[Internal fixation of lateral and medial borders for displaced scapular body fractures via minimally invasive approach:results of 23 cases].
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2019 Dec 25;48(6):651-656
Authors: Gao M, Nie D, Chang Y, Xie W, Wang Y, Pu X, Zhang W, Luo W
OBJECTIVE: To evaluate the efficacy of internal fixation of lateral and medial borders for displaced scapular body fractures via the minimally invasive approach.
METHODS: The internal fixation of lateral and medial borders via minimally invasive approach was applied in surgical treatment of 23 patients with scapular body comminuted fractures from January 2014 to June 2018. The lateral approach was made straightly orienting over the lateral border of scapula. The dissection was taken down to the deltoid fascia. The deltoid was retracted cephalically, revealing the external rotators. Blunt dissection was used down to the lateral border between infraspinatus and teres minor, exposing the fracture site. The medial incision was done along the medial border of the scapula over site of the fracture. Dissections were taken down to the fascia and the periosteum. A subperiosteal dissection was then performed to elevate the infraspinatus to the degree necessary to visualize the fracture. The medial and lateral borders of scapula body were fixed with plates and screws in a frame-like way.
RESULTS: One patient developed the delayed healing of the incisions due to liquefactive fat necrosis. The other 22 patients showed no complications of the incisions. The glenopolar angle (GPA) of fractured scapula was increased from preoperative (25±12) degrees to postoperative (41±5) degrees (P<0.01). The healing time of fractures healed was 3-8 months, with an average time of (4.4±1.3) months.
CONCLUSIONS: The lateral-medial combined fixation through minimally invasive surgical approach for the scapula body fractures allows visualization of fracture reduction without extensive muscular or subcutaneous flaps, and is associated with successful fracture healing and high functional scores of the shoulder.
PMID: 31955540 [PubMed - indexed for MEDLINE]
[The application of three-dimensional printing technique combined with three-dimensional reconstruction in mandibular fracture].
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019 Nov;33(11):1057-1059;1064
Authors: Lv JL, Zhong KT, Zheng YH, Wang P, Cai XQ, Zhang R
Objective:To explore the value and significance of the combination of 3D printing and spiral CT three-dimensional reconstruction in the diagnosis and treatment of common mandibular fractures. Method:Forty patients with mandibular fracture were collected. They were randomly divided into traditional operation group and 3D printing combined with three-dimensional reconstruction operation group. The differences between the two groups were compared according to the operation time and the recovery of fracture. Result:The operation time and trauma of 3D printing combined with three-dimensional reconstruction group were significantly better than those of traditional operation group, and the former was better than the latter （P<0.05）. Conclusion: 3D printing combined with three-dimensional reconstruction operation method realized the concept of individualized, precise and minimally invasive comprehensive treatment, which is worthy of clinical promotion.
PMID: 31914294 [PubMed - indexed for MEDLINE]
[Clinical application of HRCT three-dimensional reconstruction in traumatic ossicular chain interruption].
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019 Dec;33(12):1129-1133
Authors: Ke RD, Tang AZ, Tang XL, Gong L, Fang Q, Tan SH
Objective:To investigate the clinical value of HRCT three-dimensional reconstruction technique in traumatic auditory chain traumatic fracture. Method:The clinical data of 14 patients with traumatic ear ossicular chain interruption were analyzed retrospectively. To evaluate the injury site and degree of the auditory chain before surgery, all the 14 patients underwent,HRCT scanning and three-dimensional reconstruction. The reconstructed auditory chain was observed from multiple angles and compared with the surgical exploration results under microscope. Result:The coincidence rate between ossicular chain injury observed by temporal bone HRCT scan before operation and ossicular chain injury observed during surgery was only 28.57%, the coincidence rate between ossicular chain injury observed during surgery and ossicular chain injury observed by three-dimensional reconstruction is 85.71%.Therefore, three-dimensional reconstruction imaging technique could give the doctor more clearly and stereoscopic images for the destruction of ossicular chain. Conclusion:Preoperative three-dimensional reconstruction can display and diagnosis of auditory ossicular chain destruction more clearly. It can be used to accurately evaluate auditory ossicular chain pathological changes, to develop individualized surgical plans and assess the risk of surgery.
PMID: 31914258 [PubMed - indexed for MEDLINE]
A retrospective evaluation of reliability and reproducibility of Arbeitsgemeinschaftfür Osteosynthesefragen classification and Fernandez classification for distal radius fracture.
Medicine (Baltimore). 2020 Jan;99(2):e18508
Authors: Yinjie Y, Gen W, Hongbo W, Chongqing X, Fan Z, Yanqi F, Xuequn W, Wen M
This is a retrospective evaluated. The objective of this study was to test the interobserver reliability and intraobserver reproducibility of fracture classification with Arbeitsgemeinschaftfür Osteosynthesefragen (AO) system and Fernandez system used by 5 senior orthopedic surgeons.Anteroposterior and lateral radiographs of 160 patients hospitalized for displaced distal radius fracture were examined. Independently, 5 orthopedic surgeons evaluated the radiographs according to 2 different distal radius classification systems (3 types of results). Three statistical tools were used to measure interobserver reliability and intraobserver reproducibility. The intraclass correlation coefficient and kappa coefficient (k) were used to assess both interobserver and intraobserver agreement of AO and Fernandez. Kappa value indicated poor agreement (<0), slight (0-0.20), fair (0.21-0.40), moderate (0.41-0.60), good (0.61-0.80), and perfect (0.81-1.00).The intraobserver reproducibility of AO system (9 types) and Fernandez system were moderate with a value of 0.577 and 0.438. The intraobserver reproducibility of AO system (27 subtypes) was 0.286. The interobserver reliability of AO system (9 types) was moderate with a value of 0.469 and that of Fernandez was moderate with a value of 0.435. The interobserver reliability of AO system (27 subtypes) was 0.299.Neither of the 2 systems can give us a satisfactory agreement between interobserver reliability and intraobserver reproducibility. In AO system, the interobserver reliability and intraobserver reproducibility of the 9 types decreased with the increase of subgroups.
PMID: 31914022 [PubMed - indexed for MEDLINE]
Synostosis of Ribs after Rib Fracture Fixation: A Unique Complication.
Am Surg. 2019 Dec 01;85(12):e582-e584
Authors: Acker AY, Perry ZH, Mimon N
PMID: 31908235 [PubMed - indexed for MEDLINE]
PHYSICAL TRAINING IN REHABILITATION OF 10-13 YEARS OLD CHILDREN WITH FRACTURES OF BONES OF THE LOWER THIRD OF FOREARM.
Georgian Med News. 2019 Nov;(296):36-41
Authors: Gumenyuk S, Hrubar I, Hrubar Y, Hrabyk N, Saprun S
The research is devoted to the problem of rehabilitation of 10-13 years old children with the fractures of bones of the lower third of forearm by means of physical training. The purpose of the work is to identify factors of injuries emergence in children, creating and checking efficiency of the physical rehabilitation program on the example of the fractures of bones of the lower third of forearm. The causes of children's school injuries have been analyzed and the following are established: organizational-methodical, sanitary-hygienic and psychophysiological. The methods of evaluating the efficiency of physical rehabilitation of children with the fractures of bones of the lower third of forearm have been developed. There are three periods of physical rehabilitation, which conditionally are divided into: immobilizational, functional and training. The physical rehabilitation program for children with the fractures of bones of the lower third of forearm, the technology of conducting kinesitherapy in the process of physical rehabilitation of children with the fractures of bones of the lower third of forearm and complexes of exercises oriented on a gradual increase of amplitude of movements of radio-carpal joint and prevention of disorders of functional state of the injured segment muscles have been developed and implemented. The physical rehabilitation program for children with the fractures of bones of the lower third of forearm is based on pedagogical principles, provides appropriate forms (hygienic gymnastic, independent study), methods (gymnastic, gaming, sporting) and ensures adequate pedagogical conditions. It have been produced and recommended preventive measures of organizational (during lessons and after school time), methodical, sanitary-hygienic and educational character for the realization at schools.
PMID: 31889702 [PubMed - indexed for MEDLINE]
[Osteoporosis-specific treatment when and how?]
Internist (Berl). 2020 Jan;61(1):51-63
Authors: Schulz K, Lehnert H
Over 6 million people in Germany suffer from osteoporosis; approximately half of all women over 70 years old and approximately 1 in 5 men over 70 years old are affected. The most relevant clinical consequences of the disease are fractures leading to a clear impairment in the quality of life. Furthermore, following an osteoporotic fracture especially of the hip or vertebra there is increased mortality. Despite higher individual and socioeconomic relevance, too few patients with osteoporosis still receive adequate treatment. Based on the current guidelines of the governing body for osteology (DVO) the indications for specific medicinal treatment can be determined. Furthermore, the selection of the suitable osteoporosis medication can be carried out by considering several factors, including individual ones.
PMID: 31848647 [PubMed - indexed for MEDLINE]
The deleterious effects of smoking in bone mineralization and fibrillar matrix composition.
Life Sci. 2020 Jan 15;241:117132
Authors: Barbosa AP, Lourenço JD, Junqueira JJM, Larissa Emidio de França S, Martins JS, Oliveira Junior MC, Begalli I, Velosa APP, Olivo CR, Bastos TB, Jorgetti V, Rodolfo de Paula V, Teodoro WR, Lopes FDTQS
INTRODUCTION: This study aimed to verify the effects of cigarette smoke exposure in bone mineralization and fibrillar matrix composition as well as in bone healing after tibial fracture induction.
METHODS: C57Bl/6 Mice were assigned according to exposure and surgery: C room air; F room air and tibia open osteotomy; CS cigarette smoke; FCS cigarette smoke and tibia open osteotomy. In order to study fracture healing we performed, under anesthesia, a bone injury through a tibial shaft osteotomy. Bone samples were obtained to evaluate bone histomorphometry, trabecular morphology and volume, trabecular collagen types composition and presence of inflammatory cytokines and growth factors.
RESULTS: CS exposure significantly reduced the thickness of bone trabeculae associated with decrease in mineralizing surface and mineral deposition rate, leading a lower bone formation rate and longer mineralization time. Resorption surface and osteoclastic surface were greater in the CS group, attesting increased resorptive action. There was a decrease in type I collagen deposition and genes expression in the CS and FCS groups compared to C group and in contrast there was an increase in type V collagen deposition and genes expression in the CS, FC and FSC groups compared to C group. Also, CS exposure induced a decrease in bone forming cytokines and an increase in inflammatory associated cytokines, and these changes were intensified under fracture conditions.
CONCLUSION: Cigarette smoke exposure alters bone matrix composition and worsens bone mineralization, leading to bone fragility by increasing collagen V synthesis and deposition and impairing collagen I fibril forming and assembling. And these deleterious effects contributed to the worsening in fracture healing after tibia osteotomy.
PMID: 31837327 [PubMed - indexed for MEDLINE]
Printing 3D models of canine jaw fractures for teaching undergraduate veterinary medicine.
Acta Cir Bras. 2019;34(9):e201900906
Authors: Lima AS, Machado M, Pereira RCR, Carvalho YK
PURPOSE: To develop 3D anatomical models, and corresponding radiographs, of canine jaw fractures.
METHODS: A base model was generated from a mandibular bone scan. With this model it was possible to perform fracture planning according to the anatomical location.
RESULTS: The 3D base model of the canine mandible was similar in conformation to the natural bone, demonstrating structures such as canine tooth crowns, premolars and molars, mental foramina, body of the mandible, ramus of the mandible, masseteric fossa, the coronoid process, condylar process, and angular process. It was not possible to obtain detail of the crown of the incisor teeth, mandibular symphysis, and the medullary channel. Production of the 3D CJF model took 10.6 h, used 150.1 g of filament (ABS) and cost US$5.83.
CONCLUSION: The 3D canine jaw fractures models, which reproduced natural canine jaw fractures, and their respective radiographic images, are a possible source of educational material for the teaching of veterinary medicine.
PMID: 31826098 [PubMed - indexed for MEDLINE]
Biomechanical comparison of a new handy tension band with malleolar screw, bicortical screw and conventional tension band for the fixation of transverse medial malleolar fractures.
Eklem Hastalik Cerrahisi. 2019 Dec;30(3):301-8
Authors: Kuru T, Akpınar F, Işık C, Özkılıç R, İpek S, Mutlu İ, Kızılay H
OBJECTIVES: This study aims to compare the biomechanical features of a new handy tension band with the malleolar screw, bicortical screw and conventional tension band for the fixation of transverse medial malleolar fractures.
MATERIALS AND METHODS: This study used 20 Kirschner wires, five cerclage wires, six double-hole U pins, six cortical screws, six malleolar screws, three malleolar clamps and one osteotomy set. A total of 24 tibias of two-year-old cows were obtained and stripped from soft tissue. Each tibia was cut with an electric saw at 15 cm proximal to the tibiotalar joint surface and the proximal tibia sections were discarded. A transverse fracture line was created with an osteotome on the medial malleolus. The tibias were separated into four groups with six tibias in each group. The distal tibia medial malleolar transverse fragments were fixed under guidance of fluoroscopy with the malleolar screw, bicortical screw, conventional tension band and the new handy tension band.
RESULTS: In the application of both transverse and axial force, the new handy tension band resisted higher forces in respect of catastrophic damage force being more resistant compared to the bicortical screw, malleolar screw, and conventional tension band. However, in respect of the 2 mm displacement force of the forces applied in the axial and transverse sections, no difference was determined between the handy tension band and the other three implants.
CONCLUSION: The new handy tension band seems to be more successful when biomechanically compared with the other implants.
PMID: 31650929 [PubMed - indexed for MEDLINE]
What is the importance of canal-to-diaphysis ratio on osteoporosis-related hip fractures?
Eklem Hastalik Cerrahisi. 2019 Dec;30(3):296-300
Authors: Bozkurt HH, Tokgöz MA, Yapar A, Atik OŞ
OBJECTIVES: This study aims to investigate whether the ratio of the canal-to-diaphysis in femoral subtrochanteric region is helpful in determining risk before hip fracture.
PATIENTS AND METHODS: The study group consisted of 116 patients with osteoporotic hip fractures (26 males, 90 females; mean age 77.8 years; range, 61 to 89 years) and the control group consisted of 56 subjects (11 males, 45 females; mean age 75.3 years; range, 60 to 83 years). The canal-to-diaphysis ratio of patients in the study group was measured on plain radiographs. The results of the affected side and intact side were compared. To ensure the interobserver reliability of the measurements and to minimize technical errors, the assessments were performed twice (two weeks apart) by two different orthopedic surgeons.
RESULTS: The canal-to-diaphysis ratio was significantly increased in patients with hip fracture compared with the intact side of same patient (p<0.001) and control subjects (p<0.001). According to the results of the receiver operating characteristic analysis, canal-to-diaphysis ratio had a diagnostic value in predicting hip fracture in osteoporosis patients, and the limit value was approximately 0.53 (sensitivity: 81%, specificity: 86%). An index of 0.53 represents a risk of intertrochanteric hip fracture of 89%.
CONCLUSION: This method can be easily applied by all physicians as X-ray device is readily accessible with low cost. The risk of hip fracture should be determined, osteoporosis should be evaluated, and treatment should be started in patients with high risk to take the necessary precautions before the fracture develops.
PMID: 31650928 [PubMed - indexed for MEDLINE]
The effects of focal brain damage on fracture healing: An experimental rat study.
Eklem Hastalik Cerrahisi. 2019 Dec;30(3):267-74
Authors: Arık M, Ekinci Y, Gürbüz K, Batın S
OBJECTIVES: This study aims to investigate whether the motor cortex (MC) or the somatosensory cortex (SC) is more active during the course of bone healing after traumatic brain injury (TBI).
MATERIALS AND METHODS: Thirty-three male Wistar albino rats (age, 8 to 10 months; weighing, 250 to 300 g) were randomized into three groups as the control group, MC damage group and SC damage group. Two rats from each brain damage group were sacrificed to verify the locations of the cortical injuries. Callus formation, callus/diaphysis ratios, and serum alkaline phosphatase (ALP) levels were measured at one, three and six weeks.
RESULTS: The increases in callus masses in the control, MC, and SC groups were statistically significantly different between one and three weeks (p<0.05). Although this increase in the MC and SC groups was significant compared to the control group at the end of one week, no statistically significant difference was found between the MC and SC groups (p>0.05). There was a statistically significant difference in callus/diaphysis ratio between control, MC and SC groups in favor of MC group only at one week (p<0.05). The increase in serum ALP levels at three weeks was statistically significantly different in the MC and SC groups compared to the control group and significantly higher in the MC group compared to the SC group (p<0.05).
CONCLUSION: There is a possible relationship between enhanced fracture healing after TBI and damage in the MC. Motor cortex plays a more active role on fracture healing in TBI.
PMID: 31650924 [PubMed - indexed for MEDLINE]
Quality of Life and Cost Implications of Pseudarthrosis After Anterior Cervical Discectomy and Fusion and its Subsequent Revision Surgery.
World Neurosurg. 2020 Jan;133:e592-e599
Authors: Pennington Z, Mehta VA, Lubelski D, Elliott C, Miller JA, Benzel EC, Mroz TE
BACKGROUND: More than 120,000 anterior cervical discectomy and fusions (ACDFs) are performed annually. Pseudarthrosis is a potential delayed adverse event that affects up to 33% of patients. The degree to which this adverse event affects both patient quality-of-life (QOL) outcomes and health care costs is poorly understood.
METHODS: Patients who underwent revision surgery for pseudarthrosis between 2007 and 2012 were identified and matched to controls not experiencing pseudarthrosis in a 1:2 fashion (case/control). Cases and controls were compared regarding total health care costs incurred in the year after the index ACDF and QOL outcomes on the following metrics: EuroQol Five-Dimensions Questionnaire, Patient Health Questionnaire-9, and Pain Disability Questionnaire.
RESULTS: Of 738 patients who underwent ACDF, 11 underwent surgery for pseudarthrosis. No differences were noted between cases and controls regarding any of the matched variables. Patients in the pseudarthrosis cohort had poorer postoperative scores on the EuroQol Five-Dimensions Questionnaire mobility, usual activities, pain/discomfort, and quality-adjusted life-year dimensions. In addition, 64% of patients with pseudarthrosis had worsened quality-adjusted life-year scores compared with only 9% of controls (P < 0.01). Patients with pseudarthrosis also had poorer mental health (P < 0.01) and pain disability outcomes (P < 0.01) than did controls. Pseudarthrosis was associated with significant increases in direct costs, direct postoperative costs, and total costs (all P < 0.01).
CONCLUSIONS: This is the first study to characterize the effect of surgical revision for pseudarthrosis on both QOL outcomes and care costs after ACDF. Patients requiring revision experienced significantly poorer QOL outcomes and higher care costs relative to controls.
PMID: 31568900 [PubMed - indexed for MEDLINE]
Three-step Bending Procedure For an Easy Endomedullary K-Wire Osteosynthesis of Metacarpal Neck Fractures.
Tech Hand Up Extrem Surg. 2019 12;23(4):199-200
Authors: Guidi M, Frueh FS, Mészáros T, Erling C, Besmens I, Kim BS, Calcagni M
PMID: 31305327 [PubMed - indexed for MEDLINE]
Efficacy of the Vertebral Body Stenting System for the Restoration of Vertebral Height in Acute Traumatic Compression Fractures in a Non-osteoporotic Population.
Cardiovasc Intervent Radiol. 2019 Nov;42(11):1579-1587
Authors: Garnon J, Doré B, Auloge P, Caudrelier J, Dalili D, Ramamurthy N, Koch G, Cazzato RL, Gangi A
INTRODUCTION: To evaluate the effectiveness of percutaneous image-guided vertebral body stenting (VBS) at restoring vertebral height in acute, stable, traumatic thoracolumbar fractures in a young, non-osteoporotic population.
MATERIALS AND METHODS: A single-centre retrospective review of all traumatic non-osteoporotic fractures treated with VBS between 2010 and 2017 was performed. Inclusion criteria included patients with recent (< 10 days), symptomatic and stable thoracolumbar compression fractures. Patients with low-energy fractures, osteoporosis and age > 60/50 years (male/female) were excluded. Primary outcomes included: correction of vertebral height, correction of kyphosis angle and Beck Index on reconstructed pre- and post-procedural CBCT images. Secondary outcomes included intra-procedural stent recoil, complications, cement leakage and factors predicting height restoration.
RESULTS: Thirty-nine patients (26 men, 13 women; mean age 33.6 years, range 15-57 years) underwent VBS 5 days post-trauma on average (range 1-10), for stable compression fractures located between T5 and L5. Mean vertebral height gain, vertebral kyphosis angle correction and Beck index improvement were 3.8 mm (95% CI 3.36-4.50; P(> 3 mm) = 99.9%), 4.3° (95% CI 3.50-5.20; P(> 3°) = 99.9%) and 0.07 [95% CI 0.053-0.11], respectively (all statistically significant). Technical success was 92%, with 3 "major" stent recoils resulting in loss of vertebral height correction. No symptomatic complications were observed. No predictive factors for procedural success were identified.
CONCLUSION: VBS can significantly restore vertebral height in young patients with traumatic vertebral compression fractures.
PMID: 31201507 [PubMed - indexed for MEDLINE]
Extra-articular Corrective Osteotomy With Bone Grafting to Achieve Lengthening and Regain Alignment for Distal Radius Fracture Malunion.
Tech Hand Up Extrem Surg. 2019 Dec;23(4):186-190
Authors: Huang HK, Hsu SH, Hsieh FC, Chang KH, Chu HL, Wang JP
Surgical correction of the distal radius fracture malunion is challenging because of the 3-dimensional deformity. We propose a method by using the Kapandji intrafocal pinning in corrective osteotomy for treatment of the distal radius fracture malunion to facilitate the alignment correction while using the bone graft to restore the radial length. The surgery was started with the osteotomy from a volar approach, and the osteotomy gap was expanded gradually. Then, allobone grafting was performed to maintain the corrected radial length. We used the Kapandji intrafocal pinning dorsally to provide dorsal supporting force and radially to correct the radial inclination. Finally, a volar plate was used to buttress and push the distal fragment to fit as to regain the correct volar tilt. We enrolled 10 patients of distal radius fracture malunion with a mean age of 59.3 years. All patients had bone healing within 3 months after surgery. The mean lengthened distance was 5 mm. The radial inclination and volar tilt could be corrected with improved functional results.
PMID: 31157736 [PubMed - indexed for MEDLINE]
Fixation of a Type 3 Flexor Digitorum Avulsion Injury.
Tech Hand Up Extrem Surg. 2019 Dec;23(4):160-164
Authors: Weber MB, Chepla KJ, Bafus BT
This article describes a novel technique for flexor digitorum profundus (FDP) avulsion injuries, useful for Leddy Packer type 3, 4, and 5 injuries. Multidirectional stability is achieved with combination pull-out suture, which neutralizes the deforming force of FDP, and cerclage wire, which holds the bone fragment in an anatomic position and provides interfragmentary compression. Traditional techniques such as interosseous wires, Kirschner wires, or plating risk fragment comminution and loss of reduction due to proximal pull of FDP as demonstrated in this case report of failed Kirschner-wire fixation. The technique presented here eliminates the risk of avulsion fragment comminution and provides stable fixation that allows for early mobilization.
PMID: 31157734 [PubMed - indexed for MEDLINE]
Relationship between comorbidities and treatment decision-making in elderly hip fracture patients.
Aging Clin Exp Res. 2019 Dec;31(12):1735-1741
Authors: Wei J, Zeng L, Li S, Luo F, Xiang Z, Ding Q
BACKGROUND: Elderly patients are at a higher risk for hip fracture. Moreover, hospitalized elderly patients with hip fracture are vulnerable to adverse outcomes including higher mortality rate and long-term disability. Treatment decision-making with respect to surgical procedure and perioperative management of these patients is typically challenging owing to the presence of multiple comorbid conditions.
AIMS: The purpose of this study was to investigate the relationship between comorbidities in elderly patients with hip fracture and the treatment decision-making.
METHODS: 884 geriatric patients (age ≥ 60 years) with hip fracture were included. Comorbidities related to age were measured using the Charlson Co-morbidity Index (CCI) and age-adjusted CCI. The CCI of each geriatric hip fracture patient was calculated based on data retrieved from the medical records. The relationship of CCI and age-adjusted CCI with surgical procedure, time-to-surgery, length of hospital stay, and perioperative management (transfusion, anti-coagulation, and analgesia) was assessed.
RESULTS: Mean age of patients was 78.01 ± 8.62 years. The mean CCI was 0.79 ± 0.036; the mean age-adjusted CCI was 4.15 ± 0.047. The CCI was significantly associated with time-to-surgery (P = 0.004), surgical treatment (P < 0.001), and transfusion (P = 0.023). The age-adjusted CCI was significantly associated with surgical treatment (P < 0.001), analgesia (P = 0.003) and transfusion (P < 0.001). The length of hospital stay was associated with both CCI (P = 0.041), age-adjusted CCI (P = 0.002), and hypertension (P = 0.012). Hospital expenses showed a significant association with CCI (P = 0.000), age-adjusted CCI (P = 0.029), osteoprosis (P = 0.007), and hypertension (P = 0.001).
CONCLUSION: In this study, comorbidities were positively associated with surgical procedure and perioperative management of elderly patients with hip fracture.
PMID: 30993661 [PubMed - indexed for MEDLINE]
Betwixt and between: a surgical post-acute treatment unit (SPA) for the optimal care of elderly patients with isolated hip fractures.
Aging Clin Exp Res. 2019 Dec;31(12):1743-1753
Authors: DiGiacomo JC, Angus LDG, Cardozo-Stolberg S, Wallace R, Gerber N, Munnangi S, Charley S, McGlynn K
BACKGROUND: A performance improved project identified elderly trauma patients to have a disproportionate incidence of complications.
AIMS: The purpose of this study was to assess the efficacy of a small specialty care unit to decrease complications in patients who no longer warrant care in an intensive care unit (ICU).
METHODS: A surgical post-acute treatment unit (SPA) was developed with focused attention to cognition, nutrition, respiration, and mobilization needs of patients who no longer had physiologic need for an intensive care unit environment, but were still in need of increased attention at the bedside.
RESULTS: While ICU and hospital lengths of stay were unchanged, patients placed in the SPA experienced less complications and required less unplanned ICU re-admissions.
DISCUSSION: Geriatric patients, especially the elderly, are not simply old adults. They have unique needs as a consequence of the aging process, which can be encompassed by four pillars of intercession: cognition, nutrition, respiration, and mobilization.
CONCLUSIONS: By adapting a physical environment supported by bedside attention to address the interwoven needs of geriatric and elderly patients who no longer care in an ICU, complications and unplanned return admissions to the ICU can be decreased.
LEVEL OF EVIDENCE: III.
PMID: 30968288 [PubMed - indexed for MEDLINE]
Biochemical markers of inflammation are associated with increased mortality in hip fracture patients: the Bispebjerg Hip Fracture Biobank.
Aging Clin Exp Res. 2019 Dec;31(12):1727-1734
Authors: Norring-Agerskov D, Bathum L, Pedersen OB, Abrahamsen B, Lauritzen JB, Jørgensen NR, Jørgensen HL
PURPOSE: The purpose of this study was to examine the possible association between mortality following a hip fracture and known biochemical markers of inflammation.
METHODS: The study population was identified using two local databases from Bispebjerg Hospital (Copenhagen, Denmark): the Hip Fracture Database containing all patients admitted to the hospital with a fractured hip from 1996 to 2012 and the Hip Fracture Biobank, containing whole blood, serum and plasma taken in relation to admission on a subgroup of patients from the Hip Fracture Database, consecutively collected over a period of 2.5 years from 2008 to 2011. The following biochemical markers of inflammation were included: C-reactive protein (CRP), the soluble urokinase plasminogen activating receptor (suPAR), ferritin and transferrin. The association between the blood markers and mortality was examined using Cox proportional hazards models. Hazard ratios (HR) were expressed per quartile increase in the biochemical markers.
RESULTS: A total of 698 patients were included, 69 (9.9%) died within 30 days after sustaining a hip fracture. The HR for 30-day mortality was significantly increased with increasing quartiles of suPAR, CRP and ferritin and with decreasing quartiles of transferrin.
CONCLUSION: This study shows that 30-day mortality after a hip fracture is associated with elevated levels of suPAR, CRP and ferritin as well as with lower levels of transferrin. This excess inflammatory response is likely caused by muscle damage associated with the hip fracture. However, this needs to be further clarified.
PMID: 30707355 [PubMed - indexed for MEDLINE]
Guerin's sign reflecting pterygoid plate dysjunction.
J R Army Med Corps. 2019 Dec;165(6):454
Authors: Sahni V
A case of panfacial trauma is reported comprising of multiple facial fractures and a clearly evident Guerin's sign along with an oronasal communication. The case reinforces the importance of recognising this sign and its classical presentation.
PMID: 30610088 [PubMed - indexed for MEDLINE]