BACKGROUND:The development of heterotopic ossification (HO) is a common yet debilitating complication after elbow injuries and related surgical procedures. We intend to evaluate the regional distribution features of HO around the elbow joint in patients with post-traumatic elbow stiffness (PTES), and explore the independent risk factors for HO development in different regions. MATERIALS AND METHODS:Patients who presented with PTES attributed to HO from January 2018 to December 2019 were consecutively enrolled. The pattern of HO distribution was analyzed using Mimics software (Mimics 21.0, Materialise NV, Leuven, Belgium) and classified into 8 distinct regions: anteromedial (AM), anterolateral (AL), posteromedial (PM), posterolateral (PL), posterior (P), medial (M), lateral (L), and proximal radioulnar (PRU) regions. The initial injuries were further categorized based on the presence or absence of 5 fundamental injury types: distal humerus fracture, olecranon fracture, radial head fracture, coronoid fracture, and elbow dislocation. With the occurrence of HO in a specific region as the dependent variable and the initial injury patterns and baseline clinical data as independent variables, logistic regression analyses were conducted to identify the associated independent risk factors for HO development in different regions. RESULTS:A total of 170 patients were included. We identified PM HO in 166 patients (97.6%), P HO in 135 patients (79.4%), PL HO in 128 patients (75.3%), AM HO in 92 patients (54.1%), AL HO in 57 patients (33.5%), PRU HO in 32 patients (18.2%), M HO in 12 patients (7.1%), and L HO in 11 patients (6.5%). The results of logistic regression analyses: (1) AM HO: time interval between the initial injury and this admission ≥1 year (odds ratio [OR] = 2.338), the presence of elbow dislocation (OR = 3.193) and olecranon fracture (OR = 0.305); (2) AL HO: high energy trauma (OR = 2.073) and the presence of olecranon fracture (OR = 0.367); (3) P HO: immobilization for more than 2 weeks after the initial injury or subsequent surgical procedures (OR = 2.466); (4) PL HO: the presence of radial head fracture (OR = 2.805); (5) PRU HO: the presence of radial head fracture (OR = 8.186); (6) PM + P + PL HO: the presence of radial head fracture (OR = 2.235). CONCLUSION:The regional distribution of HO in patients with PTES exhibits distinct features, and PM HO is observed in almost all patients. The type of initial injury and its subsequent management are closely related to the occurrence and development of HO in different regions. Our findings provide valuable insights and serve as a useful reference for the clinical assessment of HO in patients with PTES.

Elbow computerized tomography (CT) scans have been widely applied for describing elbow morphology. To enhance the objectivity and efficiency of clinical diagnosis, an automatic method to recognize, segment, and reconstruct elbow joint bones is proposed in this study. The method involves three steps: initially, the humerus, ulna, and radius are automatically recognized based on the anatomical features of the elbow joint, and the prompt boxes are generated. Subsequently, elbow MedSAM is obtained through transfer learning, which accurately segments the CT images by integrating the prompt boxes. After that, hole-filling and object reclassification steps are executed to refine the mask. Finally, three-dimensional (3D) reconstruction is conducted seamlessly using the marching cube algorithm. To validate the reliability and accuracy of the method, the images were compared to the masks labeled by senior surgeons. Quantitative evaluation of segmentation results revealed median intersection over union (IoU) values of 0.963, 0.959, and 0.950 for the humerus, ulna, and radius, respectively. Additionally, the reconstructed surface errors were measured at 1.127, 1.523, and 2.062 mm, respectively. Consequently, the automatic elbow reconstruction method demonstrates promising capabilities in clinical diagnosis, preoperative planning, and intraoperative navigation for elbow joint diseases.

Objective:To compare the outcomes of isolated Mason type Ⅱ radial head fracture between operative and non-operative treatments.Methods:A retrospective study was conducted to analyze the data of patients who had been treated for isolated Mason type Ⅱ radial head fracture either operatively or nonoperatively at Department of Trauma and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University from January 2017 to October 2020. The patients were divided into a non-operative group and an operative group according to their treatment method. After 1:1 propensity score matching method was used to match the patients in the 2 groups, a total of 58 pairs of patients were successfully matched. In the operative group, there were 24 males and 34 females with a mean age of (40±14) years and a body mass index of (23.7±3.4) kg/m 2; in the non-operative group, there were 22 males and 36 females with a mean age of (42±13) years and a body mass index of (23.5±3.9) kg/m 2. Elbow flexion-extension, forearm rotation, Mayo elbow performance score (MEPS), Quick-disabilities of the arm, shoulder and hand (q-DASH) score and complications were compared between the 2 groups. Results:There was no significant difference in the baseline data between the 2 groups, indicating comparability ( P>0.05). All the patients were followed up for (24±9) months. At the last follow up in the operative and the non-operative groups, respectively, the elbow flexion-extension was 134° (132°, 136°) and 134°(131°, 136°), the forearm rotation 176° (174°, 179°) and 178° (175°, 179°), the MEPS 100 (100, 100) and 100 (100, 100), the q-DASH score 0 (0, 0) and 0 (0, 0), showing no significant differences between the 2 groups in the above items ( P>0.05). Elbow pain was reported respectively in 4 (6.9%) and 6 (10.3%) patients in the operative and non-operative groups, showing no significant difference between the 2 groups ( P>0.05). Conclusion:The outcomes of operative and non-operative treatments of isolated Mason type Ⅱ radial head fracture are comparable.

Background: We aimed to evaluate the biomechanical stiffness and strength of different internal fixa-tion configurations and find suitable treatment strategies for low transcondylar fractures of the distal humerus.Methods and materials: Thirty 4th generation composite humeri were used to create low transcondy-lar fracture models that were fixed by orthogonal and parallel double plates as well as posterolateral plate and medial screw (PPMS) configurations (n = 10 in each group) using an anatomical locking com-pression plate-screw system and fully threaded medial cortical screws. Posterior bending (maximum 50 N), axial loading (maximum 200 N) and internal rotation (maximum 10 Nmiddotm) were tested, in that order, for each specimen. Stiffness under different biomechanical settings among different configurations were compared. Another 18 sets of fracture models were created using these three configurations (n = 6 in each group) and the load to failure under axial loading among different configurations was compared.Results: Under posterior bending, the stiffness of parallel group was higher than orthogonal group (P < 0.001), and orthogonal group was higher than PPMS group (P < 0.001). Under axial loading, the stiff-ness of parallel group was higher than orthogonal group (P = 0.001) and PPMS group (P < 0.001); however, the difference between orthogonal and PPMS group was not statistically significant (P > 0.05). Under inter-nal rotation, the stiffness of parallel group was higher than orthogonal group (P = 0.044), and orthogonal group was higher than PPMS group (P = 0.029). In failure test under axial loading, the load to failure in the orthogonal group was lower than parallel group (P = 0.009) and PPMS group (P = 0.021), but the differ-ence between parallel group and PPMS group was not statistically significant (P > 0.05). All specimens in orthogonal group demonstrated "distal medial failure"; most specimens had "distal medial and trochlear failure" in the parallel group; most specimens exhibited "contact failure" in the PPMS group.Conclusion: For treating low transcondylar fractures, the overall stiffness and strength of the parallel configuration were superior to those of the orthogonal and PPMS configurations. Nevertheless, the PPMS configuration can provide adequate stability and stiffness comparable to double-plate configurations un-der axial loading. Therefore, the PPMS construct may have certain clinical value.(c) 2022 Published by Elsevier Ltd.

Objective:To study the locational distribution characteristics of the heterotopic ossification (HO) following traumatic elbow stiffness and the risk factors for HO development at different locations.Methods:Consecutively included according to our inclusion criteria in the present study were the patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from January 2018 to December 2018 for elbow release due to traumatic elbow stiffness but developed postoperative HO. Their baseline data and CT data were collected and processed using Mimics 20.0. The HO distribution for each patient was characterized at the anteromedial, anterolateral, posteromedial, posterolateral, posterior, medial, lateral, and proximal radioulnar locations. The patient's original injury was categorized into 5 types: distal humerus fracture, olecranon fracture, radial head fracture, coronoid fracture, and elbow dislocation. After the univariate analysis with the HO occurrence at a specific location as the dependent variable and the original injury and baseline data as the independent variables, the factors with P value less than 0.1 were included in the logistic regression analysis to determine the risk factors for HO at each location.Results:A total of 91 patients were included in this study. Of them, 88 had posteromedial HO (96.7%, 88/91), 62 posterior HO (68.1%, 62/91), 60 posterolateral HO (65.9%, 60/91), 41 anteromedial HO (45.1%, 41/91), 26 anterolateral HO (28.6%, 26/91), 13 proximal radioulnar HO (14.3%, 13/91), 8 lateral HO (8.8%, 8/91), and 7 medial HO (7.7%, 7/91). Logistic regression analysis showed that presence of ulnar nerve symptoms ( OR=4.354, P=0.017) and presence of original elbow dislocation ( OR=2.927, P=0.042) were the independent risk factors for the anteromedial HO development and that presence of original olecranon fracture ( OR=0.277, P=0.023) was the protective factor for the anteromedial HO development. Presence of original radial head fracture was the independent risk factor for the anterolateral HO development ( OR=2.891, P=0.033) and the posterolateral HO development ( OR=3.123, P=0.043). Conclusions:HO development in patients with post-traumatic elbow stiffness is closely related to their original injury. Posteromedial HO may develop in almost all the patients. Patients with ulnar nerve symptoms and original elbow dislocation are more prone to anteromedial HO development, but patients with original olecranon fracture are less likely to develop anteromedial HO. Patients with original radial head fracture are more likely to develop anterolateral and posterolateral HO.

目的 探讨波及肱尺关节的成人向后孟氏骨折的诊断和治疗情况.方法 回顾性分析2014年1月至2019年12月北京积水潭医院收治的16例波及肱尺关节的成人向后孟氏骨折患者的病例资料,所有患者均采用后正中入路手术,尺骨近端应用鹰嘴解剖钢板内固定,必要时辅以克氏针张力带,冠突骨折根据骨折块的大小分别应用钢板、螺钉、克氏针内固定,桡骨头骨折根据粉碎及移位程度选择Herbert钉固定或桡骨头置换.术后随访6～75个月,平均42.1个月,记录患者的肘关节屈伸、旋转活动范围及Mayo肘关节功能评分情况.结果 末次随访时16例患者的肘关节屈伸范围为55°～150°,平均99.4°,前臂旋转活动范围为80°～180°,平均137.8°.Mayo肘关节功能评分优9例、良4例、可3例,优良率为81.25％.结论 波及肱尺关节的向后孟氏骨折病情复杂,治疗难度高,术中应尽可能恢复尺骨近端的对位对线,有效恢复尺骨鹰嘴滑车切迹的解剖关系至关重要,桡骨头粉碎及移位不明显时尽可能行Herbert钉内固定,严重粉碎移位时可予以桡骨头置换.

Abstract Background To evaluate the difference of functional outcomes between OTA/AO type C, Gustilo type I/II open fractures and closed fractures of the distal humerus after open reduction and internal fixation. Methods We retrospectively analyzed the clinical data of patients with OTA/AO-C distal humerus fractures who were treated in our department from January 2014 to December 2016. The patients were divided into an open fracture group and a closed fracture group. Their baseline characteristics and functional outcomes were analyzed and compared. Results A total of 64 patients treated by operative fixation were identified (25 open and 39 closed injuries), and the average follow-up time was 35.1 ± 13.6 months. There were no significant differences in the range of motion (ROM) of the elbow, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, complications, hospitalization time, operation time, intraoperative blood loss, or medical costs between the two groups (P > 0.05). Conclusion OTA/AO type C, Gustilo I/II distal humeral open fractures can yield satisfactory clinical results similar to those of closed distal humeral fractures after open reduction and internal fixation. Level of evidence Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

Background To evaluate and compare the functional outcomes of combined medial-lateral approach open arthrolysis with and without hinged external fixation. Methods We retrospectively collected and analyzed the clinical data of patients with severe elbow stiffness who were treated in our institution from January 2018 to January 2019. All of them were treated with combined medial-lateral approach arthrolysis. There were 20 patients who had the hinged external fixation placed and 29 patients without the placement of the external fixation. Their baseline characteristics and functional outcomes were evaluated and compared. Results The average follow-up time was 28.4 ± 3.7 months. There were no significant differences in the ROM of the elbow, MEPS, VAS, DASH, or complications between the two groups. The operation time and treatment cost of the patients without external fixation were significantly lower than patients with external fixation. Conclusion Combined medial-lateral approach open elbow arthrolysis without external fixation is a safe and effective way to treat elbow stiffness. Level of evidence Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

Objective We aimed to determine the association between meteorological factors and sudden sensorineural hearing loss (SSNHL) audiogram configurations. Design Retrospective review of medical records from 1 October 2007 to 31 December 2018. Setting A tertiary hospital. Participants 510 patients with SSNHL who had data on the exact date of SSNHL onset and underwent audiological evaluation within 14 days were included. Primary and secondary outcome measures Daily values of meteorological factors, including maximum and minimum temperature, mean temperature and its day-to-day change, diurnal temperature range, atmospheric pressure, mean and maximum wind speed and relative humidity, and seasonal distributions. Results Among the 510 patients (259 women (50.8%); mean (SD) age, 46.4 (15.5) years), 108 (21.2%) displayed ascending patterns, 143 (28.0%) displayed descending patterns, 129 (25.3%) displayed flat patterns and 130 (25.5%) displayed profound patterns of audiograms. The diurnal temperature range on the day of SSNHL onset in patients with profound patterns was significantly higher than that in patient with ascending (mean difference (MD), 2.2°C; 95% CI, 0.7°C to 3.7°C; p=0.001) and descending (MD, 1.5°C; 95% CI, 0.1°C to 2.9°C; p=0.031) patterns. The relative humidity was the highest on the day of SSNHL onset in patients with ascending patterns and showed a significant difference compared with that in patients with profound patterns (MD, 8.0%; 95% CI, 0.7% to 15.3%; p=0.026). Seasonal distribution did not differ among patients with different audiogram configurations. Conclusions Profound audiogram patterns correlated with high diurnal temperature range, while ascending audiogram patterns correlated with high relative humidity in patients with SSNHL. No correlation was observed between seasons and audiogram configurations.

Background: The purpose of this study was to propose the modified trochleocapitellar index (mTCI), assess its reliability, and evaluate its correlation with post-traumatic elbow stiffness in type C2-3 distal humeral fractures among adults. Methods: From January 2013 to June 2017, a total of 141 patients with type C2-3 distal humeral fractures were included. The mTCI was calculated as the ratio between the modified trochlear and capitellar angles relative to the humeral axis (mTCI-HA), lateral humeral line (mTCI-LHL), and medial humeral line (mTCI-MHL) from anteroposterior radiographs taken immediately after the operation. The patients were divided into group A (with elbow stiffness) and group B (without elbow stiffness) based on follow-up results. To determine risk factors for elbow stiffness, univariate and logistic regression analyses were performed on each radiographic parameter separately, together with other clinical variables. Interrater reliability was assessed for all measurements. Results: Specific optimal ranges of value were identified for mTCI-HA (0.750-0.875), mTCI-LHL (0.640-1.060), and mTCI-MHL (0.740-0.900), beyond which the likelihood of elbow stiffness significantly increased (P<.001). By multivariate analysis, mTCI-HA (odds ratio [OR] 26.22, 95% confidence interval [CI] 3.39-203.07, P=.002), mTCI-LHL (OR 5.37, 95% CI 2.17-13.28, P<.001), and mTCI-MHL (OR 5.95, 95% CI 1.91-18.56, P=.002) values beyond the optimal ranges were identified as the independent risk factors for elbow stiffness. The interrater reliability of mTCI-HA, mTCI-LHL, and mTCI-MHL was 0.986, 0.983, and 0.987, respectively. Conclusion: The mTCI measurement method is reliable. Either too small or too large mTCI values were associated with post-traumatic elbow stiffness among adult patients with type C2-3 distal humeral fractures. The mTCI-HA showed a better predictive value than mTCI-LHL and mTCI-MHL. Level of evidence: Basic Science Study; Development of Classification System (C) 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

MOTIVATION:Protein post-translational modifications (PTMs) regulate a wide range of cellular protein functions. Many PTM sites from the same (intra) or different (inter) proteins often cooperate with each other to perform a function, which is defined as PTM cross-talk. PTM cross-talk within proteins attracted great attentions in the past a few years. However, the inter-protein PTM cross-talk is largely under studied due to its large protein pair space and lack of a gold standard dataset, even though the PTM interplay between proteins is a key element in cell signaling and regulatory networks.RESULTS:In this study, 199 inter-protein PTM cross-talk pairs in 82 pairs of human proteins were collected from literature, which to our knowledge is the first effort in compiling such dataset. By comparing with background PTM pairs from the same protein pairs, we found that inter-protein cross-talk PTM pairs have higher sequence co-evolution at both PTM residue and motif levels. Also, we found that cross-talk PTMs have higher co-modification across multiple species and 88 human tissues or conditions. Furthermore, we showed that these features are predictive for PTM cross-talk between proteins, and applied a random forest model to integrate these features with achieving an area under the receiver operating characteristic curve of 0.81 in 10-fold cross-validation, prevailing over using any single feature alone. Therefore, this method would be a valuable tool to identify inter-protein PTM cross-talk at proteome-wide scale.AVAILABILITY AND IMPLEMENTATION:A web server for prioritization of both intra- and inter-protein PTM cross-talk candidates is at http://bioinfo.bjmu.edu.cn/ptm-x/. Python code for local computer is also freely available at https://github.com/huangyh09/PTM-X.SUPPLEMENTARY INFORMATION:Supplementary data are available at Bioinformatics online.