Aims. The aim of this study to compare 30-day survival and recovery of mobility between patients mobilized early (on the day of, or day after surgery for a hip fracture) and patients mobilized late (two days or more after surgery), and to determine whether the presence of dementia influences the association between the timing of mobilization, 30-day survival, and recovery. Methods. Analysis of the National Hip Fracture Database and hospital records for 126,897 patients aged ≥ 60 years who underwent surgery for a hip fracture in England and Wales between 2014 and 2016. Using logistic regression, we adjusted for covariates with a propensity score to estimate the association between the timing of mobilization, survival, and recovery of walking ability. Results. A total of 99,667 patients (79%) mobilized early. Among those mobilized early compared to those mobilized late, the weighted odds ratio of survival was 1.92 (95% confidence interval (CI) 1.80 to 2.05), of recovering outdoor ambulation was 1.25 (95% CI 1.03 to 1.51), and of recovering indoor ambulation was 1.53 (95% CI 1.32 to 1.78) by 30 days. The weighted probabilities of survival at 30 days post-admission were 95.9% (95% CI 95.7% to 96.0%) for those who mobilized early and 92.4% (95% CI 92.0% to 92.8%) for those who mobilized late. The weighted probabilities of regaining the ability to walk outdoors were 9.7% (95% CI 9.2% to 10.2%) and indoors 81.2% (95% CI 80.0% to 82.4%), for those who mobilized early, and 7.9% (95% CI 6.6% to 9.2%) and 73.8% (95% CI 71.3% to 76.2%), respectively, for those who mobilized late. Patients with dementia were less likely to mobilize early despite observed associations with survival and ambulation recovery for those with and without dementia. Conclusion.
Aims. Minimally invasive fixation of pelvic fragility fractures is recommended to reduce pain and allow
Background. pelvic fractures in elderly patients often result in poor prognosis due to immobilization associated complications. Thus, the target of the treatment in this patient group is
Patients undergoing total knee arthroplasty (TKA) experience significant postoperative pain. This impedes
The use of multimodal non-opioid analgesia in hip fractures, specifically acetaminophen combined with non-steroidal anti-inflammatory drugs (NSAIDs), has been increasing. However, the effectiveness and safety of this approach remain unclear. This study aimed to compare postoperative outcomes among patients with hip fractures who preoperatively received either acetaminophen combined with NSAIDs, NSAIDs alone, or acetaminophen alone. This nationwide retrospective cohort study used data from the Diagnosis Procedure Combination database. We included patients aged ≥ 18 years who underwent surgery for hip fractures and received acetaminophen combined with NSAIDs (combination group), NSAIDs alone (NSAIDs group), or acetaminophen alone (acetaminophen group) preoperatively, between April 2010 and March 2022. Primary outcomes were in-hospital mortality and complications. Secondary outcomes were opioid use postoperatively; readmission within 90 days, one year, and two years; and total hospitalization costs. We used propensity score overlap weighting models, with the acetaminophen group as the reference group.Aims
Methods
Ankle fractures are common injuries and the third most common fragility fracture. In all, 40% of ankle fractures in the frail are open and represent a complex clinical scenario, with morbidity and mortality rates similar to hip fracture patients. They have a higher risk of complications, such as wound infections, malunion, hospital-acquired infections, pressure sores, veno-thromboembolic events, and significant sarcopaenia from prolonged bed rest. A modified Delphi method was used and a group of experts with a vested interest in best practice were invited from the British Foot and Ankle Society (BOFAS), British Orthopaedic Association (BOA), Orthopaedic Trauma Society (OTS), British Association of Plastic & Reconstructive Surgeons (BAPRAS), British Geriatric Society (BGS), and the British Limb Reconstruction Society (BLRS).Aims
Methods
Despite limited clinical scientific backing, an additional trochanteric stabilizing plate (TSP) has been advocated when treating unstable trochanteric fractures with a sliding hip screw (SHS). We aimed to explore whether the TSP would result in less post operative fracture motion, compared to SHS alone. Overall, 31 patients with AO/OTA 31-A2 trochanteric fractures were randomized to either a SHS alone or a SHS with an additional TSP. To compare postoperative fracture motion, radiostereometric analysis (RSA) was performed before and after weightbearing, and then at four, eight, 12, 26, and 52 weeks. With the “after weightbearing” images as baseline, we calculated translations and rotations, including shortening and medialization of the femoral shaft.Aims
Methods
Introduction. Proximal humeral shaft fractures are rare injury. In such case, to the best of our knowledge, the treatment by both double-plate method and the MIPO has never been seen before in the literature. Here we report our experience and management about this method. Materials & Methods. A 69-year-old man who suffered falling down at home to his right shoulder that resulted in co-existing fractures of the proximal humerus and humeral shaft. According to AO/ASIF classification, he had 11-B1 and 12-A1 fractures ipsilaterally. He was treated by double plate method with PHILOS (SYNTHES, Japan) to proximal humerus and narrow LC-LCP(SYNTHES, Japan) to humeral shaft. Intraoperatively we put the skin incision about 3.0 cm each in three places, for reduction and fixation by the MIPO. Postoperatively, external fixation was only sling and physiotherapy was initiated after third post-operative days for range of motion exercises. Results. Union was achieved after 3.0 months and, at follow-up 1 year after injury, he had no pain and a good range of shoulder movement. Constant-Murley score was 90 points. Also he had no complication such as avascular necrosis and implant failure. Discussion & Conclusion. In this case, less invasive and rigid fixation by this method could result in
Non-union has traditionally been considered a rare complication following the non-operative management of clavicle fractures. Recent studies demonstrate higher rates of non-union in adults with displaced fractures, yet the variables predicting non-union remain unclear. We evaluated the prevalence and risk factors for non-union following displaced midshaft clavicle fractures in a large consecutive series of patients managed non-operatively. 1097 consecutive adults (mean age 26.1yrs) with displaced midshaft clavicle fractures treated non-operatively in our Unit were included. All patients were interviewed, examined and underwent radiological assessment within a week of injury. All patients were managed in a sling for two weeks followed by
Background. Non-union has traditionally been considered a rare complication following the non-operative management of clavicle fractures. A growing body of evidence has demonstrated higher rates of non-union in adults with displaced fractures. However, the variables that predict non-union in these patients remain unclear. We evaluated the prevalence and risk factors for non-union following displaced midshaft clavicle fractures in a large consecutive series of patients managed non-operatively in our Unit. Materials and Methods. 1097 consecutive adults (mean age 26.1yrs) with displaced midshaft clavicle fractures treated non-operatively in our Unit were included. All patients were interviewed and examined by an orthopaedic trauma surgeon and underwent radiological assessment within a week of injury. All patients were managed in a simple sling for two weeks followed by
Surgery is often delayed in patients who sustain a hip fracture and are treated with a total hip arthroplasty (THA), in order to await appropriate surgical expertise. There are established links between delay and poorer outcomes in all patients with a hip fracture, but there is little information about the impact of delay in the less frail patients who undergo THA. The aim of this study was to investigate the influence of delayed surgery on outcomes in these patients. A retrospective cohort study was undertaken using data from the Scottish Hip Fracture Audit between May 2016 and December 2020. Only patients undergoing THA were included, with categorization according to surgical treatment within 36 hours of admission (≤ 36 hours = ‘acute group’ vs > 36 hours = ‘delayed’ group). Those with delays due to being “medically unfit” were excluded. The primary outcome measure was 30-day survival. Costs were estimated in relation to the differences in the lengths of stay.Aims
Methods
The Peri-Implant and PeriProsthetic Survival AnalysiS (PIPPAS) study aimed to investigate the risk factors for one-year mortality of femoral peri-implant fractures (FPIFs). This prospective, multicentre, observational study involved 440 FPIF patients with a minimum one-year follow-up. Data on demographics, clinical features, fracture characteristics, management, and mortality rates were collected and analyzed using both univariate and multivariate analyses. FPIF patients were elderly (median age 87 years (IQR 81 to 92)), mostly female (82.5%, n = 363), and frail: median clinical frailty scale 6 (IQR 4 to 7), median Pfeiffer 4 (1 to 7), median age-adjusted Charlson Comorbidity Index (CCI) 6 (IQR 5 to 7), and 58.9% (n = 250) were American Society of Anesthesiologists grade III.Aims
Methods
The purpose of this study was to determine the weightbearing practice of operatively managed fragility fractures in the setting of publically funded health services in the UK and Ireland. The Fragility Fracture Postoperative Mobilisation (FFPOM) multicentre audit included all patients aged 60 years and older undergoing surgery for a fragility fracture of the lower limb between 1 January 2019 and 30 June 2019, and 1 February 2021 and 14 March 2021. Fractures arising from high-energy transfer trauma, patients with multiple injuries, and those associated with metastatic deposits or infection were excluded. We analyzed this patient cohort to determine adherence to the British Orthopaedic Association Standard, “all surgery in the frail patient should be performed to allow full weight-bearing for activities required for daily livingAims
Methods
We report the long-term outcomes of the UK Heel Fracture Trial (HeFT), a pragmatic, multicentre, two-arm, assessor-blinded, randomized controlled trial. HeFT recruited 151 patients aged over 16 years with closed displaced, intra-articular fractures of the calcaneus. Patients with significant deformity causing fibular impingement, peripheral vascular disease, or other significant limb injuries were excluded. Participants were randomly allocated to open reduction and internal fixation (ORIF) or nonoperative treatment. We report Kerr-Atkins scores, self-reported difficulty walking and fitting shoes, and additional surgical procedures at 36, 48, and 60 months.Aims
Methods
Acetabular fractures in older adults lead to a high risk of mortality and morbidity. However, only limited data have been published documenting functional outcomes in such patients. The aims of this study were to describe outcomes in patients aged 60 years and older with operatively managed acetabular fractures, and to establish predictors of conversion to total hip arthroplasty (THA). We conducted a retrospective, registry-based study of 80 patients aged 60 years and older with acetabular fractures treated surgically at The Alfred and Royal Melbourne Hospital. We reviewed charts and radiological investigations and performed patient interviews/examinations and functional outcome scoring. Data were provided by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Survival analysis was used to describe conversion to THA in the group of patients who initially underwent open reduction and internal fixation (ORIF). Multivariate regression analyses were performed to identify factors associated with conversion to THA.Aims
Methods
Introduction. Superior Labral Anterior Posterior Tears are being treated surgically in increasing numbers. Stiffness is the most common complication. We reviewed 115 cases of SLAP repairs to try and identify preoperative risk factors if any for stiffness. Methods. Retrospective cohort study of 115 patients who underwent SLAP repair. All patients failed attempts at conservative therapy including NSAIDS, Physical Therapy and cortisone injections. Results. Age ranged from 16–71 years, with an average age of 46. Male 84, Female 31. patient charts and operative notes were examined from 2004–2009. We used an average of 1.64 anchors per case; we performed arthroscopic Mumford on 15 patients, subscap repair (4), 19 cases with concomitant SLAP repair and Arthroscopic rotator cuff repair Other procedures included Biceps tenotomy and tenodesis, chondroplasty, Microfracture, removal of loose bodies, synovectomy and lysis of adhesions. Twelve patients underwent revision surgery(10%) We had 5 cases of stiffness which required lysis of adhesions and synovectomy, 4 cases had previous SLAP and concomitant rotator cuff repair done at the index surgery, 4 cases had arthrosis noted at index surgery and underwent chondroplasty and 2 of them underwent micro fracture. During the revision surgery 4 had also a concomitant cuff tear (new) which required repair Average time from index surgery to revision was 11 months, the patients who developed adhesive Capsulitis and stiffness the average age was 56 years. We had 2 titanium metal anchors pull out and present as loose bodies with one of the anchor causing chondral damage, we stopped using metal anchors and we have not had this problem recur since.5 cases had Mumford procedure done during the revision surgery.5 cases needed repeat SLAP repairs and by increasing use of biceps tenotomy this incidence should decrease. Conclusions. Our large retrospective case series shows an acceptable complication rate. Stiffness (5%) is still the most common complication especially in patients older than 50, withpreexisting Glenohumeral arthritis and concomitant rotator cuff tears. Hopefully our
Complex displaced osteoporotic acetabular fractures in the elderly are associated with high levels of morbidity and mortality. Surgical options include either open reduction and internal fixation alone, or combined with total hip arthroplasty (THA). There remains a cohort of severely comorbid patients who are deemed unfit for extensive surgical reconstruction and are treated conservatively. We describe the results of a coned hemipelvis reconstruction and THA inserted via a posterior approach to the hip as the primary treatment for this severely high-risk cohort. We have prospectively monitored a series of 22 cases (21 patients) with a mean follow-up of 32 months (13 to 59).Aims
Methods
The aims of this study were to evaluate the incidence of postoperatively restricted weight-bearing and its association with outcome in patients who undergo surgery for a fracture of the hip. Patient aged > 60 years undergoing surgery for a hip fracture were identified in the 2016 National Surgical Quality Improvement Program (NSQIP) Hip Fracture Targeted Procedure Dataset. Analysis of the effect of restricted weight-bearing on adverse events, delirium, infection, transfusion, length of stay, return to the operating theatre, readmission and mortality within 30 days postoperatively were assessed. Multivariate regression analysis was used to adjust for confounding demographic, comorbid and procedural characteristics.Aims
Patients and Methods
This study describes and compares the operative management and outcomes in a consecutive case series of patients with dislocated hemiarthroplasties of the hip, and compares outcomes with those of patients not sustaining a dislocation. Of 3326 consecutive patients treated with hemiarthroplasty for fractured neck of femur, 46 (1.4%) sustained dislocations. Of the 46 dislocations, there were 37 female patients (80.4%) and nine male patients (19.6%) with a mean age of 83.8 years (66 to 100). Operative intervention for each, and subsequent dislocations, were recorded. The following outcome measures were recorded: dislocation; mortality up to one-year post-injury; additional surgery; residential status; mobility; and pain score at one year.Aims
Patients and Methods
The best method of treating unstable pelvic fractures that involve
the obturator ring is still a matter for debate. This study compared
three methods of treatment: nonoperative, isolated posterior fixation
and combined anteroposterior stabilization. The study used data from the German Pelvic Trauma Registry and
compared patients undergoing conservative management (n = 2394),
surgical treatment (n = 1345) and transpubic surgery, including
posterior stabilization (n = 730) with isolated posterior osteosynthesis
(n = 405) in non-complex Type B and C fractures that only involved the
obturator ring anteriorly. Calculated odds ratios were adjusted
for potential confounders. Outcome criteria were intraoperative
and general short-term complications, the incidence of nerve injuries,
and mortality.Aims
Patients and Methods
