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IntroductionSeveral different systems of classification have been developed to understand the complexity of pelvic ring fractures, to facilitate communication between physicians and to support the selection of appropriate therapeutic measures. The purpose of this study was to measure the inter- and intraobserver reliability of Tile AO, Young and Burgess, and FFP classification in pelvic ring fractures. The Rommens classification system (FFP) is analyzed for the first time.Materials and methodsFour reviewers (2 × senior pelvic trauma surgeon, 1 × resident, 1 × medical student) separately analyzed and classified 154 CT scans of patients with pelvic fracture. The Tile AO, the Young and Burgess, and the FFP classifications (subgroup with patients ≥ 60 years) were compared. Another blinded re-evaluation was carried out after 2 months to determine intraobserver reliability.ResultsThe overall interobserver agreement was fair for all classification systems (ICC: OTA 0.55, Young and Burgess 0.42, FFP 0.54). For specific categories, (e.g. type B or C fractures), there was a substantial agreement between the experienced surgeons (kappa: OTA 0.64, Young and Burgess 0.62, FFP 0.68). For inexperienced observers, there was a fair agreement in all systems (kappa: OTA 0.23, Young and Burgess 0.23, FFP 0.36).ConclusionsAll three classifications reach their maximum reliability with advanced expertise in the surgery of pelvic fractures. The novel FFP classification has proved to be at least equivalent when directly compared to the established systems. The FFP classification system showed substantial reliability in patients older than 60 years.

Background Large multi-centre studies of clavicle fractures have so far been missing. The aim of this observational study was to describe the epidemiology, classification and treatment of clavicle fractures in the The Swedish Fracture Register (SFR) that collects national prospective data from large fracture populations. Methods Data were retrieved from the SFR on all clavicle fractures sustained by patients ≥ 15 years of age in 2013–2014 ( n  = 2 422) with regards to date of injury, cause of injury, fracture classification and treatment. Results Sixty-eight per cent of the clavicle fractures occurred in males. The largest subgroup was males aged 15–24 years, representing 21% of clavicle fractures. At the ages of 65 years and above, females sustained more clavicle fractures than males. Same-level falls and bicycle accidents were the most common injury mechanisms. Displaced midshaft fractures constituted 43% of all fractures and were the most frequently operated fractures. Seventeen per cent of the patients underwent operative treatment within 30 days of the injury, where plate fixation was the choice of treatment in 94% of fractures. Conclusion The largest patient group was young males. Displaced midshaft fractures were the most common type of clavicle fracture as well as the most frequently operated type of fracture.

During the last two decades, extended scientific interest focused on quadrilateral plate (QLP) fractures as part of common acetabular fractures. The QLP corresponds to the medial wall of the acetabulum, and different fracture pattern of Letournel´s fracture types are associated with concomitant QLP fractures. Except anterior and posterior wall fractures, all other fracture types may be associated with QLP fractures. QLP fracture features include simple fracture lines up to highly comminuted fractures. A detailed preoperative analysis of these fractures is important to get a better understanding of intraoperative decision making. No consensus exists regarding the optimal classification and treatment of QLP fractures. Various operative approaches and treatment concepts exists depending on the specific QLP fracture type and the acetabular fracture type. Several new implants were development for optimal but often individual stabilization concepts. The gold-standard is still some medial buttressing during internal fixation predominantly using plates, but also screw fixation is considered an option. Additional dome impactions must be considered as an integral part in any QLP fracture analysis and stabilization.

SummaryPrior high-trauma fractures identified through health services data are associated with low bone mineral density (BMD) and future fracture risk to the same extent as fractures without high-trauma.IntroductionSome have questioned the usefulness of distinguishing high-trauma fractures from low-trauma fractures. The aim of this study is to compare BMD measurements and risk of subsequent low-trauma fracture in patients with prior high- or low-trauma fractures.MethodsUsing a clinical BMD registry for the province of Manitoba, Canada, we identified women and men age 40 years or older with fracture records from linked population-based healthcare data. Age- and sex-adjusted BMD Z-scores and covariate-adjusted hazard ratios (HR) with 95% confidence intervals (CI) for incident fracture were studied in relation to prior fracture status, categorized as high-trauma if associated with external injury codes and low-trauma otherwise.ResultsThe study population consisted of 64,428 women and men with no prior fracture (mean age 63.7 years), 858 with prior high-trauma fractures (mean age 65.1 years), and 14,758 with prior low-trauma fractures (mean age 67.2 years). Mean Z-scores for those with any prior high-trauma fracture were significantly lower than in those without prior fracture (P < 0.001) and similar to those with prior low-trauma fracture. Median observation time for incident fractures was 8.8 years (total 729,069 person-years). Any prior high-trauma fracture was significantly associated with increased risk for incident major osteoporotic fracture (MOF) (adjusted HR 1.31, 95% CI 1.08–1.59) as was prior low-trauma fracture (adjusted HR 1.55, 95% CI 1.47–1.63), and there was no significant difference between the two groups (prior trauma versus low-trauma fracture P = 0.093). A similar pattern was seen when incident MOF was studied in relation to prior hip fracture or prior MOF, or when the outcome was incident hip fracture or any incident fracture.ConclusionsHigh-trauma and low-trauma fractures showed similar relationships with low BMD and future fracture risk. This supports the inclusion of high-trauma fractures in clinical assessment for underlying osteoporosis and in the evaluation for intervention to reduce future fracture risk.

The incidence of geriatric acetabular fractures has shown a sharp increase in the last decades. The majority of patients are male, which is different to other osteoporotic fractures. The typical pathomechanism generally differs from acetabular fractures in young patients regarding both the direction and the amount of force transmission to the acetabulum via the femoral head. Geriatric fractures very frequently involve anterior structures of the acetabulum, while the posterior wall is less frequently involved. The anterior column and posterior hemitransverse (ACPHT) fracture is the most common fracture type. Superomedial dome impactions (gull sign) are a frequent feature in geriatric acetabular fractures as well. Treatment options include nonoperative treatment, internal fixation and arthoplasty. Nonoperative treatment includes rapid mobilisation and full weighbearing under analgesia and is advisable in non- or minimally displaced fractures without subluxation of the hip joint and without positive gull sign. Open reduction and internal fixation of geriatric acetabular fractures leads to good or excellent results, if anatomic reduction is achieved intraoperatively and loss of reduction does not occur postoperatively. Primary arthroplasty of geriatric acetabular fractures is a treatment option, which does not require anatomic reduction, allows for immediate postoperative full weightbearing and obviates several complications, which are associated with internal fixation. The major issue is the fixation of the acetabular cup in the fractured bone. Primary cups, reinforcement rings or a combination of arthroplasty and internal fixation may be applied depending on the acetabular fracture type.

Avalanches are a major cause of death in mountainous regions, primarily from asphyxia. However, increased recreational activities and climate change may be leading to more traumatic injuries, such as bone fractures, which are currently understudied. This study compared two distinct bone fracture classification systems, to better understand specific injury mechanisms in avalanche victims. We conducted a retrospective analysis of post-mortem CT scans from 13 adult avalanche victims in Grenoble, France, all with at least one bone fracture. Using MIP, MPR, and 3D reconstructions, we systematically classified fractures across ten major anatomical regions, representing the entire body. We analyzed each fracture to determine its traumatic mechanism using both the surgical AO/OTA and the anthropological Galloway et al. (2014) classification systems. The study included 13 individuals (61.5 % male; mean age: 37 years), with a total of 265 fractured bones. Fractures were most frequently observed in the thorax (52 %), spine (21 %), and skull (14 %). We found that multiple injury mechanisms, such as impact and compression, often occurred simultaneously. Both classification systems consistently identified six \"burst\"-type spinal fractures. However, for five open-book pelvic fractures, only the Galloway et al. system precisely described the specific injury mechanism. Our findings indicate that the AO/OTA and Galloway et al. classifications are complementary. The AO/OTA system offers standardized clinical utility, while the Galloway et al. system enhances forensic and anthropological interpretation by elucidating trauma mechanisms. These preliminary insights into bone injury mechanisms in avalanche events emphasize the need for interdisciplinary approaches to improve victim care and safety. •Complex, diverse fracture patterns and injury mechanisms in avalanche victims.•Galloway and AO/OTA fracture systems are complementary.•Galloway system explicitly identifies injury mechanisms.•Interdisciplinary approach enhances trauma records and safety strategies.•Including survivors would enable broader injury analysis.

Background Calcaneal fractures are the most common tarsal fractures and often result in long-term disability. Although various treatment options exist, but the relationship between Essex-Lopresti subtypes, treatment methods, and dynamic functional recovery remains unclear. Methods This retrospective study included 66 patients with intra-articular calcaneal fractures, treated between 2011 and 2021. Fractures were categorized according to the Essex-Lopresti classification (1 A–1 C, 2 A–2 C) and managed by conservative treatment, Steinmann pin fixation, or plate fixation. Functional outcomes were assessed, using the American Orthopaedic Foot and Ankle Society (AOFAS) score, radiographic parameters (Böhler and Gissane angles), and pedographic gait analysis with the Win-Track platform. Statistical analysis was performed using Kruskal–Wallis tests with Dunn–Bonferroni post-hoc analyses, Mann–Whitney U or independent-samples t-tests as appropriate, chi-square (or Fisher’s exact) tests for categorical variables, and Spearman’s rho for correlation. Results Functional outcomes varied across subtypes and treatment methods. Across subtypes, the distribution of AOFAS categories did not differ significantly (χ², p  = 0.587). Type 2 A fractures treated with Steinmann pin fixation demonstrated the highest AOFAS scores (80.4 ± 10.2; p  = 0.587). Böhler’s angle was numerically higher in the conservative group (17.0 ± 11.4°) but did not correlate with AOFAS scores (ρ = 0.01, p  = 0.94). Pedographic analysis showed that maximum plantar pressure was highest in the conservative group (1625 ± 142 kPa) and lowest in the plate fixation group (1437 ± 188 kPa; overall p  = 0.033). Gait asymmetries—particularly prolonged swing and stride duration tended to be greater in the Type 2B and 2 C subgroups, although statistical significance was limited (( p  = 0.195–0.795)). Conclusion Essex-Lopresti subtypes strongly influence clinical and gait outcomes following calcaneal fractures. Steinmann pin fixation is advantageous in Type 2 A fractures, while Type 2B fractures consistently show poor recovery. Radiographic angles alone are insufficient predictors of long-term outcomes, emphasizing the importance of integrating gait analysis with clinical scoring. Subtype-specific approaches may optimize treatment strategies and patient care. IRB number Ethics Committee of Fırat University (2022/04–04).

While the Letournel classification is the most widely used system for classifying acetabular fractures, it has some limitations, such as a limited inclusivity and a limited ability to guide surgical approaches. Introducing radiological modifiers to the Letournel classification could address those shortcomings. The main aim of this study is to identify these modifiers, determine their incidence relative to different acetabular fracture patterns, and explore their association with fractures that cannot be classified using the Letournel system. The secondary objective is to evaluate how these modifiers may improve their utility in guiding surgical approaches. The radiographs and CT scans of 236 acetabular fractures were retrospectively reviewed by 2 authors to classify the fracture and to detect the presence of the radiological modifiers, which are roof impaction, marginal impaction, head impaction, head fracture, intraarticular fragments, preoperative dislocation and its type, articular comminution, pelvic ring involvement, and quadrilateral plate involvement. Using the modifiers, the number of unclassified fractures was reduced by 90%. Some modifiers were more significantly common in the older age group. The presence of specific modifiers, such as roof impaction and intraarticular fragments, mandated the use of a different approach. We used surgical hip dislocation in 21(8.8%) cases based on specific modifiers, namely, femoral head fracture 11, roof impaction 6, and intraarticular fragment 2, pure impaction (unclassified) 1, and labral avulsion with posterior rim in 1. Infrapectineal plating was done in 14 cases (6 %) based on the presence of quadrilateral plate modifier. Identifying the characteristics of an acetabular fracture is essential for enhancing the value of its classification. Given the complex anatomy and varied injury patterns of the acetabulum, an accurate description that includes radiological modifiers—such as posterior wall involvement or quadrilateral plate displacement—provides a more comprehensive assessment. Integrating these modifiers into the Letournel classification improves its ability to predict prognosis and guides surgical planning more effectively.

High-energy impacts, like vehicle crashes or falls, can lead to pelvic ring injuries. Rapid diagnosis and treatment are crucial due to the risks of severe bleeding and organ damage. Pelvic radiography promptly assesses fracture extent and location, but struggles to diagnose bleeding. The AO/OTA classification system grades pelvic instability, but its complexity limits its use in emergency settings. This study develops and evaluates a deep learning algorithm to classify pelvic fractures on radiographs per the AO/OTA system. Pelvic radiographs of 773 patients with pelvic fractures and 167 patients without pelvic fractures were retrospectively analyzed at a single center. Pelvic fractures were classified into types A, B, and C using medical records categorized by an orthopedic surgeon according to the AO/OTA classification system. Accuracy, Dice Similarity Coefficient (DSC), and F1 score were measured to evaluate the diagnostic performance of the deep learning algorithms. The segmentation model showed high performance with 0.98 accuracy and 0.96–0.97 DSC. The AO/OTA classification model demonstrated effective performance with a 0.47–0.80 F1 score and 0.69–0.88 accuracy. Additionally, the classification model had a macro average of 0.77–0.94. Performance evaluation of the models showed relatively favorable results, which can aid in early classification of pelvic fractures.