A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures

Aims The aim of this study was to investigate the outcomes of Vancouver type B2 and B3 fractures by performing a systematic review of the methods of surgical treatment which have been reported. Materials and Methods A systematic search was performed in Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. For inclusion, studies required a minimum of ten patients with a Vancouver type B2 and/or ten patients with a Vancouver type B3 fracture, a minimum mean follow-up of two years and outcomes which were matched to the type of fracture. Studies were also required to report the rate of re-operation as an outcome measure. The protocol was registered in the PROSPERO database. Results A total of 22 studies were included based on the eligibility criteria, including 343 B2 fractures and 167 B3 fractures. The mean follow-up ranged from 32 months to 74 months. Of 343 Vancouver B2 fractures, the treatment in 298 (86.8%) involved revision arthroplasty and 45 (12.6%) were treated with internal fixation alone. A total of 37 patients (12.4%) treated with revision arthroplasty and six (13.3%) treated by internal fixation only underwent further re-operation. Of 167 Vancouver B3 fractures, the treatment in 160 (95.8%) involved revision arthroplasty and eight (4.8%) were treated with internal fixation without revision. A total of 23 patients (14.4%) treated with revision arthroplasty and two (28.6%) treated only with internal fixation required re-operation. Conclusion A significant proportion, particularly of B2 fractures, were treated without revision of the stem. These were associated with a higher rate of re-operation. The treatment of B3 fractures without revision of the stem resulted in a high rate of re-operation. This demonstrates the importance of careful evaluation and accurate characterisation of the fracture at the time of presentation to ensure the correct management. There is a need for improvement in the reporting of data in case series recording the outcome of the surgical treatment of periprosthetic fractures. We have suggested a minimum dataset to improve the quality of data in studies dealing with these fractures

Recurrence Rates Following External Valvular Stenting of the Saphenofemoral Junction: A Comparison with Simultaneous Contralateral Stripping of the Great Saphenous Vein

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A Subsonic Aircraft Design Optimization With Neural Network and Regression Approximators

The Flight-Optimization-System (FLOPS) code encountered difficulty in analyzing a subsonic aircraft. The limitation made the design optimization problematic. The deficiencies have been alleviated through use of neural network and regression approximations. The insight gained from using the approximators is discussed in this paper. The FLOPS code is reviewed. Analysis models are developed and validated for each approximator. The regression method appears to hug the data points, while the neural network approximation follows a mean path. For an analysis cycle, the approximate model required milliseconds of central processing unit (CPU) time versus seconds by the FLOPS code. Performance of the approximators was satisfactory for aircraft analysis. A design optimization capability has been created by coupling the derived analyzers to the optimization test bed CometBoards. The approximators were efficient reanalysis tools in the aircraft design optimization. Instability encountered in the FLOPS analyzer was eliminated. The convergence characteristics were improved for the design optimization. The CPU time required to calculate the optimum solution, measured in hours with the FLOPS code was reduced to minutes with the neural network approximation and to seconds with the regression method. Generation of the approximators required the manipulation of a very large quantity of data. Design sensitivity with respect to the bounds of aircraft constraints is easily generated