Hip hemiarthroplasty for femoral neck fractures in end-stage renal disease patients on dialysis compared to patients with late-stage chronic kidney disease

INTRODUCTION@#Hip fractures in patients with end-stage renal disease (ESRD) are associated with frequent complications and poorer outcomes. Patients on chronic dialysis are at additional risk of dialysis-related complications such as myocardial infarction and early osteolysis. We analysed the complications and implant survivorship of hemiarthroplasty in patients with femoral neck fractures with late-stage chronic kidney disease with and without pre-existing dialysis.@*METHODS@#We conducted a retrospective case-control study of 28 patients with ESRD and 31 patients with chronic kidney disease (CKD) Stages 3-5, who had a total of 62 fractures treated with hemiarthroplasty between 2005 and 2015. The mean age of the patients was 68.33 (50.21-86.45) years. The mean follow-up time of the group was 39 months. Patient demographics, complications, outcomes and follow-up radiographs were analysed for differences.@*RESULTS@#Patient in both groups had statistically similar demographics and comorbidity scores except for a higher incidence of hyperparathyroidism in ESRD patients on chronic dialysis (nine patients vs. zero patients; p = 0.001). These patients were more likely to develop cardiopulmonary complications in the perioperative period (odds ratio [OR] 5.04; p = 0.04) and implant loosening on radiographic analysis (OR 8.75; p = 0.02). The incidence of loosening was higher in patients with hyperparathyroidism (OR 9.80; p = 0.002). Cemented techniques, however, did not appear to be significantly associated with intraoperative fractures or loosening.@*CONCLUSION@#Patients with ESRD on chronic dialysis were more likely to develop cardiopulmonary complications and implant loosening after hemiarthroplasty for femoral neck fractures. Hyperparathyroidism should be optimised, as it may prevent loosening. Our study did not show any difference in complications or outcomes for cemented fixation.

Simultaneous Bilateral Proximal Humeri Anterior Fracture Dislocations in a Patient with 1st Onset Seizure. A Case Report and Review of the Literature

Bilateral anterior fracture-dislocations of humeral neck in a patient with seizure are extremely rare. We describe a rare case of a 33 -year-old Chinese gentleman who presented post seizure secondary to subdural gliosis, sequelae from a previous subdural haematoma. Following physical examination and radiographic assessment, including a Computed Tomography scan (CT scan), Rarely fracturedislocation of bilateral proximal humeri were diagnosed; similar fracture patterns were noted. Open reduction and internal fixation with PHILOS proximal humeral locking plate allowed early shoulder rehabilitation.