This study aimed to assess the outcomes of patients with complex rib fractures undergoing operative or non-operative management at our center over a six-year time period. Retrospective analysis was performed to identify all patients with complex rib fractures at our center from May 2016 to September 2022. Outcome measures included mechanical ventilation, tracheostomy, pneumonia, and mortality at one year. 388 patients with complex rib fractures were identified. 37 (10%) patients fulfilled criteria for surgical management and underwent rib fracture fixation; 351 patients were managed non-operatively with anaesthetic block or analgesia alone. The fixation group had a significantly higher proportion of patients with flail chest (30 (81%) vs 94 (27%), p<0.001) and were significantly more likely to require ICU admission (30 (81%) vs. 16 (5%), p<0.001) than the non-operative group. At one year follow-up, no significant differences were seen for mortality between these groups (1 (3%) vs. 27 (7%), p=0.276). Of the surgical management group, those that underwent fixation <72 hours post injury were significantly less likely to develop pneumonia than those who were delayed >72 hours (2 (18%) vs 15 (58%), p=0.038), with downward trends noted for ICU length of stay (6 vs 10 days, p=0.140) and duration of mechanical ventilation (5 vs 8 days, p=0.177); no significant differences were seen for tracheostomy (3 vs. 5, p=0.588) or mortality (0 vs 1, p=0.856). Surgical fixation of complex rib fractures improves outcomes in selected patient groups. Early surgical fixation led to reduced rates of pneumonia and may improve other outcome measures.
Osteoarthritis continues to be a major cause of pain and disability. The pathological processes leading to the end-stage of joint degeneration remain poorly understood. Advances in radiological imaging have the potential to improve understanding of the structural and functional changes observed in OA. The aim of this study was to describe the microarchitecture of the femoral head in osteoarthritis. Twenty osteoarthritic femoral heads underwent micro-computed tomography scanning at 30µm. Four parameters of micro-architecture and structure were determined: bone volume ratio (BV:TV), trabecular thickness, structural model index and degree of anisotropy. The femoral head was divided into 27 cubic volumes of interest. Analysis of variance (ANOVA) was used to assess differences between regions. Cystic and sclerotic changes were assessed qualitatively.Introduction
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