X-Ray Film under Artificial Intelligence Algorithm in the Evaluation for Nursing Effect of Gamma Nail Internal Fixation in Elderly Patients with Intertrochanteric Fracture of Femur

The aim of this work was to explore the effects of Gamma nail internal fixation for intertrochanteric fracture of femur by X-ray film classification and recognition method based on artificial intelligence algorithm. The study subjects were 100 elderly patients with intertrochanteric fracture of femur admitted to hospital. The cases were diagnosed as elderly (over 60 years old) femoral intertrochanteric fractures by X-ray or CT. They were divided into two groups, with 50 persons in each group: one group used the X-ray film evaluation image guidance based on the artificial intelligence algorithm (research group), and the other group did not use algorithmic guidance (control group). The results showed that the segmentation effect of the proposed algorithm was similar to the gold standard segmentation result, indicating that the algorithm was effective and feasible in the segmentation of fractures and bones. The global level set algorithm was set as the control. The ultimate measurement accuracy (UMA) value of the algorithm group was ( 1.77 ± 0.22 ), and the UMA value of the global level set algorithm group was ( 3.42 ± 0.36 ), indicating that the image processed by the algorithm group had obvious numerical effect, high accuracy, and good retention of details. The operation time, intraoperative blood loss, incision length, hospital stay, weight-bearing time, and fracture healing time of the two groups were all better than those of the control group. One month after surgery, the Harris score of the algorithm group was 67, and that of the control group was 51, with a 16-point difference between the two groups ( p < 0.05 ). The patient had less pain and fast recovery speed, indicating that it was a good way to treat elderly intertrochanteric fractures with the nursing effect of X-ray Gamma nail internal fixation based on an artificial intelligence algorithm. The artificial intelligence algorithm not only can be applied to the Gamma nail internal fixation of elderly patients with intertrochanteric fractures but also can be applied to the X-ray image processing of other fractures and other surgical methods to provide effective treatment for fracture patients.

Gamma 3 Long Nail for Complex Sub-Trochanteric Fractures: A Ten-Year Retrospective Study

Cephalomedullary nailing is considered the treatment of choice for trochanteric and subtrochanteric femoral fractures. The aim of this study was to report postoperative outcomes of one of the widely used trochanteric nail device, the Gamma 3 long nail. We retrospectively assessed 405 patients treated with Gamma 3 long nail in a single Level One Trauma Centre between 2010 and 2018. We finally included 261 ambulant patients with 65 years or older, a lowenergy trauma and a closed trochanteric or subtrochanteric femoral fracture. Clinical outcomes were evaluated using the Hip Fracture Functional Recovery Score (FRS), while radiological complications and failures were assessed on postoperative x-rays. More than two-thirds of patients had completed fracture consolidation within 4 months after surgery. Immediate full weight bearing was allowed postoperatively in 64.0% of patients. We reported a mortality of 24.5% at one year postoperatively. The leading clinical postoperative complication was anemia (69.3%), followed by deep venous thrombosis (7.7%). Coxa vara was observed in 73 patients (28%), followed by malreduction in flexion-external rotation of the proximal femoral fragment (26.8%). No case of lag screw cutout was reported. Our study indicated that last generation of Long Gamma nail is a reliable implant for trochanteric and subtrochanteric femoral fractures in the elderly patients, leading to high rate of bone union and reduced incidence of related complications. An excellent fracture reduction and prevention of postoperative varus malalignment are the main factors that can avoid the major postoperative complications and failures after Gamma 3 long nailing.

Radiofrequency Multi Echographic Spectrometry (REMS) Technology in Patients With Bone Artifacts

Introduction: Dual-energy X-ray Absorptiometry (DXA) is considered the gold standard examination for the evaluation of bone mineral density (BMD). However, it is known that some conditions, such as arthrosis, vertebral collapse, or vertebroplasty, result in an overestimation of the BMD measured by DXA. Conversely, Radiofrequency Echographic Multi-Spectrometry (REMS) technology is able to automatically discard signals related to bone artifacts, such as calcifications or osteophytes, thanks to the identification of unexpected spectral features (Diez-Perez et al. 2019). The aim of this work is to assess the performance of REMS technology in patients with bone alterations that could alter the densitometric examination. Materials: The bone densitometry exams, both REMS and DXA, of patients with evidences of bone alterations at lumbar vertebrae or femoral neck were analysed. Written patient informed consent was obtained before the scans. Results: Eighty-seven patients with spinal artifacts, including 22 patients with vertebroplasty, 26 patients with bone fracture and 38 patients with osteo-arthrosis were considered. At lumbar spine, the mean BMD and T-score values assessed by REMS was lower than the ones measured by DXA. Moreover, the results obtained by the two technologies were not correlated. On the contrary, the BMD and T-score values measured by REMS and DXA at the femoral site were highly correlated (p&lt;0.01), as well as BMD and the T-score values measured by DXA at the femoral neck and by REMS at the lumbar spine (p&lt;0.01). As concerning artifacts involving femoral site, a patient with an intramedullary gamma nail positioned following a displaced pertrochanteric fracture of the left femur underwent a DXA scan of the right femur and a REMS scan of both femurs. A diagnosis of osteoporosis at the right femur was posed by both technologies. At the left femur with intramedullary gamma nail, REMS only made a diagnosis of osteoporosis highly corresponding with the one performed at right femur. Conclusions: The results from the patient series with spinal artifacts and the clinical case with femoral intramedullary gamma nail show the ability of REMS to evaluate anatomical sites that would not be assessable by DXA, such as in case of implanted nails, or that would give unreliable higher BMD values, such as in case of vertebroplasty, osteo-arthrosis and bone fracture. References: Diez-Perez et al. Aging Clin Exp Res 2019;31(10):1375–89