Search Results (12)

Background and Objectives: Total hip arthroplasty (THA) is a common orthopedic procedure. It helps restore mobility and reduce pain in patients with hip joint disorders. Periprosthetic femoral fracture (PFF) is an acute complication that may occur after primary THA. The rate of PFFs after primary total hip replacement is approximately 1%. The aim of this study was to assess the overall quality of life of patients following PFF surgery. Materials and Methods: This cross-sectional study included 60 patients with PFFs of Vancouver type B (32 females and 28 males, respectively), with a mean age of 73.02 ± 8.97 years and 30 controls who underwent primary THA. Quality of life was assessed at least 12 months postoperatively using the validated Serbian SF-36 questionnaire and clinical examination. Results: Older age correlated with declines in Physical and Emotional functioning, Vitality (Energy/fatigue), and Social activities (overall SF-36: r = −0.619, p < 0.01). Patients who underwent femoral stem revision with osteosynthesis (B2 and B3) showed better quality of life compared to those who underwent osteosynthesis alone (B1) in General health perceptions (t = −2.266, p = 0.027) and Physical functioning (t = 2.526, p = 0.014). Patients after PFF surgery had lower postoperative quality of life compared to those who underwent primary THA (overall SF-36: 66.68 ± 15.60 vs. 84.10 ± 14.65, t = −5.092, p < 0.0005). Conclusions: Patients with PFF have a lower quality of life than those after primary THA, while combined stem revision and osteosynthesis yield better outcomes than osteosynthesis alone. Full article

Periprosthetic femoral fractures (PPFFs) represent the third most frequent indication for revision total hip arthroplasty (THA). Given the steadily increasing number of primary hip replacements, this complication is gaining growing attention among orthopedic surgeons. Clamshell fracture (CF) constitutes a particularly controversial and underrecognized fracture pattern that, for a long time, was not accounted for in the commonly used classification systems for PPFFs. Recent studies suggest that the incidence and clinical relevance of these injury patterns have been underestimated. Therapeutic options are manifold and depend on various patient-specific factors as well as stem stability. Despite this, the current literature remains limited, and standardized therapeutic approaches are still poorly defined. This review aims to provide a comprehensive overview of clamshell fractures as a distinct pattern of periprosthetic injuries. Furthermore, relevant treatment options dependent on biomechanical considerations will be outlined and discussed. Full article

Background and objectives: The objective was to validate the Beyond the Vancouver classification. Based on this algorithm, it was hypothesized that cemented polished tapered stems with an intact cement mantle and cementless stable stems with defined criteria could be classified as stable and therefore treated with open reduction and internal fixation (ORIF). Materials and Methods: This retrospective, single-center cohort study re-analyzed patients initially diagnosed with Vancouver type B2 fractures treated with ORIF between 2007 and 2020. Clinical and radiological outcomes were extracted from medical reports. A combined radiological and clinical score was used as the main outcome measure. Patients categorized according to the Beyond the Vancouver classification were compared for functional outcome. Results: 42 patients (25 male, 17 female) with a median (range) age of 83 years (75–88 years) and follow-up time of 25 weeks (12–35 weeks) were reviewed. It was found that ORIF achieved excellent or good results in 81% of cases for stems classified as stable (n = 16) and in 30% of cases for stems classified as loose (n = 23). Successful cases (30%), although classified as loose, all had the same fracture pattern: an intact greater trochanter and a fracture fragment attached laterally to the stem with distal fixation of the stem. Conclusions: This case series suggests that certain Vancouver B2 fractures can be treated with ORIF. The Beyond the Vancouver classification may support the categorization of ‘stable’ and ‘loose’ stems. The validity of the algorithm was supported by the observation that ORIF provided excellent and good results for the majority of stems classified as ‘stable’, but poor results for stems classified as ‘loose’. Furthermore, the fracture pattern has been shown to be a crucial factor that should be considered when treating distally fixed cementless stems. The classification was therefore expanded to include the specific fracture patterns in cementless distally fixed stems that can be successfully treated with ORIF. The Beyond the Vancouver classification can provide further guidance in the identification of ‘loose’ or ‘stable’ stems. Full article

This work studies the presence and evolution of wood construction in urban environments, using Santiago province in Chile as a relevant comparative case. The first part of the study analyzes the spatial and temporal distribution of wood-based structures in Santiago, showing that although wood has historically been used in low-rise housing, its presence has declined significantly due to increasing urban densification and the widespread adoption of materials like concrete for taller buildings. Currently, only 5.4% of Santiago’s buildings use wood structures, with their presence notably decreasing in the high-density municipalities of the city. Recent construction trends in Santiago show that the average building height is 12 stories, with timber buildings not exceeding 6 stories, despite the absence of specific restrictions in the building code for tall timber structures. The second part of this study contrasts these trends with the global development of tall timber buildings (six stories or more), which total approximately 300 worldwide as of 2024. The leading cities include Paris (with over 35 buildings) and London (over 17), followed by Zürich, Vancouver, and Portland. This study highlights the pivotal role of wood promotion policies in enabling this global expansion. Finally, a five-phase classification is proposed to evaluate the evolution of tall timber construction in a given city, emphasizing the role of public policy in enabling large-scale adoption, especially for cities such as Santiago. Full article

Objective: The increasing number of aging patients with total hip arthroplasties (THA) causes an increased incidence of periprosthetic fractures (PPF). The study aimed to evaluate the impacts of two different materials in the same-sized cemented stems on PPF in bone models. Methods: This study compared the maximum rotational torque leading to PPF when stems made of cobalt–chromium–molybdenum (Co–Cr–Mo) alloy and stainless use steel (SUS) were implanted using simulated bone models (Sawbones, 3403). The maximum destruction torque was compared statistically for each material (Co–Cr–Mo alloy vs. SUS stainless steel) in this model, and fracture patterns were examined. Results: The PPF occurred with a spiral propagation from the proximal femur towards the diaphysis, with breakage occurring near the distal end of the stem. There were no significant differences in the destruction torque values between the Co–Cr–Mo alloy (103.0 ± 14.9 Nm) and SUS (98.7 ± 15.1 Nm) samples (p = 0.575). The fractures using the bone models exhibited similar patterns in all specimens, resembling clinical PPF fracture types clinically, specifically Vancouver classification B2. Conclusions: The comparison of the maximum destruction torques of the Co–Cr–Mo alloy and SUS cemented stems in simulating PPF showed no significant differences. The results suggest that the materials of the cemented stems might not significantly affect the occurrence of PPF in THA. Full article

Background/Objectives: Periprosthetic fractures (PFs) are serious complications that can occur after total hip arthroplasty (THA), particularly in elderly patients who often have multiple comorbidities and low bone density. The surgical treatment of PFs typically involves internal fixation or revision arthroplasty, depending on the fracture type categorized by the Vancouver classification. This study examines the annual incidence of PFs and the complications that arise during hospitalization, as well as the predictive role of age in the occurrence of these fractures and their associated complications. Methods: Based on a retrospective observational study conducted over three years (2021–2023) at the Bihor County Emergency Hospital in Oradea, we analyzed 783 patients who underwent various hip surgeries. Results: The retrospective analysis identified 38 cases of PF out of 768 hip surgeries, resulting in an incidence of PF of 4.5%. Most PFs were classified as Vancouver B, with surgeries mainly involving internal fixation. Complications occurred in 23.68% of cases, including a mortality rate of 7.90%. A correlation analysis examining the relationship between age and post-surgical complications demonstrates a weak and statistically insignificant association (r = 0.120, p = 0.478). To highlight whether age is a predictive factor for PFs, we used the linear regression model; this suggests that older age explains 2.7% of the total variability in the incidence of PFs, being statistically significant ([F(1, 766) = 20.923], p < 0.001). Conclusions: The rising incidence of periprosthetic fractures is closely linked to the increasing number of total hip arthroplasties and the aging population. Fractures of this type are more common in elderly women, with no statistically significant differences have been found between the sexes. Full article

Purpose: The surgical management of periprosthetic femoral fractures is particularly challenging in geriatric patients due to physiological limitations. The choice between open reduction and internal fixation (ORIF) and hip revision arthroplasty for treating Vancouver B2 and B3 fractures remains controversial. This study aims to contribute further evidence by analyzing the in-hospital outcomes in geriatric patients with Vancouver B2/3 fractures. Methods: This retrospective study analyzed 133 patients treated for Vancouver B2/3 fractures at a level I trauma center from 2017 to 2023. Data were collected on preclinical characteristics, comorbidities, Vancouver classification, surgery-related parameters, and postoperative outcomes for an age- and gender-matched analysis. A subgroup analysis was also conducted on patients classified as American Society of Anesthesiologists (ASA) class 3 and 4. Results: Among the 133 patients, 85 suffered Vancouver B2 fractures and 48 Vancouver B3 fractures. Age-and-gender-matched analysis revealed that ORIF was more commonly performed in patients with higher ASA grades. A subgroup analysis of ASA 3 and 4 patients and an age-and-gender-matched analysis showed that ORIF resulted in shorter operation times and less blood loss. No significant differences were found in mortality or complication rates. Conclusions: ORIF is associated with shorter operation times, less bleeding, and comparable in-hospital outcomes in treating Vancouver B2/3 fractures in higher-risk geriatric patients compared to revision arthroplasty. The retrospective design and small sample size in the ORIF group are limitations of the study. Further studies with functional evaluation are still required. Full article

Hip replacement surgery is increasingly being performed on older patients, raising the risk of periprosthetic proximal femur fractures (PPFFs). While the impact of surgery timing on mortality in proximal femoral fractures is established, its effect on PPFFs remains unclear. This study aims to examine the correlation between surgery timing and mortality in PPFF patients. In a historical cohort study, we analyzed data from 79 PPFF patients treated from 2012 to 2022. Patients were categorized by surgery timing (≤48 h, 32 patients vs. >48 h, 47 patients). Outcomes and mortality rates were compared. No significant difference in mortality was observed between patients undergoing early (<48 h) and delayed (>48 h) surgery at 30 days and 1 year. Factors such as age (p = 0.154), gender (p = 0.058), ASA score (p = 0.893), Vancouver classification (p = 0.577), and surgery type (implant revision p = 0.691, OR = 0.667) did not affect 30-day mortality. However, 1-year mortality was influenced by gender (male p = 0.045) and age (p = 0.004), but not by other variables (Vancouver classification p = 0.443, implant revision p = 0.196). These findings indicate no association between surgery timing and mortality in PPFF patients, suggesting that other factors may influence outcomes. Further research is needed to optimize PPFF management. Full article

Building land-use type classification using earth observation data is essential for urban planning and emergency management. Municipalities usually do not hold a detailed record of building land-use types in their jurisdictions, and there is a significant need for a detailed classification of this data. Earth observation data can be beneficial in this regard, because of their availability and requiring a reduced amount of fieldwork. In this work, we imported Google Street View (GSV), light detection and ranging-derived (LiDAR-derived) features, and orthophoto images to deep learning (DL) models. The DL models were trained on building land-use type data for the Greater Toronto Area (GTA). The data was created using building land-use type labels from OpenStreetMap (OSM) and web scraping. Then, we classified buildings into apartment, house, industrial, institutional, mixed residential/commercial, office building, retail, and other. Three DL-derived classification maps from GSV, LiDAR, and orthophoto images were combined at the decision level using the proposed ranking classes based on the F1 score method. For comparison, the classifiers were combined using fuzzy fusion as well. The results of two independent case studies, Vancouver and Fort Worth, showed that the proposed fusion method could achieve an overall accuracy of 75%, up to 8% higher than the previous study using CNNs and the same ground truth data. Also, the results showed that while mixed residential/commercial buildings were correctly detected using GSV images, the DL models confused many houses in the GTA with mixed residential/commercial because of their similar appearance in GSV images. Full article

Objectives: As currently there is no existing biomechanical work on the topic of interest, the aim of the current study was to investigate the effect of cerclage banding distally to an intraoperatively occurring proximal periprosthetic femoral clamshell fracture versus a non-fractured femur after total hip arthroplasty. Methods: A diaphyseal anchoring stem was implanted in twenty paired human cadaveric femora, assigned to a treatment and a control group. In the treatment group, each specimen was fitted with a cerclage band placed 3 mm distally to a clamshell fracture, created with an extent of 40% of the anchoring length of the stem. The resulting fragment was not treated further. The contralateral specimens were left with the stems without further fracture creation or treatment. All constructs were tested under progressively increasing cyclic axial loading until failure. Relative bone-implant movements were monitored by motion tracking. Results: Number of cycles and the corresponding load at stem loosening, defined as 1 mm displacement of the stem along the shaft axis, were 31,417 ± 8870 and 3641.7 ± 887 N in the control group, and 26,944 ± 11,706 and 3194.4 ± 1170.6 N in the treatment group, respectively, with no significant differences between them, p = 0.106. Conclusion: From a biomechanical perspective, cerclage banding distally to an intraoperative clamshell fracture with an extent of 40% of the anchoring length of the stem demonstrated comparable resistance against hip stem loosening versus a non-fractured femur. It may therefore represent a valid treatment option to restore the full axial stability of a diaphyseal anchoring stem. In addition, it may be considered to keep the medial wall fragment unfixed, thus saving operative time and minimizing associated risks. Full article

Metallic cerclage cables are reliable and cost-effective internal fixation devices, which are largely used in surgical practice for the treatment of periprosthetic fractures. Nevertheless, complications connected with their use have been described in the literature, including the following: third-body generation, failure and consequent migration, fraying, allergies, and injury to the surgical team. The development of new materials offers alternatives to traditional metallic cables. This study compares the outcomes between two groups of patients affected by periprosthetic hip fractures, treated with titanium cables or with ultra-high-molecular-weight polyethylene (UHMWPe) iso-elastic cables. Our retrospective study aims to compare the clinical and radiological outcomes of titanium cables and UHMWPe iso-elastic cables, isolated or associated with dedicated plates, for the surgical treatment of periprosthetic fractures with stable implants. Two groups of 30 (group A—metallic cables) and 24 (group B—UHMWPe iso-elastic cables) patients have been surgically treated in our institution for hip periprosthetic fractures, between September 2017 and June 2020. The mean age of the patients was 81 years in group A and 80 years in group B. In our study, we included fractures classified as B1 or C, according to the Vancouver postoperative fractures classification; the patients were evaluated retrospectively at 1 year postoperatively, regarding the following: surgery time, blood loss, partial weight-bearing time, radiographical healing time, Harris hip score, and postoperative complications. Comparable outcomes were observed in patients from both groups. Group A showed a higher complication rate compared to group B, at 1 year postoperatively. Non-metallic nylon fiber and ultra-high-molecular-weight polyethylene (UHMWPe) cerclage cables could represent a reliable fixation device, ensuring comparable healing and complication rates with traditional titanium cerclage cables. Full article

The development and deployment of sensors for undersea cabled observatories is presently biased toward the measurement of habitat variables, while sensor technologies for biological community characterization through species identification and individual counting are less common. The VENUS cabled multisensory network (Vancouver Island, Canada) deploys seafloor camera systems at several sites. Our objective in this study was to implement new automated image analysis protocols for the recognition and counting of benthic decapods (i.e., the galatheid squat lobster, Munida quadrispina), as well as for the evaluation of changes in bacterial mat coverage (i.e., Beggiatoa spp.), using a camera deployed in Saanich Inlet (103 m depth). For the counting of Munida we remotely acquired 100 digital photos at hourly intervals from 2 to 6 December 2009. In the case of bacterial mat coverage estimation, images were taken from 2 to 8 December 2009 at the same time frequency. The automated image analysis protocols for both study cases were created in MatLab 7.1. Automation for Munida counting incorporated the combination of both filtering and background correction (Median- and Top-Hat Filters) with Euclidean Distances (ED) on Red-Green-Blue (RGB) channels. The Scale-Invariant Feature Transform (SIFT) features and Fourier Descriptors (FD) of tracked objects were then extracted. Animal classifications were carried out with the tools of morphometric multivariate statistic (i.e., Partial Least Square Discriminant Analysis; PLSDA) on Mean RGB (RGBv) value for each object and Fourier Descriptors (RGBv+FD) matrices plus SIFT and ED. The SIFT approach returned the better results. Higher percentages of images were correctly classified and lower misclassification errors (an animal is present but not detected) occurred. In contrast, RGBv+FD and ED resulted in a high incidence of records being generated for non-present animals. Bacterial mat coverage was estimated in terms of Percent Coverage and Fractal Dimension. A constant Region of Interest (ROI) was defined and background extraction by a Gaussian Blurring Filter was performed. Image subtraction within ROI was followed by the sum of the RGB channels matrices. Percent Coverage was calculated on the resulting image. Fractal Dimension was estimated using the box-counting method. The images were then resized to a dimension in pixels equal to a power of 2, allowing subdivision into sub-multiple quadrants. In comparisons of manual and automated Percent Coverage and Fractal Dimension estimates, the former showed an overestimation tendency for both parameters. The primary limitations on the automatic analysis of benthic images were habitat variations in sediment texture and water column turbidity. The application of filters for background corrections is a required preliminary step for the efficient recognition of animals and bacterial mat patches. Full article