Feng-Chen Kao

The risk of fractures is higher in patients with autoimmune diseases, but it is not clear whether the use of immunosuppressive agents can further increase this risk. To investigate this issue, a retrospective study was conducted using data from Taiwan’s National Health Insurance Research Database. Patients diagnosed with autoimmune diseases between 2000 and 2014, including psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus, were included in the study. A control group of patients without autoimmune diseases was selected from the same database during the same period. Patients with autoimmune diseases were divided into two sub-cohorts based on their use of immunosuppressive agents. This study found the risk of fractures was 1.14 times higher in patients with autoimmune diseases than in those without. Moreover, we found that patients in the immunosuppressant sub-cohort had a higher risk of fractures compared to those in the non-immunosuppressant sub-cohort. The adjusted sub-distribution hazard ratio for shoulder fractures was 1.27 (95% CI = 1.01–1.58), for spine fractures was 1.43 (95% CI = 1.26–1.62), for wrist fractures was 0.95 (95% CI = 0.75–1.22), and for hip fractures was 1.67 (95% CI = 1.38–2.03). In conclusion, the long-term use of immunosuppressive agents in patients with autoimmune diseases may increase the risk of fractures.

According to the Health Promotion Administration in the Ministry of Health and Welfare statistics in Taiwan, over ten thousand women have breast cancer every year. Mammography is widely used to detect breast cancer. However, it is limited by the operator’s technique, the cooperation of the subjects, and the subjective interpretation by the physician. It results in inconsistent identification. Therefore, this study explores the use of a deep neural network algorithm for the classification of mammography images. In the experimental design, a retrospective study was used to collect imaging data from actual clinical cases. The mammography images were collected and classified according to the breast image reporting and data-analyzing system (BI-RADS). In terms of model building, a fully convolutional dense connection network (FC-DCN) is used for the network backbone. All the images were obtained through image preprocessing, a data augmentation method, and transfer learning technology to build a mammography image classification model. The research results show the model’s accuracy, sensitivity, and specificity were 86.37%, 100%, and 72.73%, respectively. Based on the FC-DCN model framework, it can effectively reduce the number of training parameters and successfully obtain a reasonable image classification model for mammography.

This study investigates the incidence and risk factors of new vertebral body collapse (VC) after posterior instrumented spinal fusion in patients older than 70 years. This retrospective study analyzed the data of elderly patients who underwent posterior instrumented spinal fusion in the thoracolumbar spine between January 2013 and December 2017. The 2 subsamples comprised of patients who had experienced vertebral compression fracture (VCF) before the index spinal surgery (group 1, n = 324) and those who had not (group 2, n = 1040). We recorded and analyzed their baseline characteristics, their underlying comorbidities, and the details of their current instrumented spinal fusion. The incidences of new VC and screw loosening were recorded. In groups 1 and 2, the incidences of new VC were 31.8% and 22.7%, respectively, and those of new VC with screw loosening were 25.6% and 33%, respectively. The risk factor was upper screw level at the thoracolumbar junction (hazard ratio [HR] = 2.181, 95% confidence interval [CI]: 1.135–4.190) with previous VCF. The risk factors were age ≥ 80 years (HR = 1.782, 95% CI: 1.132–2.805), instrumented levels > 4 (HR = 1.774, 95% CI: 1.292–2.437), and peptic ulcer (HR = 20.219, 95% CI: 2.262–180.731) without previous VCF. Clinicians should closely monitor new VC after posterior instrumented spinal fusion in elderly patients with previous VCF with upper screw level at the thoracolumbar junction and in patients without previous VCF aged ≥ 80 years, with instrumented levels > 4 and peptic ulcer.

The purpose of the retrospective case–control study was to identify the causes of and risk factors for unplanned return to the operating room (uROR) within 24 hours in surgical patients. We examined 275 cases of 24-hour uROR in our hospital from January 2010 to December 2018. The reasons for 24-hour uROR were classified into several categories. Controls were randomly matched to cases in a 1:1 ratio with the selection criteria set for the same surgeon and operation code in the same corresponding year. The mortality rate was significantly higher in patients with 24-hour uROR (11.63% vs 5.23%). Bleeding was the most common etiology (172/275; 62.55%) and technical error (14.5%) also contributed to 24-hour uROR. The clinical factors that led to bleeding included a history of liver disease (P = .032), smoking (P = .002), low platelet count in preoperative screening (P = .012), and preoperative administration of antiplatelet or anticoagulant agents (P = .014). Clinicians should recognize the risk factors for bleeding and minimize errors to avoid the increase in patient morbidity and mortality that is associated with 24-hour uROR. Level of Evidence: Level IV.

Background: Sacral insufficiency fracture (SIF) is rarer than osteoporotic vertebral compression fracture that occurs at other levels of the thoracolumbar spine. Percutaneous sacroplasty can effectively relieve pain and improve mobility. Several sacroplasty-based techniques have been reported to date. Sacroplasty is often performed with computed tomography-guided cannula placement, which is time intensive and results in greater radiation exposure than that resulting from fluoroscopy. Herein, we report our preliminary experience with a combination of long- and short-axis alar sacroplasty techniques under fluoroscopic guidance for osteoporotic SIFs. Methods: We retrospectively reviewed 44 consecutive patients with symptomatic osteoporotic SIFs who underwent alar sacroplasty between January 2013 and February 2020. The study group comprised 19 patients who underwent a combination of long- and short-axis alar sacroplasty techniques under fluoroscopic guidance. The control group comprised the remaining 25 patients who underwent short-axis alar sacroplasty under fluoroscopic guidance. Visual analog scale (VAS) scores, operation times, injected cement volumes, and postoperative complications were recorded. Results: The VAS score for pain decreased in both groups; however, no significant difference was noted between the study and control groups in injected cement volume (3.55 ± 0.96 vs 2.94 ± 0.89 mL). The operation time was longer in the study group than in the control group (32 ± 7.1 vs 28.04 ± 4.99 min; P = 0.046). No major complications were noted. Conclusion: A combination of long- and short-axis alar sacroplasty techniques can be effectively performed under fluoroscopic guidance for osteoporotic SIFs.

Osteoarthritis typically develops after surgery for traumatic fractures of the acetabulum and may result in total hip arthroplasty (THA). We conducted a population-based retrospective study to investigate the incidence of THA after treatment of acetabular, pelvic, and combined acetabular and pelvic fractures with open reduction-internal fixation surgery compared with that in the control group. A retrospective population-based cohort study. Data were gathered from the Taiwan National Health Insurance Research Database. We enrolled 3041 patients with acetabular fractures, 5618 with pelvic fractures, and 733 with combined pelvic and acetabular fractures between January 1, 1997, and December 31, 2013, totaling 9392 individuals. The control group comprised 664,349 individuals. Study participants were followed up for the occurrence of THA until death or the end of the study period. The THA rates after surgical intervention were 17.82%, 7.28%, and 18.01% in patients with acetabular, pelvic, and combined acetabular and pelvic fractures, respectively. Moreover, they were significantly higher for the acetabular fracture, pelvic fracture, and combined-fracture groups (adjusted hazard ratios [aHRs] = 58.42, 21.68, and 62.04, respectively) than for the control group (p < 0.0001) and significantly higher for the acetabular fracture and combined-fracture groups than for the pelvic fracture group (aHRs = 2.59 and 2.68, respectively; p < 0.0001). The incidence rates of THA after surgical intervention in the pelvic fracture, acetabular fracture, and combined-fracture groups were significantly higher than that of the control group.

Primary septic arthritis of the hip is rare and potentially devastating in adults. Its optimal surgical treatment and clinical outcomes remain unclear. In this retrospective cohort study, we investigated mortality and reinfection rates after surgery of patients with septic hip arthritis. We reviewed patients treated for primary septic hip joints from October 2005 to December 2016. A total of 51 adult patients were identified, and 38 among them had destructive hip joints. A poor postoperative outcome was defined as mortality or recurrent infection within 2 years of surgery. After surgery, 7 (13.7%) patients died within 1 year and 5 (9.8%) patients developed a recurrent hip infection within 2 years. Therefore, poor outcomes occurred in 22% (n = 11) of the study cohort. Among the 38 patients with a destructive hip joint, 7 (18.4%) died within 1 year after surgery and 4 (10.5%) developed a recurrent hip infection within 2 years of surgery. Correlative infections other than infected hip joint and liver cirrhosis were identified as risk factors for poor outcomes. In conclusion, clinical physicians treating adult primary septic hip joints should be cognizant of the high failure rate of surgical treatment. In addition, the high mortality rate should be considered during the discussion of surgical treatment with these patients and their families.

Patellar tendon rupture is a potentially devastating injury. Surgical repair is the primary treatment recommended for the patients with patellar tendon ruptures. Given the tendon properties, the suture technique is critical for proper tissue repair. Providing adequate loading during early mobilization is essential to prevent tendon suture repair failure. Therefore, the current study evaluated the mechanical characteristics of various applied loadings on patellar tendon repair using Krackow suture via a porcine model. Twelve fresh porcine hindlimbs with patellar tendon rupture were repaired by Krackow method using synthetic and non-absorbable No. 5 Ethibond sutures. Loadings of 100 and 200 N were applied during the cyclic loading test. A three-dimensional optical motion capture system was used to record the gap formation at the initial, 50th, 100th, 150th, 200th, 250th, 500th, 750th, and 1000th cycle. After cyclic loading, the specimen was loaded to failure under displacement control at a rate of 1 mm/s. Suture breakage was the primary failure mode in both loading conditions. After 1000 cyclic loadings of 100 N, the ultimate failure strength was 243.6 ± 25.8 N. However, the specimens tested under 200 N of loading failed before reaching 200 cycles. Under the 100 N loading, the largest gap deformation (1.89 ± 0.23 mm) and residual deformation (0.213 ± 0.183 mm) were found in the initial cycle. The average cumulative displacement was 5.13 mm from the initial cycle to the 100th cycle and 4.5 mm from the 250th to the 1000th cycle. Our findings can serve as reference values for further comparisons with various repair techniques or materials. This study suggests that the initially applied load after patellar tendon repair is an important risk factor of re-rupture.

The incidence of acute myocardial infarction (AMI) in healthy patients undergoing noncardiac surgery is <1%. When patients with chronic kidney disease (CKD) undergo orthopedic surgery, AMI incidence can be expected to be relatively high. However, data on a population-wide scale is lacking. To investigate AMI incidence in patients with CKD (with and without dialysis) undergoing orthopedic surgery. A population-based study covering the period from January 1, 1997, to December 31, 2011. Data from the Taiwan National Health Insurance Research Database. Participants were 219,195 patients with CKD who underwent surgery between January 1, 1997, and December 31, 2011. AMI occurred in 2,708 participants (1.24%). The AMI incidence rate in the dialyzed group was 1.52%, which was higher than that in the nondialyzed group after propensity score matching. Dialysis (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.62–1.98), male (OR: 1.42; 95% CI: 1.28–1.57), diabetes mellitus (OR: 1.61; 95% CI: 1.44–1.80), hyperlipidemia (OR: 1.88; 95% CI: 1.68–2.11), old myocardial infarction (OR: 18.87; 95% CI: 16.26–1.21.90), and cerebral vascular disease (CVA) (OR: 1.29; 95% CI: 1.30–1.47) were all associated with AMI in the patients with CKD. The AMI risk was higher in the patients with CKD undergoing orthopedic surgery than in the general population, and the dialyzed group had a higher risk of AMI than did the nondialyzed group.