A fully automated sex estimation for proximal femur X-ray images through deep learning detection and classification

PurposeTo develop a fully automated deep learning pipeline using digital radiographs to detect the proximal femur region for accurate automated sex estimation.MethodRadiograph predictive features from 2122 Chinese Han clinical pelvic with ages ranging from 18 to 26 years were collected retrospectively to train and test the sex prediction model using deep machine learning’s convolutional neural networks (CNN). Model performance was assessed using a Chinese Han population with 361 samples and a white population with 50 samples. The average accuracy of the sex estimation of the two test datasets was determined.ResultsFor the Chinese Han population test dataset, the sex estimation accuracy was 94.6% (males: 93.9% and females: 94.7%). For the white population samples, the accuracy of sex estimation was 82.9% (males: 80.9% and females: 88.6%). The accuracy of CNN tested in the Chinese population was significantly higher than that tested in the White population (p < 0.001)ConclusionsThe model based on convolutional neural networks has an accuracy similar to that of current state-of-the-art mathematical functions using manually extracted features for the Chinese Han population samples, proving to be a reliable choice for the human sex estimation.     

Analysis of vertical and horizontal offsets in displaced femoral neck fracture in elderly treated with indigenous bicentric bipolar hip device

ObjectivesTo analyze the effect of indigenous bicentric bipolar prosthesis on horizontal and vertical offsets in fracture neck of femur when compared to contralateral normal hip and to evaluate functional outcomes. We hypothesized that our non-modular bipolar device restores satisfactory offsets in such patients.MethodsAll active elderly patients with displaced fracture NOF having contralateral normal hip were included. We used an indigenous bicentric bipolar hip-prosthesis, which is a non-modular single-piece device in all cases by lateral Hardinge approach. Postoperative radiograph AP view was taken in 15° internal rotation to decrease the effect of limb rotation on offset. CT scan was also used to evaluate offsets using ADW4.6 ADVANCED GE optima 128 slice software system. Subjects were followed for a minimum of 12 months postoperatively and functional outcome of effect of offsets change were evaluated by modified Harris Hip Score.ResultsThere is minimal difference in horizontal and vertical offset after bicentric bipolar hemi-replacement which is statistically insignificant supporting our hypothesis. The clinical outcomes were good to fair according to modified Harris Hip Score. The mean value of horizontal offset after our bipolar hemireplacement was 42.4 ± 2.04 mm and of normal hip was 41.8 ± 1.81 mm and P-value=0.08 in plain radiographs and value of horizontal offset in CT scan was 40.73 ± 0.27on bipolar side and 41.19 ± 0.77 on normal side. Vertical offset after bicentric bipolar was 32.67 ± 2.85 mm and vertical offset of normal hip was 32.53 ± 2.73 mm. Mean 9.77 ± 1.09 mm of calcar was preserved. Modified Harris Hip Score at 6 and 12 months postoperatively was 75.78 ± 4.16 and 79.53 ± 3.95 respectively. There was no incidence of hip dislocation.ConclusionOur study data clearly demonstrates that vertical and horizontal offsets are effectively maintained by the indigenous bicentric hip device. There was insignificant change in offsets as compared to contralateral normal side due to its design modifications. Indigenous bicentric non-modular bipolar device offers an excellent option for femur neck fractures in elderly patients in resource constrained situations. It allows rapid rehabilitation due to reduced surgical time, minimal blood loss and early return to function and activities of daily living.     

Identification of the medial femoral safe zone for drilling during dynamic hip screw side plate fixation: A CT angiogram tracing of the profunda femoris artery

Objectives

Iatrogenic injury of the Profunda Femoris Artery (PFA) at time of hip fixation surgery can increase morbidity and mortality and prolong the hospital stay. This is an injury that tends to pass unnoticed as a cause of postoperative deterioration despite being frequently reported in the literature. Our study aims to describe the anatomy of the PFA in relation to the medial femoral cortex with specific emphasis on its orientation relative to the position of a sliding hip screw side plate construct. By doing so we are able to present clear guidance to orthopaedic surgeons on how to avoid iatrogenic PFA injury at the time of hip fracture fixation.

补肾填髓汤对股骨骨折术后延迟愈合的效果观察

目的:观察和分析补肾填髓汤对股骨骨折术后延迟愈合的效果。方法:回顾分析了2014年4月-2017年4月期间在我院进行了股骨骨折术后延迟愈合治疗的40例患者的治疗过程,分为对照组(20例)和观察组(20例)。对照组患者予常规治疗,观察组则在对照组治疗的基础之上加入补肾填髓汤进行治疗。治疗后,对比两组患者之间的疗效以及骨代谢指标。结果:治疗前,两组患者骨代谢指标之间差异无统计学意义(P>0.05)。治疗后,观察组患者代谢指标改善情况优于对照组,P<0.05,两组之间差异存在统计学意义。治疗后,观察组疗效高于对照组,P<0.05,差异存在统计学意义。结论:使用补肾填髓汤治疗股骨骨折术后延迟愈患者能够大幅度提高患者疗效,提升治疗过程中的安全性,值得推广。     

Body height estimation from post-mortem CT femoral F1 measurements in a contemporary Swiss population

PurposeThe present study aimed at the comparison of body height estimations from cadaver length with body height estimations according to Trotter and Gleser (1952) and Penning and Riepert (2003) on the basis of femoral F1 section measurements in post-mortem computed tomography (PMCT) images.MethodsIn a post-mortem study in a contemporary Swiss population (226 corpses: 143 males (mean age: 53 ± 17 years) and 83 females (mean age: 61 ± 20 years)) femoral F1 measurements (403 femora: 199 right and 204 left; 177 pairs) were conducted in PMCT images and F1 was used for body height estimation using the equations after Trotter and Gleser (1952, “American Whites”), and Penning and Riepert (2003).ResultsThe mean observed cadaver length was 176.6 cm in males and 163.6 cm in females. Mean measured femoral length F1 was 47.5 cm (males) and 44.1 cm (females) respectively. Comparison of body height estimated from PMCT F1 measurements with body height calculated from cadaver length showed a close congruence (mean difference less than 0.95 cm in males and less than 1.99 cm in females) for equations both applied after Penning and Riepert and Trotter and Gleser.ConclusionsFemoral F1 measurements in PMCT images are very accurate, reproducible and feasible for body height estimation of a contemporary Swiss population when using the equations after Penning and Riepert (2003) or Trotter and Gleser (1952).     

Comparison of the Sliding and Femoral Head Rotation among Three Different Femoral Head Fixation Devices for Trochanteric Fractures

Background

Recently, various femoral head fixation devices (HFDs) for trochanteric fractures have become available. However, there are some cases in which femoral head rotation with excessive sliding of the HFD is observed and it is often followed by cutout. The purpose of this study is to compare the ability of the three types of HFDs to prevent femoral head rotation.

Methods

Between July 2005 and December 2009, 206 patients aged over 60 years with trochanteric fractures who had undergone surgical treatment using a short femoral nail in our institution were enrolled into the study. We used the gamma 3 nail (GMN) as the screw-type HFD in 66 cases, the gliding nail (GLN) as a non-cylindrical blade in 76 cases, and the proximal femoral nail antirotation (PFNA) as a cylindrical blade in 64 cases. The sliding length of HFDs and the occurrence of femoral head rotation were evaluated by assessing radiographs as the main outcome, and the results were compared among these devices.

Results

A comparison of the degree of sliding in the GMN group showed that femoral head rotation was observed significantly more frequently in cases with rotation. Further, it appeared that femoral head rotation occurred more frequently in comminuted fractures. However, no significant differences between the sliding lengths of the different HFDs were observed among three groups. Femoral head rotation was observed in 15 cases of GMN (22.7%), 0 case of GLN, and 5 case of PFNA (7.8%). Significant differences with regard to the occurrence of femoral head rotation were observed among the three groups. Furthermore, significant differences were also observed between GLN and PFNA with respect to the occurrence of femoral head rotation.

Conclusions

The ability to stabilize femoral head appears to be greater with blade-type materials than with screw-type materials. Furthermore, we believe that a non-cylindrical blade is preferable to a cylindrical blade for the surgical treatment of comminuted, unstable trochanteric fractures in order to prevent femoral head rotation and cut-out.     

儿童股骨远端骨肉瘤保留骨骺的定制肿瘤型假体重建术

 目的 介绍儿童股骨远端骨肉瘤保留骨骺的定制肿瘤型假体重建术,并探讨其工作原理、手术操作技巧、早期临床疗效以及并发症的防治。方法 2012年8月至2013年7月期间,应用肿瘤瘤段骨切除、保留骨骺的定制肿瘤型假体重建术治疗股骨远端骨肉瘤的儿童患者3例,均为男性,年龄8岁、9岁和15岁。术前给予新辅助化疗1~2周期,化疗结束后根据X线、CT 和MR等检查结果评价化疗疗效,对于化疗效果好且符合保留骨骺手术条件者采用此术式治疗。首先通过CT、MRI确定病变范围,根据影像学检查结果利用计算机辅助定制保留骨骺的肿瘤型假体以及模具,待假体定制完毕后行肿瘤瘤段骨切除、保留骨骺的定制肿瘤型假体重建术,术后指导患者进行功能锻炼,切口愈合1周后给予术后的规范化化疗,并进行长期随访。 结果 3例患者手术时间分别为3 h、4 h和6 h,术中出血量分别为300 ml、500 ml和2 200 ml。对3例患者术后随访时间 为12~24个月,根据美国骨肿瘤学会评分系统（Musculoskeletal Tumor Society,MSTS）,术后3个月功能评分分别为24分、26分和13分,短期随访显示患者肢体功能良好。1例患者出现假体感染,经保守治疗（抗炎补液、切口换药等）无效后行大腿截肢术,余2例患者未出现假体松动等其他并发症。2例患者双下肢长度相差均< 2 cm。结论 通过严格掌握保留骨骺保肢手术的适应证,配合术前及术后的新辅助化疗,保留骨骺的定制肿瘤型假体重建术为儿童股骨远端骨肉瘤的保肢治疗提供了新的选择方案,其疗效安全、可靠,且具有手术操作简单、手术时间短、术后恢复快等优点,但长期疗效尚需进一步观察。     

股骨锁定加压钢板（LCP）在儿童股骨转子下骨折中的应用

目的：探讨股骨锁定加压钢板（LCP）对儿童股骨转子下骨折的临床疗效。方法回顾性分析本院2010年2月至2012年12月收治的22例股骨转子下骨折患儿临床资料,其中男16例,女6例,平均年龄8．5岁。结果22例均获得随访,随访时间6～48个月,平均27个月,22例均骨性愈合,无断钉、脱钉、钢板松动、断板及髋内翻、关节活动障碍等并发症发生。结论股骨锁定加压钢板（LCP）对于儿童股骨转子下骨折可以有效改善传统保守牵引、克式针、弹性髓内钉固定及其他治疗方法的不足,可早期进行功能锻炼,减少关节僵直,效果良好。     

发育性髋关节发育不良儿童股骨头覆盖率三维CT测量及远期评价

目的探讨应用CT技术对发育性髋关节发育不良（developmental dysplasia of the hip,DDH）儿童的股骨头覆盖率进行三维测量的方法及其远期随访的意义。方法通过CT的原始数据结合计算机技术,测量DDH儿童术前、术后髋臼对股骨头的覆盖率。结果手术时年龄3岁或3岁以下的DDH患儿,随访时间超过4年时,股骨头覆盖率明显降低,但与对照组相比无明显差异。手术时年龄大于3岁,随访时间超过4年的DDH患儿股骨头覆盖率较正常对照组高。结论DDH患儿骨盆截骨术和股骨近端内翻截骨术后近期股骨头覆盖率最大,通常高于正常对照组;手术时年龄小于3岁的患儿,远期随访中股骨头覆盖率会有所降低;年龄超过3岁的患儿股骨头覆盖率的变化较小。CT测量股骨头覆盖率具有一定的可行性和可重复性,可用于指导DDH患儿的治疗与随访。