Summary: Pelvic-acetabular fractures lead to high mortality in elders and their association between different groups is not known. Our results indicate that older age with pelvic-acetabular fracture was significantly associated with mortality. This finding may help planning and allocating healthcare resources, risk stratification, and optimizing the treatment of pelvic fractures. Purpose: Pelvic or acetabular fractures are among main outcomes of low-energy trauma such as falls, especially in older adults. They represent approximately 3–8% of all fractures and are associated with a high mortality rate ranging from 4 to 28%. This study is aimed at comparing the incidence and trends of hip fractures and pelvic-acetabular fractures in the Taiwanese general population, gender differences in adults aged over 65 years, and mortality risk between pelvic or acetabular fractures and hip fractures and surgery trends in patients with these fractures. Methods: A retrospective study was conducted extracting data from the National Health Insurance Research Database of patients diagnosed with hip fracture and pelvic acetabular fracture between 2000 and 2018. Results: Older age with pelvic-acetabular fracture was significantly associated with increased mortality. No significant differences were found in comorbidities between the two fracture groups. Results provide clear epidemiological evidence for trends in pelvic-acetabular fractures in Taiwan and demonstrate the need for better strategies to manage these fractures and comorbidities, particularly in older adults. Conclusion: Findings of this study may aid in planning and allocating healthcare resources, risk stratification, and optimizing the treatment of pelvic fractures among older adults in Taiwan.

Study design: Retrospective cohort study. Objective: To analyze the efficacy and safety of Halo-femoral traction (HFT) following spinal release, and preoperative Halo-gravity traction (HGT) in patients with severe spinal kyphoscoliosis and spinal cord risk classification (SCRC) type 3 at the apex. Methods: A total of 73 patients (24 males, 49 females, mean age 22.4 ± 6.4 years) and 56 patients (15 males, 41 females, mean age 22.9 ± 10.4 years) were included in the HFT and HGT group, respectively. Radiographic parameters were measured at the initial assessment, post-traction, post-final surgery, and during each follow-up. Neurologic function was assessed using the Frankel score system. IONM alerts and all complications were documented. Quality-of-life was evaluated using the SF-36 questionnaire. Results: In the HFT vs HGT group, the total correction rates were 39.9 ± 7.2% v.s. 41.3 ± 6.8% for the major Cobb and 36.6 ± 9.3% v.s. 44.4 ± 9.2% for global kyphosis (GK) after final surgery, respectively. The traction contributions were 57.6 ± 11.1% v.s. 52.3 ± 9.3% for major Cobb and 70.1 ± 10.5% v.s. 63.9 ± 11.1% for global kyphosis (GK), respectively. More than half of the total correction can be achieved gradually and safely through preoperative traction with patients in an awake state. No deterioration in neurological function was found post-final surgery. During the last follow-up, SF-36 questionnaire scores improved significantly in both groups ( P < .05). Conclusions: Significant outcomes can be expected in patients with severe kyphoscoliosis, even with spinal cord risk classification (SCRC) type 3 at the apex undergoing HFT and HGT.

For patients with spinopelvic dissociation (SPD), triangular osteosynthesis is the current method for the fixation of the posterior pelvis. This study aimed to assess the recovery process and radiographic parameters associated with the functional outcomes in patients with SPD treated by triangular osteosynthesis. We collected data from 23 patients with SPD. To investigate the key aspect regarding the functional outcomes of these patients, we measured pre- and post-operative parameters, and a statistical analysis adjusted for age, gender, and time windows was used. The radiographic displacement measurement in the pre-operative period showed that the EQ−5D−5L increased by 2.141 per outlet ratio unit. The EQ−5D−5L increased by 1.359 per inlet ratio unit and 1.804 per outlet ratio during the postoperative period. The EQ−VAS increased significantly only with the inlet ratio in the postoperative period (1.270 per inlet ratio). A vertical reduction in SPD during the surgery can achieve more satisfactory outcomes than a horizontal anatomical reduction, in which the horizontal displacement causes inferior functional outcomes.

Chondrosarcoma is a malignant bone tumor that arises from abnormalities in cartilaginous tissue and is associated with lung metastases. Lymphangiogenesis plays an essential role in cancer metastasis. Visfatin is an adipokine reported to enhance tumor metastasis, but its relationship with VEGF-D generation and lymphangiogenesis in chondrosarcoma remains undetermined. Our results from clinical samples reveal that VEGF-D levels are markedly higher in chondrosarcoma patients than in normal individuals. Visfatin stimulation promotes VEGF-D-dependent lymphatic endothelial cell lymphangiogenesis. We also found that visfatin induces VEGF-D production by activating HIF-1α and reducing miR-2277-3p generation through the Raf/MEK/ERK signaling cascade. Importantly, visfatin controls chondrosarcoma-related lymphangiogenesis in vivo. Therefore, visfatin is a promising target in the treatment of chondrosarcoma lymphangiogenesis.

Study Design: Retrospective cohort study. Objective: Reciprocal changes (RCs) in unfused spinal segments can significantly affect the global alignment after corrective surgery. Identifying radiographic thresholds for guiding surgical strategies is critical for optimizing the outcomes. Materials and Methods: Ninety-eight ASD patients who underwent staged surgeries, including lateral lumbar interbody fusion (LLIF) and posterior spinal fusion (PSF), were analyzed. According to the final follow-up image, the patients were classified into balanced (BG) and imbalanced (IG) groups, with IG further stratified into proximal junctional kyphosis/failure (IG-PJK/PJF) and non-PJK/PJF (IG-NPJK/PJF). Radiographic and clinical data were collected preoperatively, postoperatively, and at 2-year follow-up. Results: The IG exhibited greater RCs in thoracic kyphosis (TK) and PI-LL mismatch from postoperative to follow-up than the BG ( P = .030, P = .008). Significant predictors included Age >65.5 y/o (AUC: .672) and Post-PT >17.5° (AUC: .852) for imbalance and Post-TK >34.5° (AUC: .755) for IG-PJK/PJF. IG-PJK/PJF showed poorer ODI scores than BG and IG-NPJK/PJF ( P = .021 and P = .022, respectively). IG-PJK/PJF showed poorer total SRS-22 scores than IG-NPJK/PJF ( P = .021). Conclusion: Increased RCs in TK was associated with adverse outcomes. Extending the upper instrumented vertebra (UIV) to the upper thoracic spine and addressing excessive TK (>34.5°) may improve alignment and reduce complications. Radiographic thresholds can provide actionable guidance in surgical planning.