Background: The number of patients with fragility fracture has been increasing. Although the increasing number of patients with fragility fracture increased the rate of fracture (refracture), the causes of refracture are multifactorial, and its predictors are still not clarified. In this issue, we collected a registry-based longitudinal dataset that contained more than 7000 patients with fragility fractures treated surgically to detect potential predictors for clinical refracture. Methods: Based on the fact that machine learning algorithms are often used for the analysis of a large-scale dataset, we developed automatic prediction models and clarified the relevant features for patients with clinical refracture. Formats of input data containing perioperative clinical information were table data. Clinical refracture was documented as the primary outcome if the diagnosis of fracture was made at postoperative outpatient care. A decision-tree-based model, LightGBM, had moderate accuracy for the prediction in the test and the independent dataset, whereas the other models had poor accuracy or worse. Results: From a clinical perspective, rheumatoid arthritis (RA) and chronic kidney disease (CKD) were noted as the relevant features for patients with clinical refracture, both of which were associated with secondary osteoporosis. Conclusion: The decision-tree-based algorithm showed the precise prediction of clinical refracture, in which RA and CKD were detected as the potential predictors. Understanding these predictors may improve the management of patients with fragility fractures.

Background: Developmental dysplasia of the hip (DDH) is a prevalent issue in infants, with ultrasound crucial for early detection. Existing automatic diagnostic models lack precision due to noise, but 3D technology may enhance it. This study aimed to create and assess a deep-learning-based model for automated DDH diagnosis by using 3D transformation technology on two-dimensional ultrasound images. Methods: A retrospective study of 417 infants at risk of DDH used ultrasound images, combining convolutional neural networks and image processing. The images were analyzed using algorithms such as HigherHRNet-W48. The approach included apex point estimation, signal heterogeneity analysis of ilium, which focused on the bony area with high intensity and evaluate ilium rotation, alpha angle creation, and the establishment of a comprehensive method for DDH diagnosis. Results: Key findings include: (1) Superior accuracy in apex point estimation by the HigherHRNet-W48 model, even better than orthopedic residents. (2) Thorough quality assessments of ultrasound images, leading to qualified and disqualified categories, with qualified images displaying notably lower error rates. (3) The AUC of the model for DDH detection in the qualifying images was 0.92, exceeding the diagnostic accuracy of the resident, indicating the diagnostic capability of the tool. Conclusions: The study developed a deep-learning-based model for DDH detection in infants, melding 3D technology with deep learning to address challenges like noise and rotation in ultrasound images. The study’s innovation demonstrated a comparative accuracy to specialized evaluations, even with non-specialist images, highlighting its potential to assist novice sonographers and enhance diagnostic precision.

Case: Coronal shear fractures of the hamate are relatively rare injuries. Surgical intervention is recommended for displaced fractures. However, there is no established surgical procedure for the displaced coronal shear fractures of the hamate. Therefore, we present 2 cases of the displaced coronal hamate fracture with metacarpal dislocations, which were successfully managed with open reduction and internal fixation, using the headless compression screw by the 2-directional approach. Conclusion: Our procedure ensured that the screw's distal end captured the hamate hook, and the displaced bone fragments were reduced considerably in both cases.

The incidence of bilateral corticosteroid-induced osteonecrosis of the femoral head (ONFH) is high. Although the precise mechanism of corticosteroid-induced ONFH development is unclear, hepatic enzyme abnormalities such as low activity of hepatic cytochrome P450 3A could be one cause. Herein, we report the case of a patient who developed ONFH in the contralateral hip after the dose of corticosteroids for idiopathic thrombocytopenic purpura was increased. Liver biopsy was done to rule out autoimmune hepatitis. A 32-year-old woman had been treated with continuous corticosteroids of up to 10 mg/day for Sjögren’s syndrome for 25 years and corticosteroid-induced ONFH in the left side. At age 33, idiopathic thrombocytopenia developed, which was treated by increasing the corticosteroid dose (40 mg/day). Two months later, liver enzyme level began to increase slightly and continued to increase. A year after corticosteroid dose increase, contralateral ONFH developed, and a liver biopsy demonstrated nonalcoholic fatty liver disease (NAFLD). The current case indicates that corticosteroid dose increase is a potential risk factor for NAFLD and contralateral ONFH. Therefore, it would be useful and important for to screen and monitor patients with hepatic enzyme abnormality for ONFH occurrence.

Prophylactic intervention for impending pathological fractures (IF) is associated with improved survival in patients with long-bone metastasis. However, information regarding whether the tumor burden and/or physical status are associated with survival benefits of intervention for IF is lacking. This multicenter retrospective study investigated 121 patients who underwent surgery for 63 impending and 58 complete metastatic fractures of the proximal femur between 2008 and 2023. After matching for age, sex, body mass index, and Katagiri-New score, 42 patients with IF were compared with 42 patients with complete pathological fractures. The 1-year mortality rate was considered the primary outcome, and was compared and stratified by risk based on the Katagiri-New score. The 1-year mortality rate was evaluated according to the surgical method in the subgroup analysis of patients with IF. The 1-year mortality rate was significantly lower in patients with IF with intermediate-to-high risk(p = 0.04), whereas no difference was observed in patients with low-to-high risk. IF was associated with a significantly higher rate of home discharge (p < 0.01) and improved post-operative ambulatory function (p = 0.07). The subgroup analysis of patients with IF revealed no difference in the survival rate between nailing and hemiarthroplasty. Patients with intermediate-to-high risk IF based on the Katagiri-New score had a lower mortality rate than those who underwent surgery for pathological fractures. A higher rate of home discharge was observed in patients with IF. Based on the Katagiri-New score, survival benefits can be obtained from prophylactic intervention for IF of the proximal femur in patients with intermediate-to high-risk.

Fracture surgery for metastatic femur is frequently performed in older adults. In contrast to impending fracture (IF), complete pathological fracture (CF) renders patients bedridden during the preoperative period, which might affect the postoperative recovery of ambulation. Thus, we aimed to investigate the clinical significance of the recovery in older adults after fracture surgery for femoral metastasis, and predictors for recovery after CF. This multicenter retrospective study enrolled 146 adults aged ≥55 years undergoing surgery. A total of 78.1% (114/146) patients showed recovery; no association was observed between the presence of postoperative weight-bearing restriction and recovery (p = 0.50). The rate of chemotherapeutic intervention was higher in patients who had recovered compared to the others (52/114 vs. 8/32, p = 0.03). Non-recovery of ambulation was an independent poor prognostic factor for one-year suvival (hazard ratio, 1.85; 95% confidence interval, 1.06–3.22; p < 0.01). Subgroup analyses showed shorter preoperative waiting periods in the recovered patients than in the others (5.6 ± 0.6 vs. 7.9 ± 1.1; p = 0.03) among CF cases. Recovery of ambulation was a prognostic factor and was associated with postoperative chemotherapy. Shorter preoperative waiting time was associated with the recovery in patients with CF. Prompt surgical intervention should be considered when older adults develop CF due to femoral metastasis.