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EClinicalMedicine 2021 May 5;35:100826. Epub 2021 May 5.

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.

Background: The locations of subsequent fractures after initial fracture in postmenopausal women are poorly characterized.

Methods: We conducted a prospective analysis of subsequent fractures after initial fracture in Women's Health Initiative (1993-2018) participants who provided follow-up (mean 15.4 years, SD 6. Read More

Front Surg 2021 28;8:620964. Epub 2021 May 28.

Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.

Fractures of the calcaneus are severe injuries of the hindfoot, mostly resulting from high-energy axial loads, which still present enormous challenges to modern trauma surgery. Possible variables influencing the outcome are the type of fracture, age, and quality of fracture reduction. These might also be factors affecting the self-reported patient outcome, but large studies are still lacking. Read More

J Health Care Poor Underserved 2021 ;32(2):1059-1068

Purpose: To evaluate if income status affects the timing of presentation to orthopaedic care, surgical treatment, or continuity of care following a closed ankle fracture.

Methods: Th is retrospective study identified 434 patients with closed ankle fractures treated with operative fixation from 2014 to 2016. Median income data were extracted using the patients' ZIP codes and data from the U. Read More

BMC Health Serv Res 2021 Jun 13;21(1):576. Epub 2021 Jun 13.

ICES, Toronto, Canada.

Background: Health care funding reforms are being used worldwide to improve system performance but may invoke unintended consequences. We assessed the effects of introducing a targeted hospital funding model, based on fixed price and volume, for hip fractures. We hypothesized the policy change was associated with reduction in wait times for hip fracture surgery, increase in wait times for non-hip fracture surgery, and increase in the incidence of after-hours hip fracture surgery. Read More

Exp Cell Res 2021 Jun 10;405(2):112648. Epub 2021 Jun 10.

Devision of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China; Department of Orthopaedics, Guangdong Provincial Key Laboratory of Bone and Cartilage Regeneration Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China. Electronic address:

The acute inflammatory stimulation occurring after a bone fracture regulates the repair and healing of local bone injury; however, under certain conditions, pyroptosis may occur in osteoblasts, which affects osteoblast proliferation and differentiation, thereby affecting the growth, development and morphological changes of bone tissue. The aim of the present study was to examine the effect of the pyroptosis inhibitor necrosulfonamide (NSA) on the proliferation and differentiation of osteoblasts and elucidate the underlying mechanism. The results revealed that NSA reversed the effects of ATP/lipopolysaccharide (LPS) on cell viability and pyroptosis, and on the mRNA and protein expression of pyroptosis-related genes. Read More

BMC Musculoskelet Disord 2021 Jun 12;22(1):539. Epub 2021 Jun 12.

Department of Wales Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.

Background: Open lower limb fractures are serious injuries requiring combined ortho-plastic surgery and have significantly worse outcomes than similar closed fractures. There is little objective published data to determine which functional outcome measures best reflect progress or completeness of physical recovery. Our hypothesis was that objective measures combining strength, mobility and balance would better reflect recovery than isolated parameters (e. Read More

Eur J Orthop Surg Traumatol 2021 Jun 12. Epub 2021 Jun 12.

Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box 99/25., Ghoubeiry, Beirut, Lebanon.

Purpose: The instep medial plantar flap is a well-known flap based on the medial plantar artery of the foot and usually used for coverage of soft tissue defects of the heel area. It has seldom been reported for coverage of anterior ankle area with exposure of the bone and metallic hardware after open reduction and internal fixation of distal tibial fractures. The primary purpose of this study is to evaluate the feasibility and viability of this flap as well as its reliability saving the internal fixation devices and efficiency protecting bone healing; the secondary purpose is to assess the condition of the flap and its cosmetic appearance, as well as occurrence of complications related to its harvesting. Read More

Ann Biomed Eng 2021 Jun 11. Epub 2021 Jun 11.

Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Road, Laurel, MD, 20723, USA.

The lower extremity is the most frequently injured body region to mounted soldiers during underbody blast (UBB) events. UBB events often produce large deformations of the floor and subsequent acceleration of the lower limb that are not sufficiently mitigated by the combat boot, leaving the calcaneus bone vulnerable to injury. Biomechanical experiments simulating UBB loading scenarios were conducted in a laboratory environment using isolated postmortem human subject (PMHS) leg components. Read More

BMJ Open 2021 06 11;11(6):e047000. Epub 2021 Jun 11.

Artificial Intelligence and Big-Data Convergence Center, Gachon University Gil Medical Center, Incheon, South Korea

Objective: To determine the association of meteorological factors and air pollutants (MFAPs) with fracture and to estimate the effect size/time lag.

Design: This is a nationwide population-based ecological study from 2008 to 2017.

Setting: Eight large metropolitan areas in Korea. Read More

Int J Clin Pract 2021 Jun 11:e14488. Epub 2021 Jun 11.

Dow University of Health Sciences, Karachi, Pakistan.

Objective: To evaluate the clinical and radiological outcomes of the Ilizarov fixator in the proximal and distal fractures of the tibia.

Materials And Methodology: This retrospective study reviewed 59 patients having high-energy intra-articular proximal and distal tibia fractures associated with severe soft-tissue injury, who were managed surgically with an Ilizarov fixator. The functional outcome was evaluated by using the American Orthopaedic Foot and Ankle Society scoring system (AOFAS) and the Association for the Study and Application of the Method of Ilizarov (ASAMI) Italy scoring system for tibial plateau and plafond fractures respectively. Read More

Cureus 2021 May 7;13(5):e14896. Epub 2021 May 7.

Orthopedics, General Hospital of Patras "Agios Andreas", Patras, GRC.

Os vesalianum pedis is a rare accessory foot ossicle. It is usually asymptomatic, however, it can be an infrequent cause of lateral foot pain. We present the case of a 19-year-old healthy male with lateral foot pain after an inversion-type injury. Read More

J Bone Joint Surg Am 2021 Jun;103(12):1132-1151

Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota.

➤: Osteochondritis dissecans occurs most frequently in the active pediatric and young adult populations, commonly affecting the knee, elbow, or ankle, and may lead to premature osteoarthritis.

➤: While generally considered an idiopathic phenomenon, various etiopathogenetic theories are being investigated, including local ischemia, aberrant endochondral ossification of the secondary subarticular physis, repetitive microtrauma, and genetic predisposition.

➤: Diagnosis is based on the history, physical examination, radiography, and advanced imaging, with elbow ultrasonography and novel magnetic resonance imaging protocols potentially enabling early detection and in-depth staging. Read More

Foot Ankle Int 2021 Jun 10:10711007211020346. Epub 2021 Jun 10.

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.

Background: The sudden and debilitating nature of lower extremity injuries can trigger mood disturbances, including major depressive disorder.

Methods: This prospective study enrolled patients undergoing operative repair of ankle fractures and Achilles ruptures and followed them for 1 year postoperatively. The validated Patient Health Questionnaire (PHQ-9) for depressive symptoms was administered at the preoperative visit and at postoperative weeks 1, 2, 4, 8, 16, 24, 32, 40, and 52. Read More

BMJ Case Rep 2021 Jun 9;14(6). Epub 2021 Jun 9.

Orthopedics & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan

A 9-year-old girl presented with malunited Salter-Harris type I fracture of distal femur treated by bone-setter (unreliable-practitioner). Assessment revealed 3 cm limb-length-discrepancy and affected leg was unable to bear weight, knee was stiff with no active-range of motion; radiographs showed displaced sagittally malunited femoral condyle with 163° posterior distal femoral angle (PDFA). Correction planned with circular-ring-external Ilizarov fixator using distraction-osteogenesis through supracondylar osteotomy and gradual anterior opening. Read More

Cureus 2021 Jun 4;13(6):e15435. Epub 2021 Jun 4.

Trauma and Orthopaedics, Royal Blackburn Hospital, Blackburn, GBR.

Syndesmotic injuries can occur with ankle fractures and can lead to destabilization of the ankle joint. As a result, it usually requires a transyndesmotic screw insertion to stabilize it. Currently, there is no consensus on the type, amount and diameter of screws used, the number of cortices needed to be engaged, the recommended time to weight-bearing, and whether the screw should be removed in these types of injuries. Read More

PLoS One 2021 8;16(6):e0252487. Epub 2021 Jun 8.

Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec (QC), Canada.

Background: The association between obesity and fracture risk may be skeletal site- and sex-specific but results among studies are inconsistent. Whilst several studies reported higher bone mineral density (BMD) in patients with obesity, altered bone quality could be a major determinant of bone fragility in this population.

Objectives: This systematic review and meta-analysis aimed to compare, in men, premenopausal women and postmenopausal women with obesity vs. Read More

J Foot Ankle Surg 2021 May 13. Epub 2021 May 13.

Chair of Department of Podiatric Surgery, AdventHealth System, Faculty, Advent Health East Orlando Podiatric Surgical Residency, Orlando, FL.

Recent literature suggests the majority of osteochondral lesions occur in the ankle joint. Previous studies have suggested that varying incidences of talar osteochondral lesions (OCLT) are associated with ankle fractures. The primary aim of our study was to investigate the incidence of osteochondral lesions associated with acute ankle fractures as observed on computed tomographic (CT) imaging. Read More

Injury 2021 May 19. Epub 2021 May 19.

Emory University Department of Orthopaedics, 59 Executive Park South, Suite 200, Atlanta, GA 30329, United States. Electronic address:

Background: The incidence of ankle fractures requiring surgical fixation is increasing. Although there has been increasing evidence to suggest that preoperative opioid use negatively impacts surgical outcomes, literature focusing primarily on ankle fractures is scarce. The purpose of this study was to investigate the relationship between preoperative opioid use and outcomes following ankle fracture open reduction and surgical fixation (ORIF). Read More

J Orthop Trauma 2021 Jun 4. Epub 2021 Jun 4.

Department of Orthopedic Surgery, Metro Health Hospital - University of Michigan Health, Wyoming, MI Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT.

Objectives: To evaluate functional outcome following lateral process talus fracture using patient-reported instruments and identify injury characteristics that portend a worse prognosis.

Design: Retrospective case series.

Setting: Level 1 academic trauma centerPatients/Participants: Fifty-three patients with isolated lateral process talus fracture and 12 months minimum follow up. Read More

Diabetes Care 2021 Jun 4. Epub 2021 Jun 4.

Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, U.K.

Objective: Fractures in Charcot neuro-osteoarthropathy (CN) often fail to heal despite prolonged immobilization with below-knee casting. The aim of the study was to assess the efficacy of recombinant human parathyroid hormone (PTH) in reducing time to resolution of CN and healing of fractures.

Research Design And Methods: People with diabetes and acute (active) Charcot foot were randomized (double-blind) to either full-length PTH (1-84) or placebo therapy, both in addition to below-knee casting and calcium and vitamin D3 supplementation. Read More

Injury 2021 Feb 26. Epub 2021 Feb 26.

Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, SP 05652-900, Brazil; Lab. Prof. Manlio Mario Marco Napoli, Faculdade de Medicina, Universidade de São Paulo, R. Ovidio Pires de Campos, 333, São Paulo, SP 05403-010, Brasil. Electronic address:

Introduction: In surgically treated rotational malleolar fractures, residual syndesmotic instability is typically assessed following fixation with the widely used intraoperative Cotton test. However, due to its dynamic nature, there are inconsistencies of the magnitude and direction of the distraction force when attempting to pull the fibula away from the tibia using a bone hook. The novel Tap test advances a cortical tap through a drilled hole in the fibula with a stable, unidirectional distraction force applied to the tibia. Read More

Foot Ankle Int 2021 Jun 4:10711007211015188. Epub 2021 Jun 4.

Department of Orthopedic Surgery, Seoul CM Hospital, Seoul, Korea.

Background: Isolated ankle syndesmosis disruption (without fibula fracture) causes acute pain and may cause chronic instability and pain. The aim of the present study was to evaluate the outcomes after anterior inferior tibiofibular ligament (AITFL) anatomical fixation using anchor sutures for unstable isolated syndesmosis disruption without fibular fractures.

Methods: This study assessed 22 athletes who were diagnosed with unstable isolated syndesmosis disruption with a positive external rotation test, had more than 2-mm diastasis on ultrasound, and had complete AITFL rupture on magnetic resonance imaging between 2004 and 2020. Read More

J Res Med Sci 2021 27;26:14. Epub 2021 Feb 27.

Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: This study was performed to determine the sensitivity and specificity of ultrasound in the diagnosis of traumatic ankle injury in comparison with magnetic resonance imaging (MRI).

Materials And Methods: This cross-sectional study was performed on 31 patients with soft-tissue injury or fracture, referring to the MRI imaging center of Alzahra and Kashani Hospitals in Isfahan from October 2018 to March 2019. After an MRI, an ultrasound of the affected ankle was performed for all patients. Read More

Autism Res 2021 Jun 3. Epub 2021 Jun 3.

Department of Clinical Pharmacy and Toxicology, Maastricht UMC+, Maastricht, The Netherlands.

Risperidone and aripiprazole, commonly used antipsychotics in children with autism spectrum disorder (ASD), have previously been associated with elevated fracture risk in other populations. The aim of this study was to evaluate and compare the risk of fracture among children with ASD using risperidone or aripiprazole. This was a retrospective, propensity-score matched cohort study, set between January 2013 and December 2018. Read More

Br J Hosp Med (Lond) 2021 May 3;82(5):1-9. Epub 2021 May 3.

Department of Trauma and Orthopaedics, King's College Hospital, London, UK.

Ankle fractures are a common injury. Assessment should include looking at the mechanism of injury, comorbidities, associated injuries, soft tissue status and neurovascular status. Emergent reduction is required for clinically deformed ankles. Read More

Nucl Med Commun 2021 Jun 1. Epub 2021 Jun 1.

Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar Department of Orthopedics, Institute of Medical Sciences & SUM Hospital Department of Orthopedics Department of Radiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

Objective: To study the sensitivity and specificity of MRI and bone SPECT-CT in detecting the pain generator in ankle and foot pain with diagnostic dilemma.

Methods: Retrospectively data of patients with ankle or foot pain who underwent both MRI and Bone SPECT-CT were analyzed. The lesions and probable pain generator sites were reported as per MRI and bone SPECT-CT findings. Read More

Medicina (Kaunas) 2021 May 12;57(5). Epub 2021 May 12.

Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital of Inje University, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Korea.

Introduction: Leriche syndrome is an aortoiliac occlusive disease caused by atherosclerotic occlusion. We report a case of Leriche syndrome with a fracture that was suspected as complex regional pain syndrome (CRPS), as the post-traumatic pain gradually worsened in the form of excruciating neuropathic pain.

Case Report: A 52-year-old woman with a history of hypertension was referred to the Department of Pain Medicine from a local orthopedic clinic because of suspected CRPS for excruciating neuropathic pain for one month. Read More

Int J Environ Res Public Health 2021 05 2;18(9). Epub 2021 May 2.

Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain.

The present study aimed to determine the epidemiology of sport-related injuries in amateur and professional adolescent athletes and the incidence of different risk factors on those injuries. Four hundred ninety-eight athletes aged 14 to 21 voluntarily participated in this prospective injury surveillance, conducted from 1 January 2019 to 31 December 2019. The information collected included: personal data, sports aspects, characteristics of the injuries, and lifestyle. Read More

Injury 2021 May 17. Epub 2021 May 17.

Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland 4215 Australia. Electronic address:

Introduction: The calcaneus is the most commonly fractured hindfoot bone, accounting for over 60% of all tarsal fractures. The aim of this study was to compare the mechanism of injury and psychological health status in patients presenting with calcaneal fractures to an age- and sex-matched control group with ankle fractures.

Patients And Methods: This retrospective study was undertaken within an orthopaedic unit at a tertiary hospital. Read More

Bone Joint J 2021 Jun;103-B(6):1040-1046

University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.

Aims: We report the long-term outcomes of the UK Heel Fracture Trial (HeFT), a pragmatic, multicentre, two-arm, assessor-blinded, randomized controlled trial.

Methods: HeFT recruited 151 patients aged over 16 years with closed displaced, intra-articular fractures of the calcaneus. Patients with significant deformity causing fibular impingement, peripheral vascular disease, or other significant limb injuries were excluded. Read More