Comparison of morbidity and mortality of hip and vertebral fragility fractures: Which one has the highest burden?

Objectives@#Hip fragility fractures were regarded as one of the most severe, but recent papers report on the underestimated burden of vertebral compression fractures. This study aims to compare morbidity and mortality of hip and vertebral fragility fractures in patients treated in the same setting. @*Methods@#Patients aged 50 years with hip fracture, and those with vertebral fracture presenting to our hospital between January 2014 and January 2017 were included. Patients were evaluated 1 year after their index fracture. SF-36 scores, mortality, and institutionalization are then recorded. Patients were divided into 2 groups: hip fractures and vertebral fractures. @*Results@#There were 106 and 90 patients respectively evaluated in hip and vertebral fracture groups at 1 year. Patients in both groups were comparable for age, sex, comorbidities and neuropsychiatric condition (P > 0.05). At 1 year follow-up, SF-36 showed better averages in all 8 scales in hip fracture group compared to vertebral fracture group. Mortality in the hip fracture group reached 32.1% compared to 10% for the vertebral fracture group (P 0.05). @*Conclusions@#When comparing patients treated in the same setting, hip fracture is associated with significantly increased mortality than vertebral fracture; however, the latter is associated with more morbidity.

Etiology, Evaluation, and Treatment of Failed Back Surgery Syndrome

The study aimed to review the etiology of failed back surgery syndrome (FBSS) and to propose a treatment algorithm based on a systematic review of the current literature and individual experience. FBSS is a term that groups the conditions with recurring low back pain after spine surgery with or without a radicular component. Since the information on FBSS incidence is limited, data needs to be retrieved from old studies. It is generally accepted that its incidence ranges between 10% and 40% after lumbar laminectomy with or without fusion. Although the etiology of FBSS is not completely understood, it is possibly multifactorial, and the causative factors may be categorized into preoperative, operative, and postoperative factors. The evaluation of patients with FBSS symptoms should ideally initiate with reviewing the patients' clinical history (observing “red flags”), followed by a detailed clinical examination and imaging (whole-body X-ray, magnetic resonance imaging, and computed tomography). FBSS is a complex and difficult pathology, and its accurate diagnosis is of utmost importance. Its management should be multidisciplinary, and special attention should be provided to cases of recurrent disc herniation and postoperative spinal imbalance.

Pronating osteotomy of the forearm for obstetrical brachial plexus palsy with supination deformity: The first cohort to show functional improvement

Introduction: Supination contracture in patients with obstetrical brachial plexus paralysis [OBPP] results in severe functional limitation of daily activities. Forearm pronation osteotomy has been used to address this problem, although the functional benefit over nonoperative management has not yet been clearly defined

Material and methods: This is a retrospective chart review of children with OBPP who underwent a pronating forearm osteotomy for their supination contracture at our institution between 2007 and 2014. Patients were evaluated for resting forearm position, forearm passive and active pronation and supination, preoperatively and at their last followup. Age correlation to outcomes was also tested. A subjective assessment tool for improvement was also used to evaluate patient-oriented outcomes

Results: Eighteen patients with a mean age of 8.5 years [3.7-17] and a mean follow-up of 55 months [24-100] were included. Preoperatively, patients had a forearm resting position of - 90 degree . Mean passive pronation was -45 degree [-30 degree to - 60 degree]. All patients had no active pronation. At their last follow-up, mean forearm resting position was - 4 degree [- 45 degree to +10 degree ;p < 0.001], mean active pronation was +26 degree [0 degree to +60 degree ; p < 0.001], mean passive pronation reached + 76 degree [+ 50 degree to + 90 degree ; p < 0.001], mean active supination was - 37 degree [- 50 degree to - 25 degree ; [p < 0.001] and mean passive supination was - 80 degree [- 90 degree to - 73 degree ; p < 0.001]. There were no correlation between age at surgery and final outcomes. Subjective self-assessment tool showed a mean partial improvement in all five tested headings

Discussion: Pronation osteotomy in OBPP patients with supination contracture is an effective reliable procedure with reproducible results. It seems to be associated with partially improved functional results in the postoperative period. While recurrence is possible, age at surgical intervention does not seem to affect the final outcome

Epidermal inclusion cyst mistaken for a post-traumatic chronic prepatellar bursitis a case report

A variety of cystic lesions are encountered around the knee joint. Particularly, the prepatellar region is the site of soft tissue lesions including mainly bursal fluid collections, joint synovial herniation and tendons ganglia. We report here the case of an exceptional prepatellar posttraumatic epidermal inclusion cyst mistaken for a prepatellar bursitis. With this case report, orthopedic surgeons should widen the array of the differential diagnosis in patients presenting with a post-traumatic prepatellar slow growing soft tissue mass, making epidermoid inclusion cyst a valid possibility to consider