Recent studies showed that preoperative deep vein thrombosis (DVT) was common after hip fracture (HF), and preoperative DVT screening has been recommended for preventing the fatal DVT-related complications, especially in elderly HF patients with high surgical risk. However, to our knowledge, no previous studies have demonstrated the correlation between the clinical risk predictors and preoperative DVT. Therefore, this study aimed to correlate those clinical predictors related to DVT risk assessment with the incidence of preoperative DVT. A prospective study was conducted, between July 2015 and June 2016, in 92 HF patients. All patients were evaluated for the DVT-related risk, as patients’ characteristics, clinical signs, D-dimer, DVT risk assessment score (Wells score and Caprini score), and then underwent doppler ultrasonography preoperatively. The incidence of preoperative DVT was correlated with each clinical risk predictor, and then significant factors were calculated for diagnostic accuracy. The average patients’ age was 78 ± 10 years. Sixty-eight patients (74%) were female. The incidence of preoperative DVT was 16.3% (n = 15). The median time from injury to doppler ultrasonography was 2 days (range 0–150 days). DVT group showed a significantly higher in Wells score and Caprini score compared to the non-DVT group (p < 0.05 all). Sensitivity and specificity of Wells score ≥ 2 and Caprini score ≥12 were 47 and 81, and 93 and 35%, respectively. DVT risk assessment may be helpful for stratifying the risk of preoperative DVT in elderly HFs. Those with Caprini score ≥ 12 should be screened with doppler ultrasonography preoperatively. Those with Wells score 0–1 had low risk for preoperative DVT, so the surgery could perform without delay.

Objective . This study aimed to assess infrared thermography (IRT) and ultrasonography (US) for detecting wrist arthritis in juvenile idiopathic arthritis (JIA) patients. Although IRT could help us in detecting joint inflammation, IRT studies in JIA patients with wrist arthritis are still limited. Currently, no validated US criteria exist for detecting arthritis, and the most useful parameters between gray-scale ultrasound (GSUS) or power Doppler ultrasound (PDUS) remain unclear. Approach . Forty-six JIA patients were included in this study. Detecting wrist arthritis at varying degrees using IRT and US were compared with physical examination. Main results . Sixteen patients had previous wrist arthritis that is currently inactive and 30 still had wrist arthritis. The median ages (IQR) were 7.7 (4.3) and 10.2 (4.8) years, respectively. Fifteen healthy participants were included, with a median age (IQR) of 9.2 (2.0) years. Using IRT, mean temperature ( T _mean ) and maximum temperature ( T _max ) at skin surface in the region of interest (ROI) in the arthritis group were higher than in the inactive group and the healthy controls with p < 0.05. When patients with arthritis were subgroup analyzed by disease severity based on physical examination, the moderate to severe arthritis had T _mean and T _max higher than the mild arthritis group with statistical significance. The heat distribution index (HDI), two standard deviations of all pixel temperature values in the ROI, in the moderate to severe arthritis group was higher than in the healthy controls ( p = 0.027). The receiver operating characteristic analysis in arthritis detection revealed diagnostic sensitivity of 85.7% and 71.4% and specificity of 80.0% and 93.3% at cut-off points of T _mean ⩾ 31.0 °C and T _max ⩾ 32.3 °C, respectively. For US, GSUS and PDUS are useful in detecting arthritis, providing high sensitivity (83.3%) and specificity (81.3%). Significance . Our study demonstrated that both IRT and US were applicable tools for detecting wrist arthritis.

Many radiographic parameters associated with the extrinsic cause of supraspinatus tears have been proposed. The aim of this study was to assess the relationship between a full-thickness degenerative supraspinatus tear (FTDST) and the patient’s radiographic parameters, including the acromiohumeral centre edge angle (ACEA) and the greater tuberosity angle (GTA). A retrospective study was conducted. We included 116 patients who underwent shoulder arthroscopic surgery at our institute. The case group included FTDST patients, whereas the control group also included patients without evidence of supraspinatus tears. In each patient, the ACEA and GTA values were measured and analyzed by two independent observers. Intra- and interobserver reliabilities were assessed. Multivariate regression analysis was performed. The ACEA values were significantly increased in the FTDST group with a mean of 26.44° ± 9.83° compared with 16.81° ± 7.72° in the control group (P < 0.001). Multivariate regression analysis also showed that higher ACEA values were associated with an FTDST (odds ratio 1.16 per degree, P = 0.01). For GTA values, a statistically significant difference was found with a mean of 70.92° ± 6.64 compared with 67.84° ± 5.56 in the control group (P = 0.02). However, stepwise regression analysis did not indicate that GTA was a predictor of FTDST. Our study demonstrated that the presence of increased ACEA values is an independent significant risk factor for the presence of FTDSTs. Consequently, GTA values may be less helpful in assessing the risk of FTDST, especially in this specific population.

Bone Mineral Density and Trabecular Bone Score in Predicting Vertebral Fractures in Male Employees of the Electricity Generating Authority of Thailand: Purpose. Osteoporotic VF is frequently asymptomatic and affects not only women but also men. Identifying patients at risk is essential for early management and prevention. BMD and the TBS are measurements of bone strength and trabecular microarchitecture, respectively. Their role in VF prediction in men is less well-studied. We determined the BMD and TBS predictive ability for osteoporotic VF in men. Methods. A total of 115 male participants of the Electricity Generating Authority of Thailand (EGAT) cohorts without a history of VF who completed the baseline BMD and TBS measurements in 2012 and a thoracolumbar spine radiograph in 2017 were recruited. The VF was assessed using the Genant semiquantitative method. Logistic regression analysis was performed to identify factors associated with the fracture. The area under the receiving operator curve (AUC) was analyzed to define VF predictive ability. Results. Forty subjects (34.78) had VFs. The unadjusted relative risks (95 confidence interval) for VF for one standard deviation decrease in the TBS and low TBS were 1.319 (1.1571.506) and 2.347 (1.4963.682), respectively, and remained significant after BMD and age adjustment. For VF prediction, combined models had a greater AUC than models predicted from a single variable. The use of low TBS, femoral neck BMD, and age provided the best AUC (0.693). Conclusion. BMD and the TBS could predict osteoporotic VF in male EGAT employees. The use of both BMD and the TBS in the VF prediction process improved predictive ability.

Intra-articular corticosteroids are widely used for adhesive capsulitis, but alternatives are needed for patients with contraindications. Hyaluronic acid (HA) and ketorolac have demonstrated individual benefits; however, evidence regarding their combined use remains limited. This study aimed to evaluate and compare the clinical outcomes of intra-articular injection of combined moderate -molecular-weight HA and ketorolac versus ketorolac alone in patients with adhesive capsulitis, focusing on shoulder function, pain reduction, and improvement in range of motion (ROM). We hypothesized that the HA + ketorolac combination would provide superior improvement in function, pain, and ROM compared with ketorolac alone. In this randomized, double-blind controlled trial, 56 patients were allocated to HA + ketorolac (n = 28) or ketorolac alone (n = 28). Each received a single intra-articular injection followed by standardized rehabilitation. Outcomes included the Thai Shoulder Pain and Disability Index (Thai SPADI), visual analog scale (VAS), passive ROM, and analgesic use, assessed at baseline and at 2, 6, 12, and 24 weeks. Both groups improved significantly in SPADI and VAS over time, with no between-group differences at any visit (24-week SPADI: 9.8 ± 12.5 vs 12.1 ± 17.8; P = .932; VAS: 0.8 ± 1.1 vs 1.4 ± 2.2; P = .501). The HA + ketorolac group demonstrated greater recovery in specific ROM planes, including significantly better external rotation at 24 weeks (mean difference 9°, 95% confidence interval [CI] 0 -18; P = .039) and greater improvement in adduction at both 2 weeks (mean difference 5°, 95% CI 0 -10; P = .039) and 24 weeks (mean difference 8°, 95% CI 2 -14; P = .012). Analgesic consumption was comparable between groups, and no serious adverse events were reported. Both HA + ketorolac and ketorolac alone significantly improved pain and function in adhesive capsulitis. Combination therapy provided small but statistically significant advantages in recovery of external rotation and adduction. Both treatments represent reasonable options, particularly for patients in whom corticosteroids are contraindicated.

Background: The submandibular gland is quite common to be affected by various disease processes in all age groups that may be difficult to differentiate clinically. Its superficial location makes it readily accessible to ultrasound evaluation. Objective: To evaluate sonographic features of abnormal submandibular gland. Methods: Ultrasound images and medical records of patients who presented with clinically suspected submandibular gland disease at a single institution were retrospectively reviewed. Demographic data, final diagnoses, further management, and sonographic findings were evaluated. Results: Eighty-one patients were identified, 56 females and 25 males (mean [SD] age, 53 [16] years; range, 1 - 87 years). The main presenting symptoms were palpable mass (31 [38.3%]) and pain (23 [28.4%]) involving the left (30 [37.0%]), the right (27 [33.3%]), and bilateral submandibular area (24 [29.6%]). Only 6 patients (8.1%) underwent further imaging. The most common final diagnoses were acute sialadenitis (38 [46.9%]), Sjögren syndrome (14 [17.3%]), tumor (6 [7.4%]), and stone (4 [4.9%]). Submandibular glands were normal in 17 of 81 patients (21%); 9 of 17 (52.9%) had abnormal lymph nodes. Among various disease entities, a significant correlation was found between Sjögren syndrome and small gland size, stone and ductal dilatation, and abnormal lymph nodes with enlarged nodal size (P < .001). Conclusions: Two-thirds of the patients had inflammatory/infectious diseases, with tumor and stone in minority. Certain ultrasound findings can suggest diagnosis. Less than 10% underwent further imaging, suggesting that ultrasound can be used to detect and guide further management of submandibular disease.