Sterile Inflammatory Response and Surgery-Related Trauma in Elderly Patients with Subtrochanteric Fractures

Cardiomyocyte regeneration after infarction: changes, opportunities and challenges

Myocardial infarction is a cardiovascular disease that poses a serious threat to human health. The traditional view is that adult mammalian cardiomyocytes have almost no regenerative ability, but recent studies have shown that they have regenerative potential under specific conditions. This article comprehensively describes the research progress of post-infarction cardiomyocyte regeneration, including the characteristics of cardiomyocytes and post-infarction changes, regeneration mechanisms, influencing factors, potential therapeutic strategies, challenges and future development directions, and deeply discusses the specific pathways and targets included in the regeneration mechanism, aiming to provide new ideas and methods for the treatment of myocardial infarction.

Postoperative Adverse Outcomes in Patients With Frailty Undergoing Urologic Surgery Among American Patients: A Propensity-Score Matched Retrospective Cohort Study

Objective

Although the 5-item modified frailty index (mFI-5) has been found to be associated postoperative outcomes, there are limited studies examining its utility in urologic surgery. Our purpose is to evaluate the association between the mFI-5 and postoperative mortality and complications among patients undergoing urologic surgery.

Methods

This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2020. All adult patients who underwent urologic procedures were included. The mFI-5 includes five items: hypertension, diabetes, congestive heart failure, chronic obstructive pulmonary disease, and physical function status. Each item is assigned one point, and an mFI-5 score of 2 or greater indicates frailty. The primary outcome was postoperative mortality, while secondary outcomes were postoperative complications. Propensity score analysis was employed to control for confounders.

Results

After propensity score matching, each group contained 55,322 surgical patients. The patients in the frailty group were at risks of in-hospital mortality (absolute risk increase [ARI] 0.29%) and higher postoperative complications, including acute myocardial infarction (ARI 0.25%), pneumonia (ARI 0.42%), sepsis (ARI 0.41%), and septic shock (0.2%). Compared to the non-frailty group, the length of hospital stay was higher in the frailty group.

Conclusion

Patients with an mFI-5 score of 2 or greater were associated with an increased risk of postoperative mortality and complications, including myocardial infarction, pneumonia, sepsis, and septic shock. The mFI-5 is a simple index that quickly identifies frail patients. This allows for the implementation of prehabilitation and nutritional strategies targeted at enhancing their physiological reserve and optimizing their surgical outcomes.

Partial weight bearing and long-term survival outcomes in extracapsular hip fractures treated with trochanteric Gamma3 nails

BACKGROUND

Benefits of partial weight bearing (PWB) in operated extracapsular hip fractures (ECF) have not been proved. We have assessed influence of PWB on long-term survival and the final mobility achieved, dependence and mortality-related factors.

METHODS

Retrospective cohort study of osteoporotic ECF in ≥ 65-year-old patients who underwent surgery with trochanteric Gamma3 nails in 2014 (n = 218), followed in the long-term (consolidation or stabilisation). According to Baumgaertner-Fogagnolo classification (138 good, 71 acceptable and 9 poor) a postoperative protocol was applied. 116 cases bore weight before discharge (Immediate Partial Weight Bearing, IPWB = 116; Not-IPWB = 102), and 118 did it after a month (Early PWB, EPWB = 118; Not-EPWB = 100). Variables were collected from medical records and complementary studies. We used FMS (Fracture Mobility Score) and the National Mortality Database from the Spanish Ministry of Health at > 5 years. EPWB and Not-EPWB were comparable, except for hospital stay and dependence. We used the Cox method for mortality. < 0.05 p-values were significant.

RESULTS

Survival improved in IPWB earlier than in EPWB, although there was no statistical significance. The final FMS was significantly favourable only in EPWB. Not-EPWB showed greater dependence. Age (per year of increment), moderate Charlson comorbidity index (not age-modified) and greater immediate post-operative estimated blood loss were independent factors for mortality, but we did not find radiological factors implied.

CONCLUSIONS

Postoperative PWB in ECF may increase mid-term and long-term survival rates, but considerably delayed in EPWB. Only EPWB improved final mobility. Not-EPWB presented with greater dependence. Only clinical factors were independently related to mortality, but no radiological factors were.

Between Consecutive Fractures: Time and Sex as Dominant Factors in Type and Severity Concordance of Contralateral Hip Injuries

Background/Objectives: Hip fractures present a global public health concern, with a forecasted rise in incidence and having associated increased mortality rates. This study aimed to investigate whether the AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification of a first hip fracture can predict the location and severity of a subsequent contralateral fracture. Methods: We retrospectively evaluated patients with non-simultaneous bilateral hip fractures between January 2000 and February 2021 and analyzed the type and severity of each fracture using the AO/OTA classification system, interval between fractures (TI), and patients' characteristics, including sex, age at time of each fracture, and radiographic measurements of hip morphology. Results: The study included 182 fractures in 91 patients (68% women, mean age: 79.5 and 82.2 years at first and second fractures, respectively; mean TI: 975 days). A strong association (lambda = 0.437, p < 0.001) was demonstrated between the first and second fracture classifications, which was higher in men (lambda = 0.60, p < 0.001) and for TI < 3 years (lambda = 0.625-0.688, p < 0.001). The mean TI was significantly shorter between the first and subsequent identical fractures than between different fracture types. However, mean hip morphological features did not significantly differ between groups. Conclusions: The initial hip fracture classification significantly predicted the type and severity of a subsequent contralateral fracture, particularly within 3 years and in men. Providing appropriate patient guidance and preventive measures is crucial, particularly for those with primary fractures that are associated with higher morbidity and mortality. Specific fracture-focused interventions, such as preventive intramedullary nail fixation, should be considered.

Risk factors and characteristics of preoperative heart failure in elderly patients with hip fracture and the influence of anemia on prognosis

BACKGROUND

Patients with preoperative acute heart failure (AHF) after hip fracture in the elderly have a worse prognosis. We aim to investigate the characteristics, risk factors and postoperative complications of elderly patients with hip fracture complicated with preoperative AHF. We also looked at the effect of the severity of anemia at admission on the prognosis of the above people.

METHODS

A retrospective study of hip fracture patients (aged ≥ 65) admitted to the Department of Geriatric Orthopaedics, Third Hospital, Hebei Medical University, was conducted from January 2018 to October 2020. We used univariate and multivariate logistic regression to assess risk factors for preoperative AHF. The Kaplan-Meier survival curve shows the relationship between the severity of anemia on admission and all-cause mortality in elderly hip fracture patients with preoperative AHF.

RESULTS

Out of the 1092 patients, 503 had preoperative AHF and the incidence of it in hip fracture patients was 46.1%. Age, coronary artery disease, chronic atrial fibrillation, Age-Adjusted Charlson Comorbidity Index (ACCI), admission anemia, admission albumin < 40 g/dl, and admission C-reactive protein (CRP) were all significantly different between those with AHF and those without. Multivariate logistic regression analysis revealed that age ≥ 80 years (OR 1.740, 95% CI 1.309-2.313), coronary artery disease (OR 1.417, 95% CI 1.017-1.975), chronic atrial fibrillation (OR 4.010, 95% CI 1.757-9.152), admission anemia (OR 1.433, 95% CI 1.051-1.953) are the independent risk factors for preoperative AHF in elderly patients with hip fracture (p < 0.05). The HF group exhibited a higher incidence of postoperative complications, such as anemia, arrhythmia, NOAF (new-onset atrial fibrillation), AIS (acute ischemic stroke), electrolyte disturbance and hypoproteinemia. The moderate-to-severe anemia group had a higher incidence of postoperative complications, including deep vein thrombosis of the lower limbs, NOAF, and hypoproteinemia, as well as all-cause mortality.

CONCLUSION

Older patients combined with admission anemia, coronary artery disease, chronic atrial fibrillation are more likely to have preoperative AHF after hip fracture. For such patients, early and effective identification and strengthening perioperative management can avoid the occurrence of adverse events. For patients with moderate and severe anemia at admission, timely intervention is recommended to reduce postoperative complications and mortality.

Correlation Between Neutrophil-Lymphocyte Ratio and Inhospital Cardiac Events in Geriatric Patients With Hip Fractures

Background: The novel inflammatory biomarker known as the neutrophil-lymphocyte ratio (NLR) has shown great potential in predicting and prognosing many diseases. However, its correlation with postoperative inhospital major adverse cardiac events (MACEs) in geriatric patients with hip fractures remains unclear. This study investigated the relationship between NLR and postoperative inhospital MACEs among geriatric patients with hip fractures. Methods: We enrolled geriatric patients with hip fractures who were hospitalized in the Department of Geriatric Traumatology and Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, between January 2023 and November 2023. After surgery, the patients were transferred to the intensive care unit (ICU) for postoperative monitoring and treatment. Patients were assigned to the MACE or non-MACE group based on the occurrence of MACEs after surgery during their hospital stay. Clinical data were retrospectively analyzed. Results: In all, 216 patients were recruited into the study: 34 in the MACE group and 182 in the non-MACE group. Univariate and multivariate analyses revealed that a medical history of stroke (odds ratio (OR) = 2.66, 95% confidence interval (CI) = 1.18-6.01; p=0.018) and elevated preoperative NLR (OR = 1.09, 95% CI = 1.03-1.17; p=0.005) were significant risk factors for postoperative inhospital MACEs. The area under the curve (AUC) of preoperative NLR-predicted MACEs was 0.65 (0.55-0.75). Patients with a preoperative NLR <6.49 were less likely to experience inhospital MACEs, demonstrating a sensitivity of 61.8% and specificity of 64.8%. Conclusion: Elevated preoperative NLR is an independent risk factor for postoperative inhospital MACEs in geriatric patients with hip fractures.

Role of Serum Biomarkers in Differentiating Periprosthetic Joint Infections from Aseptic Failures after Total Hip Arthroplasties

Background/Objectives: Periprosthetic joint infection (PJI) is a disastrous complication after joint replacement procedures as the diagnosis remains a significant challenge. The objective of this study is to assess the accuracy and test the interdependency of the proposed compound serum biomarkers for the diagnosis of PJI after total hip arthroplasties (THA). Methods: From January 2019 to December 2023, 77 consecutive cases that underwent revision total hip arthroplasties (rTHA) were included in a single-retrospective, observational cohort study. A total of 32 arthroplasties were classified as having septic complications using the European Bone and Joint Infection Society (EBJIS) definition from 2021, while the other 45 cases were assigned as aseptic failures (AF). Results: In the univariate analysis between the two groups created, statistically significant differences (p < 0.005) were found for the following variables: time from primary arthroplasty to symptom onset (Time PA-SO), neutrophil count, Lymphocyte count, haematocrit level (HCT) and haemoglobin level (HGB), C-reactive protein (CRP), the neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), monocyte lymphocyte ratio (MLR), systemic inflammation index (SII), systemic inflammation response index (SIRI), and aggregate inflammation systemic index (AISI). The ROC curve analysis showed that the SII (sensitivity 90.6% and specificity 62.2%) and the NLR (sensitivity 84.4% and specificity 64.4%) are the most accurate biomarkers. The multivariate analysis confirmed that NLR > 2.63 (p = 0.006), PLR > 147 (p = 0.021), MLR > 0.31 (p = 0.028), SII > 605.31 (p = 0.002), SIRI > 83.34 (p = 0.024), and AISI > 834.86 (p = 0.011) are all closely related to PJI diagnosis independently. Conclusions: The proposed serum biomarkers can be correlated with PJI diagnosis with the reserve of relatively low specificities.

Predictive Value of Neutrophil-Lymphocyte Ratio and Other Inflammation Indices in Febrile Seizures in Children

Objective: There is increasing evidence for the effect of inflammation on the etiology of febrile seizure (FS) patients. We aimed to investigate the role of easily accessible inflammatory markers such as the neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-lymphocyte-platelet ratio (NLPR), and pan-immune-inflammation value (PIV) in febrile seizure. Methods: A total of 300 children, including 100 with febrile convulsions (FS), 100 febrile controls (FCs), and 100 healthy controls (HCs), were included in this retrospective study. The FS group was compared with the FC and HC groups in terms of these inflammatory indexes. Results: Between the FS group and the FC group, the neutrophil count was significantly higher in the FS group (p = 0.001) and the lymphocyte count was significantly lower (p < 0.001). The NLR (p < 0.001), SII (p < 0.001), SIRI (p < 0.001), NLPR (p < 0.001), and PIV (p < 0.001) were significantly higher in the FS group than in both the FC and healthy control groups. The optimal cut-off values for predicting FS in febrile conditions were 3.59> for NLR, >870.47 for SII, >1.96 for SIRI, 0.96> for NLPR, and >532.75 for PIV. Conclusions: The inflammatory indices are inexpensive, easily accessible hematological markers that can contribute to the diagnosis of FS.

Biomechanical difference analysis of new and classic intramedullary nail devices in the treatment of basal femoral neck fractures: finite element analysis

OBJECTIVE

There is currently a lack of in-depth comparative evaluation regarding the biomechanical properties of novel intramedullary nail devices in the treatment of basal femoral neck fractures (BFNF). This study aims to utilize finite element analysis to compare the performance differences of two novel devices with traditional PFNA and InterTan nails in the fixation of BFNF.

METHODS

Based on a validated finite element model, this study constructed an accurate BFNF model and implanted four different intramedullary nail devices: PFNA, InterTan nail, PFBN (proximal femoral biomimetic nail), and NIS (novel intramedullary system). Under a vertical load of 2100N, the displacement and Von Mises stress (VMS) distribution of each group of models were evaluated through simulation testing.

RESULTS

Under a load of 2100N, the PFBN device exhibited the best performance in terms of displacement and peak stress, while PFNA performed poorly. The peak displacement of the NIS device was lower than that of PFNA and InterTan nails, while the peak stress of the InterTan nail was lower than that of PFNA and NIS.

CONCLUSION

The PFBN device demonstrates stronger load-bearing and shear-resistant properties in the treatment of BFNF, and the NIS device also shows significant improvement in stability. Therefore, both the PFBN and NIS devices are reliable internal fixation techniques for the treatment of CFIFs, with potential clinical application prospects.

B7-1 and PlGF-1 are two possible new biomarkers to identify fracture-associated trauma patients at higher risk of developing complications: a cohort study

BACKGROUND

Around 10% of fractures lead to complications. With increasing fracture incidences in recent years, this poses a serious burden on the healthcare system, with increasing costs for treatment. In the present study, we aimed to identify potential 'new' blood markers to predict the development of post-surgical complications in trauma patients following a fracture.

METHODS

A total of 292 trauma patients with a complete three-month follow-up were included in this cohort study. Blood samples were obtained from 244 of these patients. Two complication groups were distinguished based on the Clavien-Dindo (CD) classification: CD grade I and CD grade III groups were compared to the controls (CD 0). The Mann-Whitney U test was used to compare the complication groups to the control group.

RESULTS

Analysis of the patients' data revealed that risk factors are dependent on sex. Both, males and females who developed a CD III complication showed elevated blood levels of B7-1 (p = 0.015 and p = 0.018, respectively) and PlGF-1 (p = 0.009 and p = 0.031, respectively), with B7-1 demonstrating greater sensitivity (B7-1: 0.706 (male) and 0.692 (female), PlGF-1: 0.647 (male) and 0.615 (female)). Further analysis of the questionnaires and medical data revealed the importance of additional risk factors. For males (CD 0: 133; CD I: 12; CD III: 18 patients) alcohol consumption was significantly increased for CD I and CD III compared to control with p = 0.009 and p = 0.007, respectively. For females (CD 0: 107; CD I: 10; CD III: 12 patients) a significantly increased average BMI [kg/m2] from 25.5 to 29.7 with CD III was observed, as well as an elevation from one to three comorbidities (p = 0.003).

CONCLUSIONS

These two potential new blood markers hold promise for predicting complication development in trauma patients. Nevertheless, further studies are necessary to evaluate the diagnostic utility of B7-1 and PlGF-1 in predicting complications in trauma patients and consider sex differences before their possible use as routine clinical screening tools.

The Association Between Frailty Evaluated by Clinical Frailty Scale and Mortality of Older Patients in the Emergency Department: A Prospective Cohort Study

Background

Frailty epitomizes the most complex consequence of an aging population. This study aimed to evaluate the impact of frailty, measured using the Clinical Frailty Scale (CFS), on outcomes of older people in an emergency department (ED).

Methods

We conducted a prospective observational study enrolling patients aged 65 years and older in a medical center of Taiwan between March 8, 2021, and November 30, 2021. The primary outcome was 90-day mortality rate. Individuals were categorized into three groups based on the CFS scores. Logistic regression was employed to examine the influence of frailty on clinical outcomes following covariate adjustment. Survival analysis was conducted using Kaplan-Meier curves and Log rank tests.

Results

A total of 473 individuals were included in the study, with a mean age of 82.1 years, and 60.5% of them were males. The 90-day mortality rate was 10.6%. Among these groups, the CFS score 7-9 group had the highest 90-day mortality rate (15.9%), followed by the CFS score 4-6 group (8.0%) and the CFS score 1-3 group (7.1%). The multiple logistic regression analyses demonstrated a significant impact of CFS score on prognosis, with adjusted odd ratios of 1.24 (95% CI 1.06-1.47) for 90-day mortality, 1.18 (95% CI 1.06-1.31) for hospitalization, and 1.30 (95% CI 1.12-1.52) for 180-day mortality. The Kaplan-Meier curves revealed a significantly higher 90-day mortality rate for patients with high CFS scores (Log rank tests, p = 0.019).

Conclusion

In the older ED population, the severity of frailty assessed by the CFS emerged as a significant and important prognostic factor for hospitalization, 90-day mortality, and 180-day mortality.

Functional and Radiological Results Following Revision Blade Plating and Cephalomedullary Nailing in Aseptic Trochanteric and Subtrochanteric Nonunion

Background: Trochanteric and subtrochanteric fractures result in nonunion in more than 20% of cases. The aim of this study was to assess the functional and radiological results following revision cephalomedullary nailing and 95-degree angled blade plating in aseptic trochanteric and subtrochanteric nonunion. Methods: In a retrospective multi-center study between January 2010 and December 2020, a total of 68 consecutive patients (21 women and 47 men) from two European level I trauma centers with the diagnosis of aseptic nonunion were recruited. Follow-up assessment and the patients' convenience were assessed using the Harris Hip Score, Visual Analog Scale for pain at rest and on stress/exertion and Short Form-12. Results: The patients' mean age was 57 (range 26-85) years. After a follow-up period of 12 months, one case of persistent nonunion in the cephalomedullary nail group and 10 cases in the blade plate group were identified. The mean duration of surgery was 137 ± 47 min in the cephalomedullary nail group and 202 ± 59 min in the blade plate group (<0.0001). Short-term postoperative complications included wound dehiscence, bleeding, mismatched screw and hematoma. The mid-term results 12 months after surgical revision demonstrated significantly different osseous union rates (p = 0.018). The long-term functional outcome according to the Harris Hip Score 6 years (range 2-10) after revision surgery demonstrated 81 ± 21 points in the cephalomedullary nail group and 64 ± 23 points in the plate group (p = 0.026). Conclusions: This study demonstrated that the revision treatment of trochanteric and subtrochanteric nonunion using a 95-degree blade plate or cephalomedullary nail resulted in a high percentage of osseous union, with a low incidence of complications and good functional results for both methods.

Prognostic value of the systemic immune-inflammation index in critically ill elderly patients with hip fracture: evidence from MIMIC (2008-2019)

Background

The systemic immune-inflammation index (SII) showed an extensive link between immunological dysfunction and the activation of systemic inflammation. Several studies have confirmed the application of SII to orthopedic diseases. However, the significance of SII in critically ill elderly individuals with hip fracture who require intensive care unit (ICU) admission is not yet known. This study centered on exploring the relationship between SII and clinical outcomes among critically ill elderly hip fracture individuals.

Methods

The study centered around elderly patients experiencing severe illness following hip fractures and requiring admission to the ICU. These patients from the MIMIC-IV database formed the basis of this study's cohort. We stratified them into quartiles according to their SII levels. The results involved the mortality at 30 days and 1 year post-admission. Then we employ Cox proportional hazards regression analysis as well as restricted cubic splines to explore the association between the SII and clinical results in critically ill elderly patients with hip fracture.

Results

The study encompassed 991 participants, among whom 63.98% identified as females. Notably, the mortality rates attributed to any cause within 30 days and 1 year after hospitalization stood at 19.68 and 33.40%, respectively. The multivariate Cox proportional hazards model disclosed a significant correlation between an elevated SII and all-cause mortality. Following adjustments for confounding variables, individuals with a high SII showed a notable correlation with 30-day mortality [adjusted hazard ratio (HR), 1.065; 95% confidence interval (CI), 1.044-1.087; p < 0.001] and 1-year mortality (adjusted HR, 1.051; 95% CI, 1.029-1.074; p < 0.001). Furthermore, the analysis of restricted cubic splines demonstrated a progressive increase in the risk of all-cause death as the SII value rose.

Conclusion

Among critically ill elderly patients with hip fracture, the SII exhibits a non-linear association that positively correlates with both 30-day and 1-year all-cause mortality rates. The revelation indicates that the SII may play a vital role in identifying patients with hip fractures who face an escalated risk of mortality due to any cause.

Correlation between Peripheric Blood Markers and Surgical Invasiveness during Humeral Shaft Fracture Osteosynthesis in Young and Middle-Aged Patients

The treatment for humeral shaft fractures (HSFs) is still controversial, consisting of a wide variety of orthopedic osteosynthesis materials that imply different grades of invasiveness. The aim of this study is to investigate the correlation between inflammatory blood-derived markers and the magnitude of the surgical procedure in young and middle-aged patients who sustained these fractures. Observational, retrospective research was conducted between January 2018 and December 2023. It followed patients diagnosed with recent HFSs (AO/OTA 12-A and B) and followed operative treatment. They were split in two groups, depending on the surgical protocol: group A, operated by closed reduction and internal fixation (CRIF) with intramedullary nails (IMNs), and group B, operated by open reduction and internal fixation (ORIF) with dynamic compression plates (DCPs). Statistically significant differences (p < 0.05) between the two groups could be observed in injury on the basis of surgery durations, surgical times, pre- and postoperative neutrophil-per-lymphocyte ratio (NLR), postoperative platelet-per-lymphocyte ratio (PLR), monocyte-per-lymphocyte ratio (MLR), systemic inflammatory index (SII), systemic inflammatory response index (SIRI) and aggregate inflammatory systemic index (AISI). The multivariate regression model proposed revealed that NLR > 7.99 (p = 0.007), AISI > 1668.58 (p = 0.008), and the surgical times (p < 0.0001) are strongly correlated to the magnitude of the surgical protocol followed. Using receiver operating characteristic (ROC) curve analysis, a balanced reliability was determined for both postoperative NLR > 7.99 (sensitivity 75.0% and specificity 75.6) and AISI > 1668.58 (sensitivity 70.6% and specificity 82.2%). Postoperative NLR and AISI as inflammatory markers are highly associated with the magnitude of surgical trauma sustained during humeral shaft fracture osteosynthesis in a younger population.

Postoperative Hemoglobin Drop and the Associated Factors among Elective Orthopedic Surgeries in Northern Tanzania

Background

Having an estimated level of Hb drop in different orthopedic surgeries would help plan for surgery from pre- to postoperative periods. The aim of this study was to assess the Hb drop and the associated factors during the intraoperative period among elective orthopedic surgeries.

Methods

This was an analytic cross-sectional study conducted between October 2022 and March 2023, which included all patients admitted for elective orthopedic surgery who met the inclusion criteria. Data were collected before and after the patient was operated on. Information was analyzed using t-tests and ANOVA to establish the statistical significance of the Hb drop.

Results

A total of 195 participants were enrolled. The majority of the participants were male (62.1%), with the main etiology of symptoms being motor traffic accidents (31.8%). The most affected site was the femur (36.4%), followed by the spine (23.6%). The highest mean Hb drop was in total hip replacement surgeries (4.19 g/dL), with the overall mean Hb drop being 2.75 g/dL. A statistically significant difference was identified in diathermy use, duration of surgery, and patients with chronic illnesses.

Conclusion

With a mean Hb drop of 2.75 g/dL, the application of diathermy and surgeries with shorter durations resulted in a reduced Hb drop. These factors should be incorporated to minimize the drop in Hb in orthopedic surgeries. Accounting for differences in surgeries, there should not be delays in patients who have a preoperative Hb level that can sustain the mean Hb drop recorded in the study.

Exploring Quality of Life and Mortality in Pertrochanteric Fragility Hip Fractures in Northern Greece: A Single Tertiary Center Study

Background: Fragility-related pertrochanteric fractures have become a significant public health concern, with a rising incidence attributed to the expanding elderly demographic. Assessing patient-reported health-related quality of life (HRQoL), mortality, and factors correlated with them serves as a crucial metric in evaluating the effectiveness of hip fracture surgery. Methods: In a single-center retrospective study, 259 patients underwent surgical treatment with a cephalomedullary nail, with a mean follow-up of 21.7 months. Health-related quality of life (HRQoL) was assessed using SF-12 (12-item Short Form) and EQ-5D (EuroQoL-5 Dimensions) questionnaires. Mobility status was measured by the Crude Mobility Index (CMI). Surveys were administered during hospitalization and six months postoperatively. Statistical analysis involved descriptive statistics, non-parametric controls (Kendall, Mann-Whitney, and Wilcoxon), and Spearman correlation and logistic regression analysis, which were conducted using IBM SPSS version 28. Results: A statistically significant decrease was observed in the mean EQ-5D and SF-12 scores at 6 months post-op compared to the pre-fracture status. The ASA (American Society of Anaesthesiologists) score showed a significant correlation with the decrease in HRQoL measured by the SF-12 questionnaire. The 30-day post-operative mortality rate was 9.3%, increasing to 32.4% at 1 year. Notably, the 30-day mortality significantly rose during the pandemic era (5.0% vs. 12.0%; p = 0.003). Conclusions: Pertrochanteric hip fractures cause a lasting decline in quality of life. Annual mortality is high, and further investigations are needed to formulate policies that prevent hip fractures and reduce mortality rates.

Intraoperative Fracture during the Insertion of Advanced Locking Screws (T2 Alpha Femur Retrograde Intramedullary Nailing System): Report of Two Cases and Identifying Causes and Prevention

Background: Recently, the T2 alpha nailing system (Stryker, Inc.), which has advanced locking screws that can attach a screw to a rod, has been used worldwide and is expected to improve fracture fixation. We analyzed two cases of supracondylar femoral fractures in older adult patients, in which intraoperative fractures occurred during the insertion of advanced locking screws of the T2 alpha femur retrograde intramedullary nail. Case presentation: A 93-year-old and an 82-year-old woman each underwent T2 alpha femur retrograde nail fixation for supracondylar femur fractures at separate hospitals, and advanced locking screws were used as the proximal transverse locking screws. In both patients, a fracture line was observed at the proximal screw postoperatively, and the fractures were refixed with distal cable wiring and/or femoral distal plates. The patients were subsequently discharged from the same facility with no remarkable pain. Conclusions: When inserting advanced locking screws, it is necessary to enlarge the screw hole in the near-bone cortex with a counterbore drill, which might add torque to the bone cortex that could result in fractures. If the sleeve is distant from the bone, the counterbore drill will not reach the bone, the screw hole will not expand, and the insertion of advanced locking screws will apply a strong torque to the bone cortex and may result in fracture. Moreover, it is important to confirm that the counterbore drill is securely inserted under fluoroscopy and to carefully enlarge the bony foramen manually to prevent fractures during screw insertion.

Dysregulation of Inflammatory Pathways in Adult Spinal Deformity Patients with Frailty

Background/Objectives: An important aspect of the pathophysiology of frailty seems to be the dysregulation of inflammatory pathways and the coagulation system. However, an objective assessment of the impact of frailty on the recovery from surgery is not fully studied. This study sought to assess how frailty affects the recovery of adult spinal deformity (ASD) surgery using blood biomarkers. Methods: 153 consecutive ASD patients (age 64 ± 10 yr, 93% female) who had corrective spine surgery in a single institution and reached 2y f/u were included. The subjects were stratified by frailty using the modified frailty index-11 (robust [R] group or prefrail and frail [F] group). Results of commonly employed laboratory tests at baseline, 1, 3, 7, and 14 post-operative days (POD) were compared. Further comparison was performed in propensity-score matched-39 paired patients between the groups by age, curve type, and baseline alignment. A correlation between HRQOLs, major complications, and biomarkers was performed. Results: Among the propensity-score matched groups, CRP was significantly elevated in the F group at POD1,3(POD1; 5.3 ± 3.1 vs. 7.9 ± 4.7 p = 0.02, POD3; 6.6 ± 4.6 vs. 8.9 ± 5.2 p = 0.02). Transaminase was also elevated in the F group at POD3(ASD: 36 ± 15 vs. 51 ± 58 U/L, p = 0.03, ALT: 32 ± 16 vs. 47 ± 55 U/L, p = 0.04). Interestingly, moderate correlation was observed between transaminase at POD1 and 2 y SRS22 (AST; function r = -0.37, mental health r = -0.39, satisfaction -0.28, total r = -0.40, ALT; function r = -0.37, satisfaction -0.34, total r = -0.39). Conclusions: Frailty affected the serum CRP and transaminase differently following ASD surgery. Transaminase at early POD was correlated with 2 y HRQOLs. These findings support the hypothesis that there is a specific physiological basis to the frailty that is characterized in part by increased inflammation and that these physiological differences persist.

Preventing Atrophic Long-Bone Nonunion: Retrospective Analysis at a Level I Trauma Center

Background: Among the risk factors for nonunion are unchangeable patient factors such as the type of injury and comorbidities, and factors that can be influenced by the surgeon such as fracture treatment and the postoperative course. While there are numerous studies analyzing unchangeable factors, there is poor evidence for factors that can be affected by the physician. This raises the need to fill the existing knowledge gaps and lay the foundations for future prevention and in-depth treatment strategies. Therefore, the goal of this study was to illuminate knowledge about nonunion in general and uncover the possible reasons for their development; Methods: This was a retrospective analysis of 327 patients from 2015 to 2020 from a level I trauma center in Germany. Information about patient characteristics, comorbidities, alcohol and nicotine abuse, fracture classification, type of osteosynthesis, etc., was collected. Matched pair analysis was performed, and statistical testing performed specifically for atrophic long-bone nonunion; Results: The type of osteosynthesis significantly affected the development of nonunion, with plate osteosynthesis being a predictor for nonunion. The use of wire cerclage did not affect the development of nonunion, nor did the use of NSAIDs, smoking, alcohol, osteoporosis and BMI; Conclusion: Knowledge about predictors for nonunion and strategies to avoid them can benefit the medical care of patients, possibly preventing the development of nonunion.