Outcomes of cement augmentation in fragility trochanteric hip fractures - A multicenter randomized controlled trial follow-up.

PURPOSE: Cement augmentation is considered to improve the bone-implant construct stability in hip fragility fractures, additionally biomechanical studies show that cement augmentation improves the pull-out strength and increases resistance to failure. Thus far, the advantage of these technique used in a clinical scenario is yet to be determined METHODS: a randomized, multicenter, single-blinded clinical trial was conducted in patients aged 65 years or older who were admitted to two level I trauma centers with a fragility intertrochanteric hip fracture during September 2015 and December 2017. Patients were stratified into 2 groups: patients between 65 and 85 years and older than 85 years. A balanced block randomization was performed using blocks of 6 patients: 3 patients assigned to the control group (no augmentation) and 3 patients to the intervention group. Follow-up visits were done at 1, 3, 6 and 12 postoperative months documenting the tip-apex distance (TAD) as well as followed up after 5 to 7 years of surgical procedure documenting EQ5D, Parker Mobility Score and mortality rates at these different time points. RESULTS: A total of 90 patients were included but only 53 patients completed a one-year follow up. The mean immediate postoperative and one-year follow up TAD measurement from the whole cohort (20.99 mm vs 21.3 mm, respectively) showed no statistical significance (P = 0.18). For patients in the control group, the difference of TAD measurements from the immediate postoperative and one-year follow-up was -0.25 mm (P = 0.441). For patients included in the intervention group, the difference of TAD measurement from the immediate postoperative and 1-year follow up was -0.48 mm (P = 0.383). No statistical difference was found when stratified by age (p = 0.78). One patient from the control group had an implant failure after 1-month postoperative. Readmission after 30 days showed no statistical difference between both groups (7 vs. 7 patients, p = 0.754). Augmentation did not show a difference in most of the functional outcomes nor quality of life after 5 to 7 years of surgical procedure. CONCLUSIONS: The use of augmentation can be considered a safe procedure for the fixation of fragility hip fractures.

Conservative management of warthin tumour.

BACKGROUND: Warthin tumour (WT) is usually treated by surgery to establish a histologic diagnosis. Conservative management is considered appropriate for patients with significant comorbidities, making anesthesia high risk. Preoperative fine-needle aspiration cytology (FNAC) is useful in diagnosing WT, making conservative management an option. In our institution, patients with an FNAC diagnostic of WT have the option of conservative management. METHOD: Retrospective review of cases of WT over 10 years (1996-2006) to study the demographics of patients treated conservatively and surgically and to establish the accuracy of FNAC. RESULTS: Eighty-six cases of WT were identified during the study period for which FNAC was diagnostic, of which 58 cases (67.4%) were treated conservatively and 28 cases (32.6%) were treated by superficial parotidectomy. A further seven cases of WT were diagnosed on histology as the corresponding FNAC was incorrect in two cases and nondiagnostic in five cases. With regard to WT, FNAC in our unit had a sensitivity of 80% and a specificity of 100%. Females accounted for 54.7% of cases, which is much higher than previously reported and likely reflects the high prevalence of smoking among females in Liverpool. CONCLUSION: Conservative management for WT on the basis of a diagnostic FNAC was employed in 67.4% of cases. This included young patients who preferred to avoid surgery. Conservative management is a viable option if reliable cytologic reporting is available.