Background: This study aimed to construct a risk prediction model to estimate the odds of osteoporosis (OP) in elderly patients with type 2 diabetes mellitus (T2DM) and evaluate its prediction efficiency. Methods: This study included 21,070 elderly patients with T2DM who were hospitalized at six tertiary hospitals in Southwest China between 2012 and 2022. Univariate logistic regression analysis was used to screen for potential influencing factors of OP and least absolute shrinkage. Further, selection operator regression (LASSO) and multivariate logistic regression analyses were performed to select variables for developing a novel predictive model. The area under the receiver operating characteristic curve (AUROC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) were used to evaluate the performance and clinical utility of the model. Results: The incidence of OP in elderly patients with T2DM was 7.01% (1,476/21,070). Age, sex, hypertension, coronary heart disease, cerebral infarction, hyperlipidemia, and surgical history were the influencing factors. The seven-variable model displayed an AUROC of 0.713 (95% confidence interval [CI]:0.697–0.730) in the training set, 0.716 (95% CI: 0.691–0.740) in the internal validation set, and 0.694 (95% CI: 0.653–0.735) in the external validation set. The optimal decision probability cut-off value was 0.075. The calibration curve (bootstrap = 1,000) showed good calibration. In addition, the DCA and CIC demonstrated good clinical practicality. An operating interface on a webpage (https://juntaotan.shinyapps.io/osteoporosis/) was developed to provide convenient access for users. Conclusions: This study constructed a highly accurate model to predict OP in elderly patients with T2DM. This model incorporates demographic characteristics and clinical risk factors and may be easily used to facilitate individualized prediction.

In this study, we aimed to compare the outcomes of the two-stage induced membrane technique (IMT) and one-stage autografting in the treatment of aseptic atrophic nonunion in lower limb long bones. From January 2014 to January 2022, we reviewed all surgically treated long bone nonunion patients, including patients aged 18 years or older with atrophic nonunion, who were either treated with the two-stage induced membrane technique (IMT) or one-stage autografting. Outcome parameters interns of clinical, quality of life and healthcare burden were recorded and retrospectively analysed between the two treatment populations. The follow-up time was at least 1 year. In total, 103 patients who met the criteria for aseptic atrophic nonunion were enrolled. Among them, 41 (39.8%) patients were treated with two-stage IMT, and 62 (60.2%) patients were treated with one-stage autologous bone grafting. The follow-up time was 12 to 68 months, with an average of 28.4 months. The bone healing rate was comparable in both groups (IMT: 92.7% vs. one-stage grafting: 91.9%, P = 0.089) at 12 months post-operation, and the bone healing Lane–Sandhu score was superior in the IMT group (mean: 8.68 vs. 7.81, P = 0.002). Meanwhile, the SF-12 scores of subjective physical component score (PCS) (mean: 21.36 vs. 49.64, P < 0.01) and mental health component score (MCS) (mean: 24.85 vs. 46.14, P < 0.01) significantly increased in the IMT group, as well as in the one-stage grafting group, and no statistically significant difference was found within groups. However, the total hospital stays (median: 8 days vs. 14 days, P < 0.01) and direct medical healthcare costs (median: ¥30,432 vs. ¥56,327, P < 0.05) were greater in the IMT group, while the complications (nonunion 8, infection 3, material failure 2, and donor site pain 6) were not significantly different between the two groups (17.1% vs. 19.4, P = 0.770). The data indicate that two-stage method of IMT serves as an alternative method in treating atrophic nonunion; however, it may not be a preferred option, in comprehensive considering patient clinical outcomes and healthcare burden. More evidence-based research is needed to further guide clinical decision-making.

Purpose: The treatment of primary traumatic anterior shoulder dislocation varies widely. However, recent basic science and clinical data do not unify the specific immobilization methods. We aimed to compare the effectiveness of immobilization in internal rotation, external rotation and external rotation combined abduction after primary anterior dislocation of the shoulder. Methods: A total of 165 patients (80 males and 85 females, average age, 61 years, range 18–73 years) with the diagnosis of acute primary traumatic anterior shoulder dislocation were immobilized at in internal rotation (IR, n = 62), external rotation (ER, n = 53), external rotation combined abduction (ERAb, n = 50) after manipulative reduction. The mean follow-up period was 23.85 months (range 16–28 months). Patients received rehabilitation program immediately after immobilization. We assessed functionality by constant-Murley score (CMS), American Shoulder and Elbow Surgeons Scale (ASES) and stability by Western Ontario Shoulder Instability Index (WOSI) in week 6, months 3, 6, 12, and 24 . Otherwise, the measured humeral upward distance (HUD) and humeral forward distance (HFD) on Computed Tomography (CT) of the shoulder were determined in day 1 and sixth weeks after immobilization. Results: for HUD and HFD, there were statistically significant differences between shoulder joint immobilization at 1 day and 6 weeks within each group ( P < 0.001), and there were all significantly bigger than in the contralateral side on the day 1 of immobilization ( P < 0.001), but after 6 weeks of shoulder joint immobilization, although slight differences existed between the affected and non-affected side in each group, none of these varieties reached significance ( P > 0.05). Intragroup comparisons of the constant-Murley score (CMS), American Shoulder and Elbow Surgeons Scale (ASES) and Western Ontario Shoulder Instability Index (WOSI) in the different time periods revealed significant differences ( P < 0.001). Furthermore, upon release of immobilization at the 6-week postoperative interval, the ERAb group demonstrated superior early phase mobility and functional recovery compared to the other two cohorts. However, longitudinal evaluation revealed no statistically significant differences in functional outcomes among the groups after the 3-month follow-up assessment. Conclusions: Internal rotation, external rotation, and external rotation combined abduction immobilization are effective methods for reducing postoperative complications of acute anterior shoulder dislocation and we recommend the external rotation combined abduction immobilization approach to promote early recovery of shoulder function.