-the-art conventional ensemble classifiers and deep CNN models.CONCLUSION:This new screening model provides a new option for the "safe zone" prediction of acetabular cup.

Background and Objectives: The anatomical reduction (AR) is usually considered the best option for frac-tures. Nevertheless, in unstable trochanteric hip fractures (UTHF), previous clinical reports found that the positive medial cortical support (PMCS, an over-reduction technique) attained higher mechanical stability, but this challenging clinical finding still needs experimental validation. Methods: This study constructed in-silico and biomechanical PMCS and AR models, with the use of the most clinically-representative geometry design of fracture models, the multi-directional design in FE anal-ysis, and the subject-specific (osteoporotic) bone material properties, to make the models better mimic the actual condition in clinical settings. Then multiple performance variables (von-Mises stress, strain, integral axial stiffness, displacement, structural changes, etc.) were assessed to uncover details of integral and regional stability. Results: Among in-silico comparison, PMCS models showed significantly lower maximum displacement than AR models, and the maximum von Mises stress of implants (MVMS-I) was significantly lower in PMCS models than in AR models (highest MVMS-I in -30 degrees-A3-AR of 1055.80 +/- 93.37 MPa). Besides, PMCS models had significantly lower maximum von Mises stress along fracture surfaces (MVMS-F) (highest MVMS-F in 30 degrees-A2-AR of 416.40 +/- 38.01 MPa). Among biomechanical testing comparison, PMCS models showed significantly lower axial displacement. Significantly lower change of neck-shaft angle (CNSA) was observed in A2-PMCS models. A fair amount of AR models converted into the obvious negative medial cortical support (NMCS) condition, whereas all PMCS models kept the PMCS condition. The results were also validated through comparison to previous clinical data. Conclusions: The PMCS is superior to the AR in the UTHF surgery. The current study opens up the second thought of the role of over-reduction technique in bone surgery. (c) 2023 Elsevier B.V. All rights reserved.

The objective of this review was to summarize the applications of sonoelastography in testicular tumor identification and inquire about their test performances. Two authors independently searched English journal articles and full conference papers from CINAHL, Embase, IEEE Xplore®, PubMed, Scopus, and Web of Science from inception and organized them into a PIRO (patient, index test, reference test, outcome) framework. Eleven studies (n = 11) were eligible for data synthesis, nine of which (n = 9) utilized strain elastography and two (n = 2) employed shear-wave elastography. Meta-analyses were performed on the distinction between neoplasm (tumor) and non-neoplasm (non-tumor) from four study arms and between malignancy and benignity from seven study arms. The pooled sensitivity of classifying malignancy and benignity was 86.0% (95%CI, 79.7% to 90.6%). There was substantial heterogeneity in the classification of neoplasm and non-neoplasm and in the specificity of classifying malignancy and benignity, which could not be addressed by the subgroup analysis of sonoelastography techniques. Heterogeneity might be associated with the high risk of bias and applicability concern, including a wide spectrum of testicular pathologies and verification bias in the reference tests. Key technical obstacles in the index test were manual compression in strain elastography, qualitative observation of non-standardized color codes, and locating the Regions of Interest (ROI), in addition to decisions in feature extractions. Future research may focus on multiparametric sonoelastography using deep learning models and ensemble learning. A decision model on the benefits–risks of surgical exploration (reference test) could also be developed to direct the test-and-treat strategy for testicular tumors.

BackgroundThe fixation of inferior pole fractures of the patella (IPFPs) is still a great challenge for surgeons.Materials and methodsWe introduced a new fixation method for IPFP fixation, that is, separate vertical wiring plus bilateral anchor girdle suturing fixation (SVW-BSAG). Three finite element models including the anterior tension band wiring (ATBW) model, separate vertical wiring (SVW) model and SVW-BSAG model, were built to evaluate the fixation strength of different fixation methods. A total of 41 consecutive patients with IPFP injury were enrolled in this retrospective study, including 23 patients in the ATBW group and 18 patients in the SVW-BSAG group. The operation time, radiation exposure, full weight-bearing time, Bostman score, extension lag versus contralateral healthy leg, Insall-Salvati ratio, and radiograph outcomes were employed to assess and compare the ATBW group and SVW-BSAG group.ResultsThe finite element analysis confirmed that the SVW-BSAG fixation method was as reliable as the ATBW fixation method in terms of fixed strength. Through retrospective analysis, we found that there was no significant difference between the SVW-BSAG and ATBW groups in age, sex, BMI, fracture side, fracture type, or follow-up time. There were no significant differences between the two groups in the Insall-Salvati ratio, 6-month Bostman score, and fixation failure. Compared with the ATBW group, the SVW-BSAG group showed advantages in intraoperative radiation exposure, full weight-bearing time, and extension lag versus the contralateral healthy leg.ConclusionThe finite element analysis and clinical results showed that SVW-BSAG fixation methods are a reliable and valuable for IPFP treatment.

The trochanteric hip fracture is one of the most serious public health issues. Surgical intervention achieves early mobilization and prevents secondary complications. In recent years, the positive anteromedial cortical support, one non-anatomical fracture reduction technique, acquired wide recognition but with new controversial issues: the lack of experimental studies; the comparison between positive and neutral cortical support; the comparison between anterior and medial cortical support; the difference between neutral cortical support and anatomical reduction; and the comparison between Chang and Baumgaertner reduction quality criteria. This review provides an overview of related reports of clinical study, finite element analysis as well as biomechanical testing, and summarizes the research progress and debate in this field.

Different concentrations of calcium titanate (CaTiO3) nanoparticles were loaded into the Silk fibroin (SF) solution to construct porous SF@CaTiO3 hybrid scaffolds, which were shown to have enhanced properties for stimulating peripheral nerve regeneration. Surface charges, crystallization intensity, wettability, porosity, and morphology were measured and analyzed. We analyzed the hybrid porous SF@CaTiO3 scaffolds that affected the expansion of Schwann cells. The results demonstrated a concentration-dependent influence on the dispersion of nanoparticles in the CaTiO3 hybridized SF scaffolds. Incorporating CaTiO3-NPs into the porous SF@CaTiO3 hybrid scaffolds can boost hydrophobicity while decreasing surface charge density and porosity. The hybridized scaffolds mostly had an orthorhombic calcium titanate crystal structure with amorphous Silk fibroin mixed. Schwann cell cultures revealed that SF@CaTiO3 hybrid scaffolds containing an optimal CaTiO3-NPs concentration could stimulate the proliferation, attachment, and protection of Schwann cell biological functions, suggesting the scaffolds' potential for use in peripheral nerve regeneration.

Objective:The inverted triangle configuration of the three cannulated screws is the classic fixation method most commonly performed for undisplaced femoral neck fractures in young and geriatric patients. However, the posterosuperior screw has a high incidence of cortical breach, known as an in-out-in (IOI) screw. In this study, we present a novel posterosuperior screw placement strategy to prevent the screw from becoming IOI.Methods:Using computed tomography data and image-processing software, 91 undisplaced femoral neck fractures were reconstructed. The anteroposterior (AP), lateral, and axial radiographs were simulated. To simulate the intraoperative screw placement process, participants used three screw insertion angles (0°, 10°, and 20°) to place the screw on the AP and lateral views of the radiograph according to the three established strategies. On the AP radiograph, a screw was placed abutting (strategy 1), 3.25 mm away from (strategy 2), or 6.5 mm away from (strategy 3) the superior border of the femoral neck. On the lateral radiograph, all the screws were placed abutting the posterior border of the femoral neck. Axial radiographs were used to evaluate the screw position.Results:In strategy 1, all the placed screws were IOI regardless of the screw insertion angle. In strategy 2, 48.3% (44/91) of IOI screws occurred at a 0° screw insertion angle, 41.7% (38/91) of IOI screws occurred at a 10° screw insertion angle, and 42.9% (39/91) of IOI screws occurred at a 20° screw insertion angle situation. In strategy 3, no IOI screw occurred, and the screw insertion angles did not affect the safety and accuracy of screw placement.Conclusions:Screws placed according to strategy 3 are safe. The reliability of this screw placement strategy is unaffected by a screw insertion angle of less than 20 degrees.