Metatarsal Fracture Leading to Massive Pulmonary Embolism

A Machine Learning Framework for Assessing the Risk of Venous Thromboembolism in Patients Undergoing Hip or Knee Replacement

Venous thromboembolism (VTE) is a well-recognized complication that is prevalent in patients undergoing major orthopedic surgery (e.g., total hip arthroplasty and total knee arthroplasty). For years, to identify patients at high risk of developing VTE, physicians have relied on traditional risk scoring systems, which are too simplistic to capture the risk level accurately. In this paper, we propose a data-driven machine learning framework to identify such high-risk patients before they undergo a major hip or knee surgery. Using electronic health records of more than 392,000 patients who undergone a major orthopedic surgery, and following a guided feature selection using the genetic algorithm, we trained a fully connected deep neural network model to predict high-risk patients for developing VTE. We identified several risk factors for VTE that were not previously recognized. The best FCDNN model trained using the selected features yielded an area under the ROC curve (AUC) of 0.873, which was remarkably higher than the best AUC obtained by including only risk factors previously known in the medical literature. Our findings suggest several interesting and important insights. The traditional risk scoring tables that are being widely used by physicians to identify high-risk patients are not considering a comprehensive set of risk factors, nor are they as powerful as cutting-edge machine learning methods in distinguishing low- from high-risk patients.

Early Active Rehabilitation Treatment for a Patient with a Stable Type of Fifth Metatarsal Base Fracture: a Case Report

In China, the stable type of fifth metatarsal base fracture is usually treated by rehabilitation methods after the limbs have been fixed for approximately 4 weeks. A 37-year-old woman fractured her fifth metatarsal base, with a stable fracture type. From the second day of the fracture onward, she agreed to participate in rehabilitative treatment that did not involve surgery or long-term fixation. Fourteen days after the fracture, the patient was able to bear 100% of her body weight and stand for 20 min in a normal posture with supportive elbow crutches. She was able to return to work with double elbow crutches after 25 days. On the 30^th day after the fracture, the patient was able to walk 300 m outdoors without any walking aids and with no discomfort. Two months after the fracture, the patient went jogging and was participating in all of her normal daily activities. This case shows that, for stable type fractures of the fifth metatarsal base, rehabilitation starting on the second day after the fracture can help accelerate the patient’s return to normal physical activities.