[Artículo traducido] Mortalidad a 30 días en pacientes con fractura de fémur proximal durante la pandemia COVID-19 en Vizcaya (País Vasco)

OBJECTIVES

Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection.

DESIGN

Retrospective comparative study.

SETTING

Three university hospitals in Biscay province (Basque Country, Spain).

PATIENTS

77 patients over 65 years-old with PFF (AO 31-A and 31-B).

INTERVENTION

Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test.

MAIN OUTCOME MEASUREMENTS

30-Day mortality rate and risk factors for mortality.

RESULTS

Of a total 77 patients, 10 were diagnosed with SARS-CoV-2 infection. Mean age was 85 years. Patients with SARS-CoV-2 infection had higher BMI (29.53 kg/m²) compared to patients without infection (24.09 kg/m²) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥ 91 years-old, ASA class IV and BMI > 25 kg/m² were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized.

CONCLUSIONS

SARS-CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality.

LEVEL OF EVIDENCE

Level III study.

Prognostic factors after a traumatic hip dislocation. A long-term retrospective study

INTRODUCTION

Traumatic hip dislocations can have devastating complications such as osteoarthritis or osteonecrosis. The aim of this study was to identify the variables and prognostic factors associated with clinical and radiological outcome after a traumatic hip dislocation at long-term follow-up.

MATERIAL AND METHODS

A review was performed of all dislocations and fracture-dislocations of the hip from January 1999 to December 2012. A computed tomography scan was performed after reduction in all cases. The Harris Hip Score and modified Merle-d'Aubigné-Postel method were used for clinical evaluation and radiological assessment was performed according to the Thompson and Epstein classification.

RESULTS

There were 30 cases in 29 patients with a mean follow-up of 11 years (range, 4-17). The great majority were simple dislocations (21; 70%) vs. complex dislocations (9; 30%). Closed reduction was performed in less than 6h in all except one case (29; 96.7%). All of the patients with simple dislocations had an excellent outcome without radiological signs of osteoarthritis at the end of the follow-up (P<.01). Overall, arthritic signs had developed in 4 patients (13.3%) and avascular necrosis was noted in 3 patients (10%). Five patients with intraarticular fragments were treated non-operatively, and 3 of them developed arthritic changes (P<.05).

CONCLUSION

Our study suggests that complex dislocations are associated with poorer functional and radiological outcomes than simple dislocations. We also found a strong association between intraarticular fragments and osteoarthritis, so surgical fragment removal could be considered in these cases.

Cauda equina syndrome secondary to lumbar disc herniation: Surgical delay and its relationship with prognosis

OBJECTIVE

To determine whether surgical treatment delayed for more than 48 hours in patients with cauda equina syndrome (CES) influenced the clinical outcome.

MATERIAL AND METHODS

A retrospective study of 18 patients treated in our hospital from March 2000 to January 2012, after presenting with CES. The pre- and post-operative clinical status was determined: existence of back pain and/or sciatica, sensory disturbance in the perineum, sensory and motor deficits in the lower extremities, and the degree of sphincter incontinence (complete or incomplete CES). A clinical assessment was performed using the Oswestry disability index.

RESULTS

As regards the onset of symptoms, 44% (8 of 18) of patients were treated at an early stage (within 48 hours). None of the patients with complete CES operated in the early stage had urinary incontinence, and also had greater motor recovery. Of the 5 patients with complete CES who underwent delayed surgery, 3 showed residual urinary incontinence. A mean of 12.55 was obtained on the Oswestry disability index scale at the end of follow-up.

CONCLUSION

Although no statistically significant difference was found in our study, we observed greater motor and sphincter recovery in patients who were operated on within 48 hours.

Late sciatic nerve axonotmesis following acetabular reconstruction plate

Sciatic nerve injuries associated with acetabular fractures can be post-traumatic, perioperative or postoperative. Late postoperative injury is very uncommon and can be due to heterotopic ossifications, muscular scarring, or implant migration. A case is presented of a patient with a previous transverse acetabular fracture treated with a reconstruction plate for the posterior column. After 17 years, she presented with progressive pain and motor deficit in the sciatic territory. Radiological and neurophysiological assessments were performed and the patient underwent surgical decompression of the sciatic nerve. A transection of the nerve was observed that was due to extended compression of one of the screws. At 4 years postoperatively, her pain had substantially diminished and the paresthesias in her leg had resolved. However, her motor symptoms did not improve. This case report could be relevant due to this uncommon delayed sciatic nerve injury due to prolonged hardware impingement.