For displaced femoral neck fractures (FNFs) in geriatric patients, there remains uncertainty regarding the effect of total hip arthroplasty (THA) compared with hemiarthroplasty (HA) in the guidelines. We aimed to compare 90-day surgical readmission, in-hospital complications, and charges between THA and HA in these patients. The Hospital Quality Monitoring System was queried from 1 January 2013 to 31 December 2019 for displaced FNFs in geriatric patients treated with THA or HA. After propensity score matching, which identified 33,849 paired patients, outcomes were compared between THA and HA using logistic and linear regression models.Aims
Methods
The traditional Kocher approach for lateral elbow exposure is often complicated by injury to the posterior interosseous nerve (PIN) and the lateral ulnar collateral ligamentous (LUCL). Kaplan approach is less commonly used, due to its known proximity to the PIN. Extensor Digitorum Communis (EDC) splitting approach allows possible wide surgical exposure and low risk of LUCL damage. The comparison of PIN injury during surgical dissection among these 3 common lateral approaches was not previously evaluated. We aim to determine the anatomical proximity of the PIN in these 3 common lateral elbow approaches and to define a safe zone of dissection for the surgical exposure. Cadaveric dissections of 9 pairs of fresh frozen adult upper extremities were performed using EDC splitting, Kaplan and Kocher approach to the radial head sequentially in a randomised order. The radial head and PIN were exposed. A mark was made on the radial head upon the initial exposure during dissection. Measurements from the marked point of the radial head to the PIN were made. Study has been approved by the ethics committee.Background
Methods
Overall in-hospital fracture mortality was 1.3% (117 fractures). Fracture specific in-hospital mortality was 2.8% (75 fractures) for hip fractures, 5% (13) for non rami pelvic fractures, 1% (20) for spinal fractures, 0.5% (6) for femoral fractures and near 0%(1) for tibial fractures. In-hospital mortality increased with age (0.4% mortality between 21–40 years, 0.6% between 41–60 years, 0.9% between 61–70 years, 1.7% between 71–80 and 4% between 81–90 years). Infection related causes of death were most common. The mean duration from hospital admission until death was 19 days (SD 20, range 1–34). More hip and spine fractures were seen in Chinese and more femoral and tibial fractures were seen in Malay and Indian patients, and this difference was statistically significant. Logistic regression analysis showed only increased patient age, male gender and fracture type as statistically significant risk factors for increased in-hospital mortality. Subgroup analysis showed a 30 and 20 times increased risk of in-hospital mortality for pelvic (p=0.001, 95% CI 4, 241) and hip (p=0.003, 95% CI 3, 159) fractures respectively.
There have been recent reports linking alendronate and a specific pattern of subtrochanteric insufficiency fracture. We performed a retrospective review of all subtrochanteric fractures admitted to our institution between 2001 and 2007. There were 20 patients who met the inclusion criteria, 12 of whom were on long-term alendronate. Alendronate-associated fractures tend to be bilateral (Fisher’s exact test, p = 0.018), have unique radiological features (p <
0.0005), be associated radiologically with a pre-existing ellipsoid thickening of the lateral femoral cortex and are likely to be preceded by prodromal pain. Biomechanical investigations did not suggest overt metabolic bone disease. Only one patient on alendronate had osteoporosis prior to the start of therapy. We used these findings to develop a management protocol to optimise fracture healing. We also advocate careful surveillance in individuals at-risk, and present our experience with screening and prophylactic fixation in selected patients.
