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Objective: We conducted this meta-analysis to explore the risk factors and incidence of deep surgical site infections (DSSIs) after orthopaedic trauma surgery. Methods: A systematic search was conducted across various databases, including MEDLINE, Embase, Cochrane Library, and Web of Science, for studies examining risk factors associated with DSSIs after bone trauma procedures. The search concluded on September 1, 2024. Data analysis was performed using Stata 15.0. Results: Among 2,722 publications screened, 16 studies that met the eligibility criteria were included in the analysis, involving a total of 22,318 patients, of whom 894 experienced DSSIs. The meta-analysis revealed a combined incidence of deep infections after orthopedic trauma surgery at [ES = 6.7%, 95% CI (5.1%–8.2%)]. Risk factors identified included male gender [OR = 1.99, 95% CI (1.39, 2.86), p < 0.0001], current smoking status [OR = 2.60, 95% CI (1.85, 3.65), p < 0.0001], open injuries [OR = 3.17, 95% CI (1.72, 5.85), p < 0.0001], a BMI greater than 26.0 kg/m2 [OR = 1.95, 95% CI (1.24, 3.07), p = 0.004], wound class ≥ 2 [OR = 2.40, 95% CI (1.56, 3.70), p < 0.0001], and a surgery duration of 60 min or more [OR = 2.41, 95% CI (1.63, 3.55), p < 0.0001]. These factors significantly contribute to the risk of developing DSSIs post-surgery. However, age did not exhibit a significant difference. Conclusion: This study identifies key risk factors for DSSI following orthopedic trauma surgery, addressing a gap in the existing literature and offering some insights for clinical decision-making. To mitigate the risk of DSSI, clinical practice should encourage patients to lose weight and quit smoking prior to surgery, optimize surgical procedures, and improve wound management strategies. Future research should aim to standardize follow-up durations and further refine the classification of risk factors, in order to validate and expand on the conclusions of this study. [ABSTRACT FROM AUTHOR]

BACKGROUND: The psychological resilience of patients with traumatic lower extremity fractures is relevant and has been studied in the postoperative rehabilitation phase; yet, few studies have focused on the early preoperative phase. OBJECTIVE: This study aims to explore preoperative psychological resilience in patients with traumatic lower extremity fractures. METHODS: This single-center cross-sectional survey design study was conducted over 5 months from December 2022 to April 2023 in a tertiary hospital in Shanghai, China. We used a convenience sampling method to assess psychological resilience in traumatic lower extremity fracture patients electronically. We administered the online surveys using the Questionnaire Star applet prior to surgery using the following tools: (a) general information questionnaire, (b) Numerical Rating Scale, (c) Connor–Davidson Resilience Scale, and (d) General Self-Efficacy Scale. RESULTS: A total of N = 175 patients were studied, of which n = 166 patients fully completed the survey for a response rate of 95%. Patients with traumatic lower extremity fractures demonstrated a low degree of psychological resilience preoperatively (M = 49.28, SD = 13.64). Patients' psychological resilience and self-efficacy showed a significant positive correlation (r =.577). Factors associated with patients' psychological resilience in multivariate linear analyses included level of education, medical insurance, and self-efficacy (p <.05). CONCLUSION: We found that preoperative psychological resilience in patients with traumatic lower-extremity fractures is poor and influenced by various factors; thus, future efforts should focus on providing timely, targeted interventions. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the impact of sarcopenia on clinical outcomes after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF). Methods: We retrospectively analyzed the medical records of patients with single-segment OVCF who underwent percutaneous kyphoplasty (PKP) between September 2021 and August 2022. Patients were categorized into a sarcopenia group (43 patients) and a non-sarcopenia group (125 patients) based on their Advanced Skeletal Muscle Index (ASMI). Clinical and radiological data were collected and analyzed. Results: There were no significant differences between the sarcopenia and non-sarcopenia groups in age, sex, bone mineral density (BMD), body mass index (BMI), fractured segment, fracture type, surgical approach, bone cement volume, bone cement distribution, comorbidities, preoperative and immediate postoperative VAS and ODI scores (P >.05). However, the time to ambulation, hospital stays, VAS and ODI scores at follow-up, excellent/good rate, and the incidence of residual pain and re-fractures in the non-sarcopenia group were significantly better than those in the sarcopenia group (P <.05). Meanwhile, radiological outcomes, including regional kyphosis and vertebral height loss rate, were significantly better in the non-sarcopenia group than in the sarcopenia group at 6 and 12 month follow-ups (P <.05). Conclusion: Clinical outcomes after PKP in patients with OVCF could be negatively affected by sarcopenia. Therefore, prevention and treatment of sarcopenia should be actively considered in the management of patients with OVCF. [ABSTRACT FROM AUTHOR]

Summary: Fractures often cause irreversible harm in Duchenne muscular dystrophy (DMD). This study investigated the trajectory of bone mineral density (BMD) using group-based trajectory modeling and identified that BMD acts as an early-stage indicator of clinically significant bone fragility. The greater the early-stage BMD, the better the 4-year bone health outcome. Purpose: Most Duchenne muscular dystrophy (DMD) children suffer bone loss after long-term glucocorticoid (GC) exposure, which induces scoliosis and fragility fractures. To assess the BMD progression pattern and individual medical risk markers for these phenotypes in young ambulatory boys with DMD, and provide evidence-based suggestions for clinical management of bone health. Methods: A retrospective longitudinal cohort study of 153 boys with DMD in West China Second University Hospital (2016–2023) was performed. Group-based trajectory modeling was used to study the BMD progression pattern, and potential predictors were further analyzed by logistic regression and survival analysis. Results: One hundred and fifty-three participants were included, 71 of which had more than 3 BMD records. Three BMD trajectories were identified. Baseline BMD and age-started GC and were independent predictors of trajectory attribution. The median survival time of the first observation of low BMD in GC-treated DMD boys was 5.32 (95% CI 4.05–6.59) years, and a significant difference was tested (P < 0.001) among the three trajectory groups. Conclusion: BMD may serve as a novel early indicating marker for monitoring bone fragility for DMD. We proposed a bone health risk stratification through BMD progression trajectory that allows us to adapt the osteoporosis warning sign in DMD from a fixed threshold approach to a more individualized strategy, where baseline BMD and age of glucocorticoid initiation can provide an earlier prediction of bone loss. Better management of primary BMD may be able to delay or avoid the onset of adverse bone health outcomes in the fifth year in children with DMD. [ABSTRACT FROM AUTHOR]

Background: The association between bone fracture and cardiovascular diseases is examined in this study. While basic research has established a connection between fractures and heart attacks through the linkage between bones and arteries, population studies have not provided clear evidence. The aim of the present study is to investigate the association between bone fracture and the occurrence of myocardial infarction in a natural population during long-term follow-up. Methods: A total of 13,196 adult participants with bone fracture history at baseline from the China Health and Nutrition Survey (CHNS) prospective cohort were included in this study. Baseline investigation was performed in 1997–2009 and the outcome was followed up till 2015. Hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Results: From 1997 to 2015, a total of 329 incident myocardial infarction cases were identified. In univariate and multivariate Cox regression analysis, a history of bone fracture was associated with an increased risk of myocardial infarction incidence in the total population (for the crude model: HR = 2.56, 95% CI 1.83–3.53, P < 0.001; for the multivariate model: HR = 1.43, 95% CI 1.02–1.99, P = 0.036). In the stratified analysis, bone fracture was not associated with an increased risk of incident myocardial infarction in subjects with age < 50 years (HR = 0.71, 95% CI 0.34–1.47, P = 0.356), but significantly associated with an increased risk of incident myocardial infarction in subjects with age ≥ 50 years (HR = 1.80, 95% CI 1.23–2.63, P = 0.003). Conclusions: It is suggested by the present study that bone fracture may be associated with an increased risk of incident myocardial infarction in the elderly population during long-term follow-up. [ABSTRACT FROM AUTHOR]

Purpose: Prevalence of osteoporotic fracture (OPF) is increasing with ageing, resulting in a significant financial burden for healthcare. However, research on the nationwide epidemiological data of OPF in Chinese elderly is still scarce. The aim of this study was to investigate the prevalence and risk factors of OPF in Chinese population aged 60 years or order. Methods: A cross-sectional survey was conducted in an elderly Chinese population in five centres. Questionnaire investigation and imaging examination were taken in all participants to identify OPF prevalence and risk factors. Diagnosis of OPF was determined based on imaging of vertebral fractures or history of fall-related fractures. We then used multivariate logistic regression model to analyze the associations between the potential risk factors and OPF. Results: The overall prevalence of OPF in population aged 60 years or older was 24.7% (1,071/4,331), showing an increasing trend with age (P < 0.001). The prevalence of OPF was geographically distinct (P < 0.001), but similar between men and women (P > 0.05). Up to 96.8% of OPFs consisted of vertebral fractures, especially involving T11, T12, and L1 segments. Advanced age (≥ 80), vision loss, severe hearing loss, multiple exercise forms, chronic kidney disease, osteoarthritis, and trauma-related vertebral fractures were significantly associated with risk factors, while education level and vitamin D supplementation were associated with protective factors of OPF. Conclusion: High prevalence of OPF is a serious threat to bone health among elderly people in China. There is an urgent need for effective strategies to diagnose, prevent, and treat OPF in elderly adults. [ABSTRACT FROM AUTHOR]

Summary: We developed a new tool to assess the severity of osteoporotic vertebral fracture using radiographs of the spine. Our technique can be used in patient care by helping to stratify patients with osteoporotic vertebral fractures into appropriate treatment pathways. It can also be used for research purposes. Purpose: The aim of our study was to propose a semi-quantitative (SQ) grading scheme for osteoporotic vertebral fracture (OVF) on anteroposterior (AP) radiographs. Methods: On AP radiographs, the vertebrae are divided into right and left halves, which are graded (A) vertical rectangle, (B) square, (C) traverse rectangle, and (D) trapezoid; whole vertebrae are graded (E) transverse band or (F) bow-tie. Type A and B were compared with normal and Genant SQ grade 1 OVF, Type C and D with grade 2 OVF, and Type E and F with grade 3 OVF. Spine AP radiographs and lateral radiographs of 50 females were assessed by AP radiographs SQ grading. After training, an experienced board-certified radiologist and a radiology trainee assessed the 50 AP radiographs. Results: The height-to-width ratio of the half vertebrae varied 1.32–1.48. On lateral radiographs, 84 vertebrae of the 50 patients had OVFs (38 grade 1, 24 grade 2, and 22 grade 3). On AP radiographs, the radiologist correctly assigned 84.2%, 91.7%, and 77.2% and the trainee correctly assigned 68.4%, 79.2%, and 81.8% of grade 1, 2, and 3 OVFs, respectively. Compared with lateral radiographs, the radiologist had a weighted Kappa of 0.944 including normal vertebrae and 0.883 not including normal vertebrae, while the corresponding Kappa values for the trainee were 0.891 and 0.830, respectively. Conclusion: We propose a new semi-quantitative grading system for vertebral fracture severity assessment on AP spine radiographs. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the risk and safety profile of non-steroidal anti-inflammatory drugs (NSAIDs) for osteoporotic fractures in patients with rheumatoid arthritis (RA). Methods: 298 RA patients admitted to The First People's Hospital of Huzhou, Huzhou, China from August 2020 to September 2022, were investigated. Patients were assigned to groups based on drugs used viz: control group received anti-rheumatic drugs other than NSAIDs; corticosteroid group received dexamethasone, disease-modifying anti-rheumatic drugs (DMARDs) groups received sulfasalazine, NSAID group received either diclofenac or ibuprofen etc. Each group of patients received the respective treatment frequently for at least 3 years. The primary outcome in this study was the incidence of osteoporotic fracture resulting from fragile bone and deterioration of bone mass. Results: The incidence of osteoporotic fracture was highest in NSAID group (11.58 %) when compared to 5.44, 4.96, and 2.36 % in the corticosteroid, DMARD and control groups, respectively (p < 0.05). This shows that users of NSAIDs had a 5-fold higher risk of osteoporotic fracture than patients in control group (OR = 1.26 (95 % CI: 1.22 - 1.81)) and 2-fold possibility of osteoporotic fracture when compared to corticosteroid users ((OR = 1.46 (95 % CI: 1.57 - 2.32)) and DMARD users (1.83 (95 % CI: 1.26 - 1.67)). Conclusion: Rheumatoid arthritis patients on NSAIDs such as celecoxib, diclofenac, ibuprofen, indomethacin, and oxaprozin are at risk of developing osteoporotic fracture. Therefore, NSAIDs must be used with proper counseling in RA patients to minimize the risk of osteoporotic fracture. In future, the study duration will need to be extended to determine the long-term effects and potential changes in bone properties. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Video health education has been increasingly adopted in the clinic to expand patient guidance and improve perioperative outcomes. To date, however, it is unclear whether the use of short-form videos and web-based clinician-created forums actually improve the perioperative experience of patients. Objective: To evaluate the effect of application of short-form video health education on the health knowledge and satisfaction with nursing care of patients with lower extremity fractures. Methods: This study is a quasi experimental study, using convenient sampling method and grouping according to historical control., one hundred and twenty-two patients admitted with lower limb fractures to the orthopedic ward of a tertiary first-class general hospital in Fujian, China were enrolled in this study. Based on their admission order, patients admitted from September 2021 to November 2021 were enrolled into the control group (n = 61) and patients admitted from December 2021 to March 2022 were enrolled in the intervention group (n = 61). Both groups received identical admission-based patient education, perioperative care, and discharge rehabilitation instructions. The control group received the traditional education method while the intervention group received a short-form educational video in addition to the traditional education method. Patient perioperative health knowledge and patient satisfaction with nursing care during treatment of lower limb fractures were compared across the two groups. Results: Preoperative health knowledge in the intervention group was 95.1%, compared to 82.0% in the control group (χ2 = 3.954, P<0.05). The Newcastle satisfaction with nursing scales score in the intervention group was (80.902 ± 7.016) points, compared to (78.131 ± 8.213) points in the control group. These group differences were statistically significant (P < 0.05). Conclusion: The application of a short-form educational video during the perioperative care of patients with lower limb fractures may improve patients' understanding of perioperative health and increase satisfaction with nursing care. [ABSTRACT FROM AUTHOR]

Summary: This study involving 674 elderly osteoporotic fracture (OPF) patients undergoing orthopedic surgery investigated the long-term outcomes of acute phase reaction (APR) after initial zoledronic acid (ZOL). Those who had an APR had a 97% higher risk of mortality and a 73% lower rate of re-fracture than patients who did not. Introduction: Annual infusion of ZOL efficiently decreases the risk of fracture. A temporary APR, consisting of flu-like symptoms, myalgia, and fever, is frequently observed within 3 days after the first dose. This work aimed to identify whether the occurrence of APR after initial ZOL infusion is a reliable indicator of drug efficacy for mortality and re-fracture in elderly OPF patients undergoing orthopedic surgery. Methods: This retrospectively observed work was constructed on a database prospectively collected from the Osteoporotic Fracture Registry System of a tertiary level A hospital in China. Six hundred seventy-four patients 50 years old or older with newly identified hip/morphological vertebral OPF who received ZOL for the first time after orthopedic surgery were included in the final analysis. APR was identified as a maximum axillary body temperature greater than 37.3 °C for the first 3 days after ZOL infusion. We utilized models of multivariate Cox proportional hazards to compare the risk of all-cause mortality in OPF patients with APR (APR+) and without APR (APR-). Competing risks regression analysis was used to examine the association between the occurrence of APR and re-fracture when mortality was taken into account. Results: In a fully adjusted Cox proportional hazards model, APR+ patients had a significantly higher risk of death than APR- patients with a hazard ratio [HR] 1.97 (95% CI, 1.09–3.56; P-value = 0.02). Furthermore, in an adjusted competing risk regression analysis, APR+ patients had a significantly reduced risk of re-fracture compared with APR- patients with a sub-distribution HR, 0.27 (95% CI, 0.11–0.70; P-value = 0.007). Conclusions: Our findings suggested a potential association between the occurrence of APR and increased mortality risk. An initial dose of ZOL following orthopedic surgery was found to be protective against re-fracture in older patients with OPFs. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the prevalence of sarcopenia according to the old and new Asian Working Group on Sarcopenia (AWGS) operational criteria and explore the effects of sarcopenia on adverse outcomes in older adults with type 2 diabetes (T2D). Methods: A total of 386 patients with T2D aged ≥ 60 years were recruited in retrospective cohort study. Sarcopenia was assessed with different versions of the AWGS consensus, including the AWGS2014, AWGS2019H (muscle mass adjusted for height), and AWGS2019B (muscle mass adjusted for body mass index). The median follow-up period was 47 months. The composite primary endpoint was the first occurrence of cardiovascular disease (CVD), fragility fracture, and all-cause mortality and the secondary outcomes included the three separate components of the primary outcome. Results: In this study, the prevalence of sarcopenia under different criteria was significantly different, with AWGS2019H having the highest prevalence of 31.3%. The agreement among sarcopenia criteria was unsatisfactory. By Cox regression analysis, all three AWGS definitions of sarcopenia were associated with the composite outcome of all-cause mortality, fracture and CVD (hazard ratio [HR], 2.69 vs. HR, 2.63; vs. HR, 2.23; model 3). Further exploratory analysis, sarcopenia defined by the AWGS2019H criteria was an independent risk factor for death, incident CVD, and fractures. While AWGS2014 criteria was an increased risk factor of death and CVD. The AWGS2019B criteria were only associated with incident fractures. Conclusion: All three AWGS definitions of sarcopenia were associated the composite primary endpoint. Additionally, the AWGS2019H criteria may be a better independent risk factor for negative health outcomes. [ABSTRACT FROM AUTHOR]

Backgroud: The influencing factors of osteoporosis are complex, the incidence of osteoporosis is higher in middle-aged and elderly women, and osteoporotic fractures (OF) can seriously affect quality of life. Currently, the correlation analysis between gastrointestinal diseases and OF focuses more on diseases such as gastric cancer and inflammatory bowel disease (IBD). This study analyzed the risk factors for osteoporosis and osteoporotic fractures in 1567 postmenopausal women in Fuzhou, China. The purpose is to explore the potential influence of gastrointestinal diseases on the occurrence of OF. Methods: According to inclusion and exclusion criteria, a total of 1567 subjects were included in the analysis of OP risk factors, including 647 in the OP group and 920 in the NOP group. A total of 616 subjects were included in the analysis of correlation between OF and gastrointestinal diseases, including 132 in OF group and 484 in NF group. Statistical analysis shows that age (OR = 1.062, 95% CI = 1.045–1.080), height (OR = 0.089, 95% CI = 0.009–0.857), weight (OR = 0.981,95% CI = 0.967–0.995) and nature of work (P = 0.010) are the main risk factors for osteoporosis in postmenopausal women in southeast China, and gastrointestinal diseases (OR = 1.583, 95% CI = 1.070–2.343) and height (OR = 0.003, 95% CI = 0.000-0.104) are the main risk factors of OF. Conclusions: The main factors affecting the occurrence of OP in postmenopausal women in southeast China are individual characteristic. Gastrointestinal diseases that do not directly affect BMD increase the risk of OF in osteoporotic patients. [ABSTRACT FROM AUTHOR]

Summary: This study revealed that there was no significant linear relationship between fasting C-peptide (FCP) level and bone mineral density (BMD) or fracture risk in type 2 diabetes mellitus (T2DM) patients. However, in the FCP ≤ 1.14 ng/ml group, FCP is positively correlated with whole body (WB), lumbar spine (LS), and femoral neck (FN) BMD and negatively correlated with fracture risk. Purpose: To explore the relationship between C-peptide and BMD and fracture risk in T2DM patients. Methods: 530 T2DM patients were enrolled and divided into three groups by FCP tertiles, and the clinical data were collected. BMD was measured by dual-energy X-ray absorptiometry (DXA). The 10-year probability of major osteoporotic fractures (MOFs) and hip fractures (HFs) was evaluated by adjusted fracture risk assessment tool (FRAX). Results: In the FCP ≤ 1.14 ng/ml group, FCP level was positively correlated with WB, LS, and FN BMD, while FCP was negatively correlated with fracture risk and osteoporotic fracture history. However, FCP was not correlated with BMD and fracture risk and osteoporotic fracture history in the 1.14 < FCP ≤ 1.73 ng/ml and FCP > 1.73 ng/ml groups. The study has shown that FCP was an independent factor influencing BMD and fracture risk in the FCP ≤ 1.14 ng/ml group. Conclusions: There is no significant linear relationship between FCP level and BMD or fracture risk in T2DM patients. In the FCP ≤ 1.14 ng/ml group, FCP is positively correlated with WB, LS, and FN BMD and negatively correlated with fracture risk, and FCP is an independent influencing factor of BMD and fracture risk. The findings suggest that FCP may predict the risk of osteoporosis or fracture in some T2DM patients, which has a certain clinical value. [ABSTRACT FROM AUTHOR]

This research strived to analyse the significant factors affecting the driver's post-accidental behavioural changes. The target sampling technique analysed 325 surgical patients in three government hospitals in north China who got a bone fracture. Structural equation modelling (SEM) technique results considerably differ in behavioural changes. Surgical patients believe that post-accidental behavioural changes combined with WOM creation by surgical patients (drivers) can improve road safety and accidental awareness at a macro level. The f2 results from SEM show that drivers' post-accidental behavioural changes were strongly affected by accidental trauma and due to attitude toward precautionary measures. Strong effect on WOM creation by driver's behavioural changes and accidental trauma. Mediation effect shows 34.31%, 30.14%, and 29.88% as a partial but significant effect of behavioural changes. Since this is preliminary research in this area, our findings will provide avenues for future research and enrich the policy aspects. [ABSTRACT FROM AUTHOR]

Background: Prevalence information is the first step in developing preventive procedures or health services. This study was conducted to systematically evaluate the epidemiology of osteoporotic fractures in Chinese elderly aged ≥ 60 years and to provide evidence-based evidence for the prevention and treatment of osteoporotic fractures. Methods: We identified relevant studies by searching the literature published in PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang Data, and VIP databases from the establishment of the database until August 2022. We used a random-effects model to obtain prevalence estimates and identified sources of heterogeneity and comparisons of prevalence among different groups through subgroup analysis and sensitivity analysis. Results: A total of 29 articles were included in this study, and the prevalence of osteoporosis fractures in elderly Chinese was high (18.9%). The prevalence has increased significantly over the past decade (from 13.2% in 2000–2010 to 22.7% in 2012–2022). The prevalence of osteoporosis is higher in women than in men (18.5% vs 14.3%) and increases with age. The northern region was higher than the southern region (20.3% vs 18.9%), and the spine, hip, and distal forearm were the most common sites of fracture. Conclusion: The prevalence of osteoporotic fractures in the Chinese elderly is 18.9%, and timely prevention and treatment are necessary. [ABSTRACT FROM AUTHOR]

Background: This study explores the latest epidemiological characteristics of posterior malleolus fracture and compares the epidemiological differences of posterior malleolus fracture in different periods, regions, and adult age groups. Methods: Clinical information of inpatients with posterior malleolus fracture in Shanghai Tongji Hospital and Karamay Central Hospital from January 2014 to February 2022 was reviewed and collected. The imaging data of patients were acquired using the Picture Archiving and Communication Systems. A statistical analysis was performed as to gender, current age, year of admission, injury mechanism, fracture type, and posterior malleolus fracture classification. Moreover, a comparative analysis was conducted on the injury mechanisms and morphological differences of posterior malleolus fracture at different periods, regions, and age groups. Results: A total of 472 patients (210 patients from Shanghai Tongji Hospital and 262 patients from Karamay Central Hospital) with posterior malleolus fracture and an average age of 48.7 ± 15.6 were included in this study. The peak of posterior malleolus fracture occurs in the age group of 50–59. The injury mechanisms mainly involve low-energy fall and sprain (411 cases, 87.1%), followed by traffic accidents (52 cases, 11.0%), and fall injury from height (9 cases, 1.9%). With aging, the number of fall and sprain cases increases and reaches the peak at the age of 50–59, followed by progressive decline. Traffic accidents presents a relatively flat small peak in the age group of 40–59. The number of cases according to different fracture types shows the following ascending order: trimalleolar fracture-supination external rotation (335 cases, 71.0%) > bimalleolar fracture (60 cases, 12.7%) > trimalleolar fracture-pronation extorsion (43 cases, 9.1%) > posterior malleolus + tibial shaft fracture (19 cases, 4.0%) > simple posterior malleolus fracture (15 cases, 3.2%). The numbers of cases corresponding to the Haraguchi I Type, II Type, and III Type of posterior malleolus fractures were 369 (78.2%), 49 (10.4%), and 54 (11.4%), respectively. The Tongji IIA Type represented the highest number of cases (249 cases, 52.8%), followed by the IIB Type (120 cases, 25.4%), I Type (54 cases, 11.4%), IIIB Type (36 cases, 7.6%), and IIIA type (13 cases, 2.8%). The trimalleolar fracture-supination external rotation, Haraguchi I Type and Tongji IIA Type of posterior malleolus fractures all presented an obvious peak of incidence in the age group of 50–59. However, no obvious statistical difference was observed in the injury mechanism, Haraguchi classification, and Tongji classification of posterior malleolus fractures among different years and regions in recent years (P > 0.05). Conclusions: The injury mechanism of posterior malleolus fracture mainly involves low-energy fall and sprain cases. The trimalleolar fracture-supination external rotation, Haraguchi I type and Tongji IIA type of posterior malleolus fracture are predilection fracture types, and all present an obvious incidence peak in the age group of 50–59. Elderly patients have high risks of falling and their bones are more fragile, conditions which are potential risk factors of posterior malleolus fracture. Early positive control has important significance. This study provides references for relevant basic and clinical studies of posterior malleolus fracture. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical effect of unilateral puncture vertebroplasty with curved diffusion needle (CDN) in the treatment of thoracolumbar osteoporotic vertebral compression fracture (OVCFs). Methods: We used the method of a retrospective study. The clinical data of 38 patients with OVCFs treated by unilateral puncture vertebroplasty with curved diffusion needle from January 2021 to January 2022 were analyzed. The operation time and the amount of bone cement injected were recorded to observe the leakage and dispersion of bone cement during the operation and the incidence of vertebral re-fracture at the last follow-up. Visual analog scale (VAS) and Oswestry disability index (ODI) were used to evaluate the pain and functional improvement before and after surgery. Results: All patients successfully completed the operation. The operation time was 31.2 ± 5.1 min, and the bone cement injection volume was 4.8 ± 1.1 ml. During the operation, three patients had bone cement leakage, and the leakage rate was 7.8%. The bone cement dispersion was excellent in 31 cases, among which seven cases were good; the postoperative follow-up time was 3–10 months, with an average of 6.3 months; no vertebral body re-fracture occurred. VAS score and ODI at 1d after the operation and at the last follow-up were significantly improved compared with those before the operation, and the difference was statistically significant (P < 0.05). Also there was a significant difference between the postoperative 1d and the last follow-up (P < 0.05). Conclusions: Unilateral puncture vertebroplasty for the treatment of thoracolumbar OVCFs can obtain good bone cement distribution, safety and does not increase complications, and the clinical effect is satisfactory. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Palaeopathological analyses have great potential to provide insights into dinosaurs' palaeobiology and life histories, but few cases have been reported in China. In this study, we report on four pathological sauropod ribs excavated in the same quarry of the Middle Jurassic in Yunyang County, Chongqing, southwest China. Based on morphological observation, computerised tomography (CT)-based energy spectrum data, and image analyses, three types of pathology were identified: traumatic fracture, fracture after bone infection, and osteosclerosis. This study increases the knowledge of dinosaur pathology, especially of Jurassic sauropods, and highlights the use of energy spectrum CT in palaeopathological studies. [ABSTRACT FROM AUTHOR]

Study design: This is an observational retrospective cohort study. Objective: The purpose of this study is to investigate the incidence rate of depression and anxiety and the changes in patients treated with percutaneous kyphoplasty (PKP) following ERAS protocol. Summary of background data: The incidence of depression and anxiety is not uncommon in patients with osteoporotic vertebral compression fracture (OVCF), which affects the prognosis of surgery. Enhanced recovery after surgery (ERAS) protocols can improve the perioperative stress response of patients. Materials and methods: Patients were treated conventionally in 2019 as the control group (CG) (n = 281), and patients were treated according to the ERAS protocol in 2020 as the intervention group (IG) (n = 251). All patients were evaluated for depression and anxiety using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 at admission, postoperative 1 week, 1 month and 3, 6, 12 months. Results: The degree of depression statistically decreased in the IG at follow-up periods (p < 0.001), and the degree of anxiety statistically decreased at 1 week (p < 0.001), 1 month (p < 0.001), 3 months (p = 0.017). Patients in the IG could soothe depression and anxiety disorders faster than patients in the CG and maintain psychological stability at the follow-up periods. The percentage of moderate or above depression in the IG was statistically fewer than in the CG at follow-up periods (p < 0.01). The odds ratio (OR) was respectively 0.410, 0.357, 0.294, 0.333, 0.327 from 1 week to 12 months. While the percentage of patients with moderate or above anxiety significantly decreased in the IG at 1 week (p < 0.001), OR = 0.528, 1 month (p = 0.037), OR = 0.309 and 12 months (p = 0.040), OR = 0.554, no differences between 3 months (p = 0.187) and 6 months (p = 0.133). Conclusion: PKP following ERAS protocol to treat patients with OVCF had a better effect on relieving postoperative anxiety and depression than following conventional protocol. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the effects of transitional care (TC) programs on the health outcomes of discharged older patients with osteoporotic vertebral compression fractures (OVCFs). Methods: A total of 160 older patients were recruited from two campuses of a public teaching hospital in China. Patients were grouped according to the campus to which they were admitted. The TC programs commenced one day before discharge and lasted 6 months after discharge. Repeated‐measures analysis of variance was used to analyse the effects of the TC programs. Results: The TC programs improved the discharge of older patients with OVCF in their activities of daily living (ADLs), pain levels and social support, and decreased fracture recurrence rates. Conclusions: This study provides evidence of concurrent clinical improvements and health outcomes in discharged older patients with OVCFs from the effects of TC programs based on social support theory. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To compare the risk of osteoporotic fractures between the urban and urban-rural fringe populations in southern China and to explore the effect of bone turnover markers on fracture risk. Methods: Epidemiological investigations were conducted in the urban and urban-rural fringe areas of southern China in June 2018. Residents aged 40 years and over who signed informed consent forms were included. Physical examination and questionnaire collection were completed. Bone turnover markers (BTMs) including osteocalcin (OC) and beta cross-linked C-telopeptide of type 1 collagen (ß-CTX) were tested. Bone mineral density (BMD) of the femoral neck and lumbar vertebrae 1-4 were measured using dual energy X-ray absorptiometry. Fracture risk assessment tool (FRAX) values were calculated to show the probability of major osteoporotic fracture (PMOF) and probability of hip fracture (PHF) over the next 10 years. Results: A total of 1,051 participants were included in this study, including 553 in the urban areas and 498 in the urban-rural fringe areas. The average PMOF and PHF were 3.4 (2.3-5.4) % and .6 (.3-1.5) %, respectively. Compared with that in the urban populations, the femoral neck BMD in the urban-rural fringe populations was lower and FRAX values were generally higher, especially for women. FRAX values in various populations were mainly negatively correlated with lumbar and femoral neck BMD and were positively correlated with ß-CTX; meanwhile, only PHF was negatively correlated with OC. After adjusting for sex, elevated ß-CTX levels significantly increased the risk of high PMOF in various populations and increased the risk of high PHF in the urban-rural fringe populations. In particular, the risks of increased PMOF and PHF could increase by as much as 33 times and 19.5 times, respectively, in the urban-rural fringe areas. Conclusion: The urban-rural fringe populations in Southern China may be at risk of osteoporotic fracture. In addition to being related to BMD, the FRAX value also correlates with some BTMs. Combining FRAX with BMD, and BTMs may better predict the fracture risk. [ABSTRACT FROM AUTHOR]

Background: To analyze the growth disturbance after distal tibia physeal fracture in children. Methods: Data about children with distal tibia physeal fractures between September 2015 to September 2018 were collected, including age, gender, affected side, Salter–Harris classification, initial maximal displacement, with or without fibula fracture, open or closed reduction, the method of fixation, time to surgery, blood loss, duration of operation, and complications. Patients were placed in the growth disturbance group when leg length discrepancy was equal to or greater than 1.5 cm, or when they had more than 5 degrees of varus or valgus deformity. Others were placed in the no-growth disturbance group. Results: A total of 143 patients (96 boys and 47 girls) were enrolled in this study. The length of the follow-up periods averaged 29.34 ± 7.46 months (26 to 61 months). Among the total of 143 patients, the incidence of growth disturbance was 15.39% (22/143). The no-growth disturbance group consisted of 121 patients (84 boys and 37 girls), with a mean age of 11.50 ± 3.20 years, and there were 68, 52, and 1 injuries to the left, right, and bilateral sides, respectively. The average maximal displacement was 5.51 ± 3.18 mm, and 27.27% (33/121) of patients also had a fibula fracture. The growth disturbance group contained 22 patients (12 boys and 10 girls) with a mean age of 9.32 ± 3.56 years, and there were 12, 10, and 0 injuries on the left, right, and bilateral sides, respectively. The average maximal displacement was 5.77 ± 4.89 mm, and 45.45% (10/22) of patients also had a fibula fracture. There was a significant difference in age (p = 0.004) and fibula fracture (p = 0.011) between the two groups. More patients had Salter–Harris types III and IV fractures in the growth disturbance group than in the no-growth disturbance group (p = 0.043). Conclusions: Children with Salter–Harris types III and IV fractures, younger children, and children with fibula fractures all have a higher incidence of growth disturbance after distal tibia physeal fractures. Level of evidence: Level III-Prognostic study. [ABSTRACT FROM AUTHOR]

Deficiency of calcium and vitamin D is a common finding in postmenopausal osteoporosis (PMOP). However, the effect of cigarette smoking on the serum levels of calcium and 25-hydroxyvitamin D [25(OH)D] remains inconclusive. The data of 432 inpatients with PMOP between January 2016 and October 2019 were collected from the hospital information system of the Second Hospital of Shanxi Medical University. The associations between smoking habits and serum calcium and 25(OH)D levels were analyzed by multiple linear regression. The intensity and duration of smoking were also conducted in the analysis to detect the dose-dependent effect of cigarette smoking. Significant differences were found between smokers and never smokers regarding serum calcium and 25(OH)D levels. The multiple linear regression model showed significant negative associations of the daily number of cigarette smoking and the smoking durations with the serum calcium and 25(OH)D levels. Moreover, the effect of smoking on the decreased levels of serum calcium and 25(OH)D showed a dose-dependent manner. Cigarette smoking was negatively associated with the serum calcium and 25(OH)D levels in patients with PMOP. Early detection of serum calcium and 25(OH)D may contribute to predicting fracture risk, and smoking cessation intervention is necessary for patients with POMP. [ABSTRACT FROM AUTHOR]

Background. To explore the normal changes in bone turnover markers (BTMs) and the correlations between the different BTMs after osteoporotic vertebral compression fracture (OVCF). Meanwhile, we explored the related differences that exist between sexes. Methods. A total of 130 OVCF patients were retrospectively reviewed. Using IBM SPSS 19.0 statistical software, the differences in the levels of BTMs and clinical parameters between sexes were assessed using Student's unpaired t test, and one-way ANOVA was used for the comparison of the three groups of samples. The correlations between P1NP, CTX, and clinical factors were assessed using Pearson's correlation coefficient. Results. P1NP was 52.15 ng/ml within two weeks in male patients, and the level increased to 96.33 ng/ml after 12 weeks; in female patients, the increase was not as obvious as in male patients. CTX in male patients reached as much as approximately twice the initial value after 12 weeks. However, the situation in female patients was diverse. CTX was 0.58 ng/ml within two weeks and increased to 0.61 ng/ml within 2-12 weeks after the onset of OVCF. Subsequently, CTX decreased suddenly after 12 weeks. The increase in P1NP levels within 2 weeks after OVCF was significantly correlated with the levels of osteocalcin (OC) and bone-specific alkaline phosphatase (BAP). Changes in CTX within 2 weeks after OVCF were considerably related to phosphorus, 25 hydroxyvitamin D (25-OHD), OC, and BAP. Conclusion. The levels of P1NP and CTX increased differently in males and females after OVCF. The levels of OC and BAP were correlated with the levels of P1NP and CTX within 2 weeks of OVCF. [ABSTRACT FROM AUTHOR]

BACKGROUND: Osteoporotic hip fractures have posed a significant burden to society, and more epidemiological data is required. OBJECTIVE: To compare the epidemiological differences of hip fracture patients in Spain and China. METHOD: This was a retrospective comparative study. Comparisons were made in terms of morbidity, demographic and anthropometric characteristics, length of stay, cost of hospitalization, and mortality by consulting the medical histories of osteoporotic hip fractures in two hospitals. The t test was used for measurement data, and the X2 test was used for count data. The difference is statistically significant when p< 0.05. RESULTS: A total of 757 patients were enrolled in this study, with 426 from Virgen Macarena University Hospital (HUVM) and 331 from Xi'an Daxing Hospital (XDH). The average age was 81.4 ± 9.26 and 76.0 ± 8.08 years; the proportion of women was 74.9% and 68.0%, respectively. The incidence of osteoporotic hip fractures in Seville residents over 50 years old was approximately 239 per 100,000 residents, compared to 158 per 100,000 residents in Xi'an. The timing of surgery in Spanish patients was significantly longer than in Chinese patients, 78.7 ± 48.2 vs. 60.7 ± 43.1 hours, p= 0.000. There were 81 deaths in Spain and 43 deaths in China during the one-year follow-up period (p= 0.026). CONCLUSIONS: In terms of incidence, demographics, surgical methods, and mortality, there are significant differences between hip fracture patients in Seville, Spain and Xi'an, China. [ABSTRACT FROM AUTHOR]

Osteoporotic fractures, also known as fragility fractures, are prevalent in the elderly and bring tremendous social burdens. Poor bone quality, weak repair capacity, instability, and high failure rate of internal fixation are main characteristics of osteoporotic fractures. Osteoporotic bone defects are common and need to be repaired by appropriate materials. Proximal humerus, distal radius, tibia plateau, calcaneus, and spine are common osteoporotic fractures with bone defect. Here, the consensus from the Osteoporosis Group of Chinese Orthopaedic Association concentrates on the epidemiology, characters, and management strategies of common osteoporotic fractures with bone defect to standardize clinical practice in bone repair of osteoporotic fractures. [ABSTRACT FROM AUTHOR]

Summary: The widely recommended fracture prediction tool FRAX was developed based on and for the general population. Although several adjusted FRAX methods were suggested for type 2 diabetes (T2DM), they still need to be evaluated in T2DM cohort. Introduction: This study was undertaken to develop a prediction model for Chinese diabetes fracture risk (CDFR) and compare its performance with those of FRAX. Methods: In this retrospective cohort study, 1730 patients with T2DM were enrolled from 2009.08 to 2013.07. Major osteoporotic fractures (MOFs) during follow-up were collected from Electronic Health Records (EHRs) and telephone interviews. Multivariate Cox regression with backward stepwise selection was used to fit the model. The performances of the CDFR model, FRAX, and adjusted FRAX were compared in the aspects of discrimination and calibration. Results: 6.3% of participants experienced MOF during a median follow-up of 10 years. The final model (CDFR) included 8 predictors: age, gender, previous fracture, insulin use, diabetic peripheral neuropathy (DPN), total cholesterol, triglycerides, and apolipoprotein A. This model had a C statistic of 0.803 (95%CI 0.761–0.844) and calibration χ2 of 4.63 (p = 0.86). The unadjusted FRAX underestimated the MOF risk (calibration χ2 134.5, p < 0.001; observed/predicted ratio 2.62, 95%CI 2.17–3.08), and there was still significant underestimation after diabetes adjustments. Comparing FRAX, the CDFR had a higher AUC, lower calibration χ2, and better reclassification of MOF. Conclusion: The CDFR model has good performance in 10-year MOF risk prediction in T2DM, especially in patients with insulin use or DPN. Future work is needed to validate our model in external cohort(s). [ABSTRACT FROM AUTHOR]

Clinical vertebral fractures and femoral neck fractures are severe osteoporotic fractures that increase morbidity and mortality. Anthropometric variables are associated with an increased risk of osteoporotic fractures, but it is not clear whether body surface area (BSA) has an effect on clinically severe osteoporotic fractures. The study included total of 3,694 cases of clinical vertebral fractures and femoral neck fractures (2,670 females and 1,024 males) and 3,694 controls without fractures who were matched with the cases by sex and age. There was a significant positive correlation between BSA and bone mineral density (BMD) in female and male fracture patients (females: r = 0.430-0.471, P < 0.001; males: r = 0.338-0.414, P < 0.001). There was a significant systematic increase in BMD in both genders at various skeletal sites, grouped by BSA quartile. The osteoporosis rates of the lumbar spine (97.9%), femoral neck (92.4%) and total hip (87.1%) in the female Q1 group were significantly higher than those in the Q4 group (P < 0.001), which were 80.0%, 57.9% and 36.9%, respectively, in the Q4 group; the osteoporosis rates of the lumbar spine, femoral neck, and total hip were 53.9%, 59.4%, and 36.3% in the male Q1 group, and 15.2%, 21.9%, and 7.03% in the Q4 group, which were significantly lower than those in the Q1 group (P < 0.001). In age-adjusted Cox regression models, the risk of fracture in the remaining three groups (Q2, Q3, and Q4) for weight, BMI, and BSA for both genders, compared with the highest quartile (Q1 by descending quartile stratification) were significantly higher. In models adjusted for age and BMD, only men in the BSA Q3 (HR = 1.55, 95% CI = 1.09-2.19) and BSA Q4 groups (HR = 1.41, 95% CI = 1.05-1.87) had significantly higher fracture risks. In models adjusted for age, height, weight, BMI, and BSA, low BMD was the greatest fracture risks for both sexes. Our results showed that BSA was closely related to BMD, prevalence of osteoporosis, and fracture risk, and that a decline in BSA may be a new potential risk factor for osteoporotic fractures in Chinese men. [ABSTRACT FROM AUTHOR]

In aging society, osteoporotic fractures have become one major social problem threatening the health of the elderly population in China. Compared with conventional fractures, low bone mass, bone defect and retarded healing issues of osteoporotic fractures lead to great difficulties in treatment and rehabilitation. Addressing major concerns in clinical settings, we proposed the "three in one" bone repair strategy focusing on anti-osteoporosis therapies, appropriate bone grafting and fracture healing accelerating. We summarize misconceptions and repair strategies for osteoporotic fracture management, expecting improvement of prognosis and clinical outcomes for osteoporotic fractures, to further improve therapeutic effect and living quality of patients. [ABSTRACT FROM AUTHOR]

Background: Fractures are the most common type of unintentional injury in children, with traumatic upper limb fractures accounting for approximately 80% of all childhood fractures. Many epidemiological investigations of upper limb fractures in children have been conducted, but with the development of society, the patterns of childhood fractures may have changed. This study aimed to analyze the epidemiology and economic cost factors of upper limb fractures in Chinese children. Methods: We retrospectively reviewed children with upper limb fractures or old upper limb fractures hospitalized between December 1, 2015, and December 31, 2019, in 22 tertiary children's hospitals, under China's Futang Research Center of Pediatric Development. We used the ICD10 codes on the front sheet of their medical records to identify cases and extracted data on age, sex, injury cause, fracture site, treatment, the year of admission and discharge, visiting time, and various costs during hospitalization from the medical record. Results: A total of 32,439 children (21,478 boys and 10,961 girls) were identified, of whom 32,080 had fresh fractures and 359 had old fractures. The peak age was 3–6 years in both sexes. A total of 4788 were infants, 14,320 were preschoolers, 10,499 were in of primary school age, and 2832 were adolescent. Fractures were most frequent in autumn (August to October). Admissions peaked at 0 o'clock. Among the 32,080 children with fresh upper limb fractures, the most common fracture site was the distal humerus, with a total of 20,090 fracture events including 13,134 humeral supracondylar fractures and 4914 lateral humeral condyle fractures. The most common cause of injuries was falling over. The most common joint dislocation accompanying upper limb fractures occurred in the elbow, involving 254 cases. Surgery was performed in 31,274 children, and 806 did not receive surgery. Among those with clear operative records, 10,962 children were treated with open reduction and 18,066 with closed reduction. The number of cases was largest in the East China region (Anhui Province, Shandong Province, Jiangsu Province, Zhejiang Province, and Fujian Province), with 12,065 cases overall. Among the 359 children with old fractures, 118 were admitted with a diagnosis of "old humerus fracture," accounting for the highest proportion; 244 underwent surgical open reduction, 16.16% of whom had osteotomy. For the children with fresh fractures, the average total hospital cost was 10,994 yuan, and the highest average total hospital cost was 14,053 yuan, for humeral shaft fractures. For the children with old fractures, the average total hospital cost was 15,151 yuan, and the highest average total hospital cost was 20,698 yuan, for old ulna fractures. Cost of materials was the principle factor affecting total hospital cost, followed by surgery and anesthesia costs, both in children with fresh fractures and those with old fractures. Significant differences were observed in all hospital costs (P < 0.001) except treatment costs (P = 0.702), between children with fresh fractures and those with old fractures. Among the 32,439 children, full self-payment accounted for the highest proportion of all payment methods, involving 17,088 cases, with an average cost of 11,111 yuan. Conclusion: Information on the epidemiological characteristics of childhood fractures suggests that health and safety education and protective measures should be strengthened to prevent upper limb fractures in children. For both fresh and old fractures, the cost of materials was the principal factor affecting total hospital cost, followed by surgery and anesthesia costs. The overall average total hospital cost is higher in children with old fractures than in children with fresh fractures. Among all children, full self-payment, at 53% of children, accounted for the highest proportion of all payment methods. Hospital costs are a headache for those families who will pay on their own. It can lead to a delayed treatment and unhealed fractures or malunion in some children. Therefore, the child trauma care system and training on fractures need to be improved, to reduce the late presentation of fractures. These combined measures will improve children's quality of life, reduce the expenditure of families, and decrease the public health burden. To provide better medical services for children, authorities must improve the allocation of health resources, establish a comprehensive medical security system for children, and set up more child trauma centers. [ABSTRACT FROM AUTHOR]

Purpose: As an important public health problem, osteoporosis (OP) in China is also in an upward trend year by year. As a standard method for diagnosing OP, dual-energy X-ray absorptiometry (DXA) cannot analyze the pathological process but only see the results. It is difficult to evaluate the early diagnosis of OP. Our study was carried out through a serum metabolomic study of OP in Chinese postmenopausal women on untargeted gas chromatography (GC)/liquid chromatography (LC)–mass spectrometry (MS) to find possible diagnostic markers. Materials and Methods: 50 Chinese postmenopausal women with osteoporosis and 50 age-matched women were selected as normal controls. We first used untargeted GC/LC-MS to analyze the serum of these participants and then combined it with a large number of multivariate statistical analyses to analyze the data. Finally, based on a multidimensional analysis of the metabolites, the most critical metabolites were considered to be biomarkers of OP in postmenopausal women. Further, biomarkers identified relevant metabolic pathways, followed by a map of metabolic pathways found in the database. Results: We found that there may be metabolic pathway disorders like glucose metabolism, lipid metabolism, and amino acid metabolism in postmenopausal women with OP. 18 differential metabolites are considered to be potential biomarkers of OP in postmenopausal women which are a major factor in metabolism and bone physiological function. Conclusion: These findings can be applied to clinical work through further validation studies. It also shows that metabonomic analysis has great potential in the application of early diagnosis and recurrence monitoring in postmenopausal OP women. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous vertebroplasty (PVP) was recently performed for treating patients with osteoporotic vertebral compression fractures (OVCF). However, recompression of cemented vertebra with significant vertebral height loss occurred in the patients after PVP was observed during the follow-up period. The purpose is to explore the risk factors among several potential predictors for the height loss of treated vertebral bodies after PVP in patients with OVCF. Methods: A study of 93 patients who had undergone PVP between May 1, 2016, and March 1, 2019, at the Spine Center of Huadong Hospital Affiliated to Fudan University was conducted. The fractured vertebral height loss ratio ≥ 15% at final follow-up were defined as cemented vertebra recompression. The following variables were measured and collected: age, gender, body mass index (BMI), bone mineral density (BMD), volume of bone cement injected, bone cement leakage, fractured vertebra segment, contact between bone cement and endplates, serum of calcium and phosphorus, and six kinds of bone turnover markers. Results: Mann–Whitney U test and Univariate Logistic regression analysis showed that the cemented vertebra recompression was correlated with BMD, contact between bone cement and endplates, parathyroid hormone (PTH), and 25-hydroxy vitamin D3 (25-OH-D3). Following multivariate modeling, multiple factors logistic regression elucidated that high BMD (P < 0.001, OR = 0.089) and high level of serum 25-OH-D3 (P = 0.012, OR = 0.877) were negatively correlated with the cemented vertebra recompression after PVP. Conclusion: Decreased BMD and lower level of serum 25-OH-D3 might be two critical and significant risk factors for the height loss of cemented vertebrae after PVP. [ABSTRACT FROM AUTHOR]

Background: Little is known about the incidence rates and importance of major modifiable risk factors for hip and major osteoporotic fractures in low‐ and middle‐income countries. We estimated the age‐ and sex‐specific incidence of hip, major osteoporotic, and any fractures and their associated risk factors in Chinese adults. Methods: This was a prospective study of 512,715 adults, aged 30–79 years, recruited from 10 diverse areas in China from 2004 to 2008 and followed up for 10 years. Age‐ and sex‐specific incidence rates were estimated, and Cox regression was used to yield adjusted hazard ratios (HRs) and population attributable fractions for risk factors. Results: The incidence rates of hip fracture in Chinese adults were 5.1 (95% confidence interval [CI] 5.0–5.3) per 10,000 person‐years; they were higher in women than in men and increased by two‐ to threefold per 10‐year older age. Among men, five risk factors for hip fracture, including low education (HR = 1.23; 95% CI 1.04–1.45), regular smoker (1.22, 1.03–1.45), lower weight (1.59, 1.34–1.88), alcohol drinker (1.18, 1.02–1.36), and prior fracture (1.62, 1.33–1.98), accounted for 44.3% of hip fractures. Among women, lower weight (1.30, 1.15–1.46), low physical activity (1.22, 1.10–1.35), diabetes (1.62, 1.41–1.86), prior fracture (1.54, 1.33–1.77), and self‐rated poor health (1.29, 1.13–1.47) accounted for 24.9% of hip fractures. Associations of risk factors with major osteoporotic or any fractures were weaker than those with hip fractures. Conclusions: The age‐ and sex‐specific incidence rates of hip fracture in Chinese adults were comparable with those in Western populations. Five potentially modifiable factors accounted for half of the hip fractures in men and one quarter in women. [ABSTRACT FROM AUTHOR]

Background: Traumatic asphyxia (TA) is a rarely reported disease characterized as thoraco-cervico-facial petechiae, facial edema and cyanosis, subconjunctival hemorrhage and neurological symptoms. This study aimed to report 51 children of TA at the pediatric medical center of west China.Methods: Scanned medical reports were reviewed and specific variables as age, sex, cause of injury, clinical manifestations and associated injuries were analyzed using SPSS 25.0.Results: The average age of patients was 5.3 ± 2.9 (1.3-13.2) year-old. Thirty (58.8%) were boys and 21 (41.2%) were girls. Most TAs occurred during vehicle accident, object compression and stampede. All patients showed facial petechiae (100.0%, CI 93.0-100.0%), 25 (49.0%, CI 34.8-63.2%) out of 51 presented with facial edema, 29 (56.9%, CI 42.8-70.9%) presented with subconjunctival hemorrhage, including bilateral 27 and unilateral 2. Six patients had facial cyanosis (11.8%, CI 2.6-20.9%). Other symptoms were also presented as epileptic seizure, vomiting, incontinence, paraplegia, etc. The most frequent companion injury was pulmonary contusion (76.5%, CI 64.4-88.5%). Other companion injuries included mediastinal emphysema, fracture, cerebral contusion and hemorrhage, hypoxic-ischemic brain injury, abdominal organ contusion, mastoid hemorrhage, hematocele of paranasal sinuses, spinal cord injury, hepatic insufficiency, myocardial injury and retinal hemorrhage and edema. Treatment was mainly supportive. No death occurred in our study. The prognosis is rather good if without damage of central nervous system.Conclusion: TA could bring out multiple symptoms, among which retinal hemorrhage and edema, spinal cord injury and viscera impairment have been less observed. Comprehensive physical and auxiliary examination should be performed considering TA. Its prognosis is rather good with focus on life-threatening complications. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: With the increasing aging of China’s population, the number of people with osteoporotic fracture is also gradually increasing. How to improve the treatment effect and improve people’s healthy living standards is attracting the attention of clinicians, engineers and researchers. OBJECTIVE: To review the research progress of improving the treatment effect of osteoporotic fracture, and propose a improvement plan of treatment effect. METHODS: The relevant articles were searched from Wanfang Medical Database, CNKI Database, PubMed Database, and Elsevier Database by computer. The search terms were “osteoporosis, fractures, surgical treatment, implants, anti-osteoporosis treatment, growth factors” in Chinese and English. The time was limited from 2010 to 2020. Finally, 48 articles were included for review. RESULTS AND CONCLUSION: (1) At present, the therapeutic effect can be improved by optimizing surgical treatment and anti-osteoporosis treatment. The surgery of bone compression can improve fusion degree between the short-term implant and fracture site bone tissue. The use of locking plate fixation technology can improve the growth and recovery of bone tissue at the fracture site. During the operation, autogenous bone, allogeneic bone, artificial bone materials, and ceramic materials were used as implants, which could fill the bone defect, but there were still some problems, such as limited donor, secondary operation, immune rejection, and insufficient biological activity. (2) Biodegradable polymeric materials, with good biosecurity, biocompatibility, plasticity, and remodelability, are hotspot in the research of osteoporotic fracture repair materials. (3) The introduction of Epimedium, bisphosphonates, and other drugs achieved better therapeutic effect than surgery alone. (4) Mechano growth factor-Ct24E as a typical force growth factor is conducive to improving the therapeutic effect, which promotes the adhesion, proliferation, differentiation and mineralization of osteoblasts. (5) Individually designed orthopedic implants need to have a three-dimensional structure that conforms to the formation of bone tissue. Three-dimensional printing technology can provide a physical structure that matches the patient’s fracture site. (6) In addition, after comprehensively analyzing the therapeutic effects of four aspects, including surgical procedures, implants, drugs, and growth factors, the author thinks that using force growth factor, anti-osteoporosis drug, biodegradable polymer, composite implants, and the application of three-dimensional printing technology together, and cooperating with the surgical treatment of advanced technology, can promote the growth of bone tissue, improve bone quality, enhance fusion, and obtain proper three-dimensional structure, and achieve comprehensive improvement of the treatment effect of osteoporotic fractures. [ABSTRACT FROM AUTHOR]

Background and purpose -- Identification of pathogens causing fracture-device-related infection (FDRI) is always a challenge as the positive rate of standard tissue sampling culture (TSC) remains unsatisfactory. This study evaluates the efficiency of implant surface culture (ISC) as an adjunct to standard TSC for identification of FDRI-associated microorganisms. Patients and methods -- Between November 2020 and March 2022, patients diagnosed with FDRI defined by the International Fracture-Related Infection (FRI) Consensus Group, and indicated for implant removal, underwent both methods for bacteria detection. The test order of ISC and TSC was randomly selected for each patient included, as a withinperson randomized design. For ISC, the recovered implants were gently covered with tryptic soy agar after rinsing with normal saline twice, and then incubated at 37 5% CO2 for up to 14 days. For TSC, 5 specimens were sampled and sent to the Clinical Laboratory of Southern Medical University Nanfang Hospital, Guangzhou, for culture and identification. Results -- 42 consecutive patients were included, with a mean age of 46 years. The most frequent infection site and implant type were the tibia (21 cases) and plates with screws (30 cases), respectively. Altogether 21 patients were found with positive outcomes by both methods, and the identi- fied pathogens were consistent. ISC found an additional 15 patients showing positive results, which were negative by TSC. Furthermore, the mean culture time of ISC was shorter than that of TSC (1.5 days vs. 3.2 days). Interpretation -- ISC may be a useful adjunct to TSC for detection of bacteria causing FDRI, with a relatively higher positive rate and a shorter culture time. [ABSTRACT FROM AUTHOR]

On June 23, 2020, Prolia® (denosumab) was approved by the National Medical Products Administration (NMPA) in the People's Republic of China as the first monoclonal antibody for the treatment of postmenopausal women with osteoporosis at high risk of fractures. Its brand name in Chinese is 普罗力, a transliteration from the English name "Prolia", which has an implied meaning of "to give strength to everyone"— a suitable name for a potent anti-resorptive therapy. The approval was supported by a novel marketing authorization application (MAA) that included data from Prolia's global clinical trial program establishing favorable efficacy and safety, augmented by results from a real-world evidence (RWE) study confirming the effectiveness and safety of Prolia in clinical practice within Taiwan and Hong Kong. Key constructs for this registration-quality RWE study included the fit-for-purpose assessment of data quality, methodology and quantitative assessment of potential biases, good practices of study conduct, and reproducibility of results. Using data from clinical practice in Taiwan and Hong Kong to evaluate the benefits versus risks of Prolia treatment in ethnic Chinese women with postmenopausal osteoporosis, the RWE study results for effectiveness were comparable to efficacy demonstrated in the global clinical trial program and results for safety were consistent with the incidence observed in global post-marketing safety studies. While RWE is often used to monitor postmarket safety of drug products, support health insurance coverage decisions, and inform clinicians on real-world use of medicines, it has not been widely used to support regulatory approval for new medicines in lieu of clinical bridging studies in countries where such studies are required. Well-conducted registrational RWE studies can play a pivotal role in complementing the totality of evidence presented in an MAA. The benefits of such an approach include avoiding the collection of additional placebo-controlled trial data in populations where adequate ethnic characterization of efficacy, effectiveness, and safety may already exist from postmarketing sources, and accelerate access for patients to innovative medicines in important regions. Here, we describe a regulatory case study of a novel MAA incorporating RWE that provided important evidence to confirm the benefit:risk of a new drug and facilitated a label expansion to a new patient population. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The 1-year mortality rate after femoral intertrochanteric fracture is higher than that of femoral neck fracture, which also belongs to hip fracture (Cui et al. in Arch Osteoporos 14(1):55, 2019). With the application of the concept of co-management model of orthopedics and geriatrics, the short-term and long-term mortality of all types of hip fractures has decreased (Van Heghe et al. in Calcif Tissue Int, 2021, https://doi.org/10.1007/s00223-021-00913-5). However, the mortality of Chinese femoral intertrochanteric fracture patients under this model has not been reported in the literatures. Aim: This paper aims to study the risk factors of postoperative all-cause mortality in aged patients with femoral intertrochanteric fracture under the co-management model of orthopedics and geriatrics. Materials and methods: This is a single-center prospective cohort study based on the real world, under the co-management of orthopedics and geriatrics, 363 patients aged ≥ 65 years with femoral intertrochanteric fracture were enrolled and followed up for 2–3 years; 52 patients were lost to follow up. Age, gender, body mass index (BMI), history of comorbidities, hip Bone Mineral Density (BMD), fracture history, 25(OH)D level, hemoglobin level, anti-osteoporosis treatment were risk factors to be tested. Kaplan–Meier survival curves and multivariate Cox proportional hazards models were constructed to analyze the impact of factors on all-cause mortality. Results: (1) Most of the dead patients were older (the mean age was 83.4 years, compared with 79.8 years for surviving patients), with more complications and without anti-osteoporosis medication; gender, pre-fracture history, BMI, total hip BMD, hemoglobin, 25(OH)D had no difference between the dead and the living patients. (2) Elderly patients with Intertrochanteric fracture can benefit from the early treatment of Zoledronic Acid (within 3 days after the operation). Conclusion: Under the co-management of orthopedics and geriatrics, to Chinese patients with Femoral Intertrochanteric fracture, Doctors should pay more attention to their age and chronic disease, and give anti-osteoporosis treatment if allowed. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Osteoporosis (OP) is an increasingly important public health issue, women constitute approximately 80% of those diagnosed with OP. Improved risk perception regarding OP is important for early prevention. This study aimed to examine the association among socio-demographic, communication related variables and risk perception regarding OP. An online survey with 950 participants was conducted. The survey comprised 19 questions pertaining to lifestyle, general health, bone fracture awareness and demographics. Bivariate analyses were used to examine unadjusted relations among socio-demographic, communication related variables and comparative perceived risk of OP. Ordinary least squares (OLS) regression analysis was used to analyze the association between communication media exposure, information processing mode, educational level, self-efficacy and risk perception for OP. Results suggest that some socio-demographic variables (gender, educational level, income) and some communication relevant variables (communication media exposure, the ability to acquire information and systematic information processing) were positively associated with higher OP risk perception, while self-efficacy was negative factor. The study also showed that heuristic-systematic processing and self-efficacy were found to moderate the impact of communication media on risk perceptions. Improved understanding of the impact of communication on risk perception may aid in the development of effective intervention strategies to reduce the burden of OP. [ABSTRACT FROM AUTHOR]

As more new fossils are discovered, a great number of extraordinary specimens have greatly enhanced our understanding of bone features in dinosaurs. The fracture patterns of dinosaur bones are distinctive and easily identifiable, and thus have received increasing attention. Some pioneering modern medical studies have categorised two types of bone fractures, including traumatic (a broken bone caused by an injury) and pathologic (a broken bone caused by a disease) fractures. Here, we investigated two fossil specimens collected from Yangchuanosaurus hepingensis and Gigantospinosaurus sichuanensis, respectively, which were both uncovered in the Sichuan Basin, southwestern China. These specimens were subjected to osteological examination, CT scanning and spectral data analysis. Thus, multiple lines of evidence indicate that the bone fracture in the two dinosaurs is attributed to different factors. [ABSTRACT FROM AUTHOR]

• Hip fracture incidences varied substantially in Asia-pacific countries/regions. • Australia, Taiwan and Japan had the highest crude rates. • Korea and Japan had the highest age- and sex- standardized rates. • The female-to-male ratio was highest in Japan and lowest in China. • Temporal decreases in standardized rates were observed in Korea, China and Japan. This systematic review aimed to update fragility hip fracture incidences in the Asia Pacific, and compare rates between countries/regions. A systematic search was conducted in four electronic databases. Studies reporting data between 2010 and 2023 on the geographical incidences of hip fractures in individuals aged ≥50 were included. Exclusion criteria were studies reporting solely on high-trauma, atypical, or periprosthetic fractures. We calculated the crude incidence, age- and sex-standardised incidence, and the female-to-male ratio. The systematic review was registered with PROSPERO (CRD42020162518). Thirty-eight studies were included across nine countries/regions (out of 41 countries/regions). The crude hip fracture incidence ranged from 89 to 341 per 100,000 people aged ≥50, with the highest observed in Australia, Taiwan, and Japan. Age- and sex-standardised rates ranged between 90 and 318 per 100,000 population and were highest in Korea and Japan. Temporal decreases in standardised rates were observed in Korea, China, and Japan. The female-to-male ratio was highest in Japan and lowest in China. Fragility hip fracture incidence varied substantially within the Asia-Pacific region. This observation may reflect actual incidence differences or stem from varying research methods and healthcare recording systems. Future research should use consistent measurement approaches to enhance international comparisons and service planning. [ABSTRACT FROM AUTHOR]

Background: Fragility fracture is associated with bone mineral density (BMD), and most databases used in related researches are instrument-matched. Little is known about the relationship between BMD and fragility fracture risk of native Chinese, especially using local databases as reference databases.Objective: To investigate relationship between BMD and risk of fragility fracture in native China.Methods: 3,324 cases, including 2,423 women (67.7 ± 8.9 years) and 901 men (68.4 ± 11.6 years) having radiological fragility fractures and 3,324 age- and gender-matched controls participated in the study. We measured BMD at posteroanterior spine and hip using dual-energy X-ray absorptiometry (DXA), calculated BMD measurement parameters based on our own BMD reference database.Results: BMDs and mean T-scores were lower in case group (with clinical fragility) than in control group (without clinical fragility). In patients with fragility fractures, prevalence of lumbar osteoporosis, low bone mass, and normal BMD were 78.9 %, 19.3 %, and 1.8 %, respectively, in women, and 49.5, 44.8 %, and 5.7 %, respectively, in men. In hip, these prevalence rates were 67.2 %, 28.4 %, and 4.4 % in females, and 43.2 %, 45.9 %, and 10.9 % in males, respectively, showing differences between females and males. Multivariate Cox regression analysis showed that after adjusting age, height, weight, and body mass index, fracture hazard ratio (HR) increased by 2.7-2.8 times (95 % CI 2.5-3.1) and 3.6-4.1 times (95 %CI 3.0-5.1) for women and men respectively with decreasing BMD parameters. In both sexes, risk of fragility fracture increased approximately 1.6-1.7 times (95 % CI 1.5-1.8) for every 1 T-score reduction in BMD.Conclusions: Risk of clinical fragility fracture increases with decreasing BMD measurement parameters and anthropometric indicators in native China, and fracture HR varies from gender and site. [ABSTRACT FROM AUTHOR]

Purpose Amid the outbreak of coronavirus disease 2019 (COVID-19), effective measures have been taken in China to suggest people wearing masks and staying at home. The majority of the people stayed at home, which had an obvious impact on the occurrence of traumatic fractures. This study aimed to describe the epidemiologic characteristics of traumatic fractures during the COVID-19, and provide reference for targeted control measures for the whole world by proposing China's experiences. Methods This was a retrospective & comparative multi-center study with data obtained from 11 hospitals in five provinces of China. Patients were enrolled into this study, who sustained fractures from 20 January to 19 February 2020 and the same period in 2019 (based on Chinese lunar calendar). All patients were divided into two groups: epidemic group (admitted in 2020) and control group (admitted in 2019). The data of patients' demographics (age and gender), injury related data (fracture type, fractured site, osteoporosis fracture, concurrent fractures, injury mechanism, places where fracture occurred, ISS score, Gustilo-Anderson Classification for open fracture), mortality and treatment modality were compared between the two groups. Results A total of 2,489 patients with 2,590 fractures were included. In the epidemic group, there were 865 patients, including 483 (55.8%) males and 382 (44.2%) females with an average age of 53.1 ± 23.1 years (range, 1 to 105). In the control group, there were 1,624 patients, including 876 (53.9%) males and 748 (46.1%) females with an average age of 51.2 ± 21.5 years (range, 1 to 98). Patients in the epidemic group was significantly older than those in the control group (t=-2.046, P = 0.045). For epidemic group, the mostly commonly involved age group was elderly patients, whereas it was middle-aged adults for the control group (χ² = 14.642, P = 0.002). For epidemic group, a total of 576 (66.6%) patients had their fracture occurring at home, while in the control group there was 183 (11.3%). The proportion rates of low energy injuries (79.1%, 684/865), osteoporotic fractures (32.5%, 294/906) and closed fractures (94.5%, 817/865) in the epidemic group were significantly higher when compared to the control group, respectively (34.4%, 559/1624; 26.9%, 453/1684; 91.9%, 1,493/1692; all P<0.05). The proportion rates of Gustilo-Anderson classification (5.5%, 16/865), concurrent fractures (2.3%, 20/865), and injury severity score (15.6 ± 6.7) in epidemic group were significantly lower than those in the control group, respectively (52.8%, 199/1624; 3.9%, 63/1624; 20.1 ± 8.7; all P<0.05). No positive case with COVID-19 was diagnosed in the epidemic group. The mortality rate in the epidemic group (0.46%) was similar with that in the control group (0.43%). Conclusions Our findings confirmed the importance of the measures to restrict people's movement and wear masks in the prevention of the spread of COVID-19. The epidemiological characteristics of traumatic fractures amid the epidemic changes dramatically, and more attempts should be focused on the prevention of low energy injuries of elderly population. [ABSTRACT FROM AUTHOR]