Clustering of morphological fracture lines for identifying intertrochanteric fracture classification with Hausdorff distance–based K-means approach

Li, Jiantao; Tang, Shaojie; Zhang, Hao; Li, Zhirui; Deng, Wei; Zhao, Chen; Fan, Lianghui; Wang, Guoqi; Liu, Jianheng; Yin, Peng; Xu, Gaoxiang; Zhang, Licheng; Tang, Peifu

doi:10.1016/j.injury.2019.03.032

Cited by 32 publications

(18 citation statements)

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“…To evaluate the 3D distance between the acromion and the humeral head, the STL data for the glenoid and coracoid parts of the scapula surface models were removed using Meshlab software (version 1.3.3; ISTI, Pisa, Italy). The minimum distance of these two bone surface models was automatically computed as the Hausdorff distance using the Meshlab software [ 14 – 16 ]. This distance indicates that any point in the acromion surface model can be reached at any point in the humeral head surface model by advancing at least the distance.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of three-dimensional acromiohumeral distance in the standing position and comparison with its conventional measuring methods

et al. 2020

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Background Narrowing of the acromiohumeral distance (AHD) implies a rotator cuff tear. However, conventional AHD measurements using two-dimensional (2D) imaging or with the patient in the supine position might differ from that while standing during daily activity. This study aimed to evaluate the three-dimensional (3D) actual distance between the acromion and humeral head in the standing position and compare the AHD values with those obtained using conventional measuring methods. Methods Computed tomography (CT) images of 166 shoulders from 83 healthy volunteers (31 male and 52 female; mean age 40.1 ± 5.8 years; age range, 30–49 years) were prospectively acquired in the supine and standing positions using conventional and upright CT scanners, respectively. The minimum distance between the acromion and humeral head on the 3D surface models was considered as the 3D AHD. We measured the 2D AHD on anteroposterior digitally reconstructed radiographs. The AHD values were compared between the supine and standing positions and between the 2D and 3D measurements. Results The mean values of 2D AHD were 8.8 ± 1.3 mm (range, 5.9–15.4 mm) in the standing position and 8.1 ± 1.2 mm (range, 5.3–14.3 mm) in the supine position. The mean values of 3D AHD were 7.3 ± 1.4 mm (range, 4.7–14.0 mm) in the standing position and 6.6 ± 1.2 mm (range, 4.4–13.7 mm) in the supine position. The values of 3D AHD were significantly lower than those of 2D AHDs in both the standing and supine positions (P < 0.001). The values of 2D and 3D AHDs were significantly lower in the supine position than in the standing position (P < 0.001). Conclusions This study evaluated the 3D AHD of normal shoulders in the standing position using an upright CT scanner. The present results indicated that assessments in the supine position can underestimate the value of the AHD compared with those made in the standing position and that assessments using 2D analysis can overestimate the value.

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Section: Methodsmentioning

confidence: 99%

Evaluation of three-dimensional acromiohumeral distance in the standing position and comparison with its conventional measuring methods

et al. 2020

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“…Otherwise, the fracture will result in loss of reduction, secondary stabilization may result in implant support (Fig 3). According to our team's early research in recent years 30 , most of the anterior cortex of intertrochanteric fracture is simple fracture, so the anterior medial cortex needs to provide stable support. In patients with intertrochanteric fractures, osteoporosis is severe, and the strength of the anterior medial cortex is limited.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for mechanical failure of proximal femoral nail anti-rotation (PFNA–II) in the treatment of intertrochanteric fractures (AO/OTA 31-A1, A2)

Nie¹,

Jiang²,

Li³

et al. 2020

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Background: Intertrochanteric fracture is associated with severe morbidity and mortality. The results of postoperative implant failure are catastrophic. The aim of this study was to determine risk factors for implant failure in intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA–II) through the assessment of early therapeutic effects.Methods: A single-center retrospective study was conducted on a continuous series of 123 intertrochanteric fracture patients treated with PFNA-II between Dec 2018 and Oct 2019. Perioperative medical and imaging data were collected. The patients were divided into two groups according to whether implant failure of not. The differences in reduction quality, nail length and tip apex distance (TAD) were analyzed to determine the risk factors of implant failure.Results: A total of 80 patients were enrolled, with an average age of 80.2 years old. There were 6 patients with implant failure. There was no significant difference in demographic index between the two groups. The reduction quality of failure group was good, accept and poor with each 2 patients, and that of the non-failure group was 35, 35 and 4 patients respectively. The difference of reduction quality between the two groups was statistically significant. The risk of postoperative implant failure in patients with poor reduction quality was 8.75 times that of patients with good and acceptable reduction from the Logistic regression analysis（OR=8.75，95%CI 1.215-62.99）. The differences in nail length, ASA and bone quality were not statistically significant. Conclusion: Reduction quality is a risk factor of implant failure in intertrochanteric fractures treated with PFNA-II. Even if the medial femoral cortex is anatomically reduced, there will be a triangular void area between the nail and the medial femur, which are prone to coxa vara and implant failure. Therefore, good reduction is the key to treat intertrochanteric fracture.

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“…In 2017, Etsuo Shoda et al proposed the classi cation of intertrochanteric fractures by 3-D-CT 19 . In 2019, Jiantao Li et al further classi ed femoral fractures into ve classi cations using the Hausdorff distance-based K-means approach 12 . However, we believe that a comprehensive fracture classi cation should not only accurately diagnose fractures, guide treatment, and predict the prognosis of fractures, but also be reproducible and simple for use by clinicians across the scope of practice.…”

Section: Discussionmentioning

confidence: 99%

Morphological Analysis of Posterior-Medial Intertrochanteric Fracture Patterns Using Fracture-Mapping Technique

Ren

et al. 2020

Preprint

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Background: The purpose of this study was to analyze the fracture patterns of different posterior-medial wall types of intertrochanteric fractures by 3-D fracture-mapping technique and to further assess their clinical utility.Methods: In a retrospective analysis of interochanteric fractures treated in a large trauma center, fractures were classified into predesigned groups based on 3D-CT imaging techniques, and a 3-D template of the intertrochanteric region was graphically superimposed on the fracture line. Fracture characteristics were then summarized based on fracture-mapping. Finally, radiographic parameters, function, and range of motion were recorded in different fracture classification states.Results: A total of 348 intertrochanteric fractures were included. There were 111 patients (31.9%) in the posterolateral + posteromedial + medial group, with the most severe fracture displacement (typically characterized by fragmentation of the posteromedial wall into three isolated fragments). There were 102 cases (29.3%) in the posterolateral + posteromedial + simple medial group, and the most common fracture feature was a complete fragment posteromedially. A total of 81 cases (23.3%) were classified into the posterolateral + medial group, with the medial fracture line extending the anterior fracture line but leaving the lesser trochanter intact. In the isolated medial group of 33 cases (9.5%), the fracture type was similar to type IV, but the integrity of the greater trochanter was ensured. In the posteromedial + medial group of 12 cases (3.4%), the fracture was characterized by an interruption when the fracture line of the anterolateral wall extended to the posteromedial wall, often resulting in a complete isolated fragment posteromedially and medially. There were 9 patients (2.6%) in the isolated posterolateral group. In addition, we found significantly different radiographic scores and range of motion scores between groups.Conclusions: This morphometric study helps us to further characterize posterior-medial fracture patterns of intertrochanteric fractures, which may be closely related to different clinical outcomes. Further studies are needed to verify the reliability of this classification scheme in clinical application.Study Design: Crossover Study Design; Level of evidence, 3.

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Clustering of morphological fracture lines for identifying intertrochanteric fracture classification with Hausdorff distance–based K-means approach

Cited by 32 publications

References 24 publications

Evaluation of three-dimensional acromiohumeral distance in the standing position and comparison with its conventional measuring methods

Evaluation of three-dimensional acromiohumeral distance in the standing position and comparison with its conventional measuring methods

Risk factors for mechanical failure of proximal femoral nail anti-rotation (PFNA–II) in the treatment of intertrochanteric fractures (AO/OTA 31-A1, A2)

Morphological Analysis of Posterior-Medial Intertrochanteric Fracture Patterns Using Fracture-Mapping Technique

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