Application of an in-hospital, surgeon-led anti-osteoporotic medication algorithm in patients with hip fractures improves persistence to medication and can prevent the second fragility fracture.

INTRODUCTION: Secondary fracture prevention is an essential part of hip fracture treatment. Despite this, many patients are discharged without the appropriate anti-osteoporotic medication. The aim of this study is to report the outcomes of the application of an in-hospital, surgeon-led anti-osteoporotic medication algorithm to patients with hip fractures. MATERIALS AND METHODS: This prospective cohort study followed patients with hip fractures who were treated at a tertiary referral hospital between 2020 and 2022. At discharge, anti-osteoporotic medication according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) Foundation algorithm was prescribed to all patients. Multivariate Cox regression analysis was used to investigate the risks of non-persistence to medication and of secondary fracture. RESULTS: Two hundred thirteen consecutive patients were prospectively followed. Mean follow-up was 17.2 ± 7.1 months. Persistence to medication at 2 years was 58% (95%CI 51-65%). A secondary osteoporotic fracture occurred in 1/126 (0.8%) persistent patients and 9/87 (11.4%) non-persistent patients. Multivariable Cox regression analysis confirmed that persistence to medication was significantly associated with a lower risk of secondary fracture (cause-specific hazard ratio [csHR] 0.05; 95%CI 0.01-0.45; p = 0.007). CONCLUSION: The application of the surgeon-led AO Foundation algorithm enables the in-hospital initiation of anti-osteoporotic treatment, leading to better persistence to medication and decreased incidence of secondary osteoporotic fractures.

Femoral 3-in-1 Nerve Block for Total Knee Replacement, an Analgesic Approach Not to Be Neglected. Single Center Experience and Literature Review.

OBJECTIVES: Total Knee Replacement Surgery (TKR) is one of the most common elective orthopedic operations. Postoperative pain after total knee replacement, remains a challenge. In this retrospective observational study, we evaluated the effectiveness of 3-in-1 nerve block in patients after total knee arthroplasty compared to standard opioid treatment, and we state the reasons why this approach should still be considered. METHODS: To evaluate the effectiveness of the 3-in-1 nerve block, we assessed the acute pain service archive and compared the values of the visual analog scale, by separating patients into two groups according to the analgesic regimen they received as per local protocols. In group A, patients received 0.25% bupivacaine through a 3 in 1 block catheter and additional meperidine IM if needed, while in group B they received meperidine every six hours. RESULTS: Our analysis showed the statistically significant better effectiveness of 3-in-1 nerve block with bupivacaine administration in postoperative TKR pain control compared to repeated administration of meperidine. CONCLUSION: The results of our study suggest that 3-in-1 nerve block with bupivacaine is an option that must always be considered in order to alleviate post-operative pain after TKR.

Elbow heterotopic ossification after distal biceps tendon repair presenting as median nerve neuropathy: A case report.

Ruptures of the distal attachment of the biceps brachii are rare injuries that typically occur in the dominant arm of men between the third and fourth decade of life. Surgical repair is indicated in active patients. Complications of surgical repair include neurovascular injury, heterotopic ossification, wound infection, elbow stiffness and re-rupture. Heterotopic ossification of the elbow is a rare complication of distal biceps tendon repair operations. It may be entirely asymptomatic or present with symptoms and signs such as swelling, erythema, pain, palpable mass, vascular and nerve compression or joint movement restriction. We present a case of heterotopic ossification presenting as median nerve neuropathy after distal biceps tendon repair using a limited volar single incision.

Patient-Reported Outcome Measures (PROMs) Relevant to Musculoskeletal Conditions Translated and Validated in the Greek Language: A COSMIN-Based Systematic Review of Measurement Properties.

BACKGROUND: The use of patient-reported outcome measures (PROMs) constitutes a valuable tool in evaluating the quality of care offered in orthopaedic surgery. The aim of this review is to identify the PROMs that have been translated into and validated in the Greek language, summarise their measurement properties, and evaluate their methodological quality according to the COSMIN Risk of Bias Checklist. METHODS: A structured literature search was conducted using the databases PubMED/MEDLINE, Embase, Scopus, and the Cochrane Library in order to identify PROMs relevant to musculoskeletal conditions translated and validated in the Greek language. The methodological quality of the studies was assessed according to the COSMIN Risk of Bias Checklist, and the quality of measurement properties according to the COMSIN criteria. RESULTS: Literature search yielded 6743 articles. After removal of duplicates and screening of the articles, 32 studies including PROMs related to musculoskeletal conditions were identified. The studies included 31 PROMs and reported 171 measurement properties. Methodological quality was adequate for 81 of them (47.3%). The most commonly reported measurement properties were internal consistency, reliability, construct validity and responsiveness. CONCLUSION: The majority of PROMs translated into Greek involves the lower extremity and especially knee pathologies. The search revealed that there are areas of Musculoskeletal Medicine such as skeletal trauma, musculoskeletal oncology, and paediatric orthopaedics in which patient reported-outcome measures have not been translated into Greek. Translation and validation of new outcome measures is encouraged, using studies designed in compliance with the COSMIN guidelines, and further validation of the translated instruments.

Anterior hip dislocation with simultaneous anterior column and anterior wall acetabular fracture: A case report.

INTRODUCTION: Isolated anterior column and anterior wall fractures are a relatively rare subgroup of acetabular fractures. They represent 6,3% of all acetabular fractures. Surgical treatment is indicated for fractures with displacement more than 5 mm and when incongruence of the articular surface and/or instability of the joint is evident, in order to allow early mobilization and prevent further complications, such as posttraumatic hip arthritis. Open reduction and internal fixation is the usual standard of care. Closed reduction and percutaneous fixation can be performed in minimally displaced fractures. In the herein article, we describe the unique combination of anterior hip dislocation along with anterior column and anterior wall fractures in a middle-aged patient, after a fall from small height. CASE REPORT: A 56-year-old female patient was brought to the emergency department after an accidental fall from height less than 2 m. Upon arrival her right hip was abducted, shortened and externally rotated. CT scan of the pelvis revealed anterior dislocation of the right hip, an impaction injury of the femoral head, and fractures of anterior column and anterior wall of the acetabulum. Closed reduction of the hip was performed. Open reduction and internal fixation of the fractures was carried out utilizing the extended Smith-Petersen approach in a scheduled manner 5 days after admission. At one-year follow-up after the injury the patient had returned to all of her pre-injury activities and she was able to walk exercising full weight bearing without residual pain. CONCLUSION: Anterior hip dislocation with simultaneous isolated anterior column and anterior wall fracture is an injury of rare incidence. Orthopaedic surgeons treating fractures should be aware of this entity and the herein article can serve as a reference regarding the management of such an uncommon injury.

Anterior Column and Anterior Dome Marginal Impaction Acetabular Fracture Treated with a Modified Smith-Petersen Approach along with Anterior Superior Iliac Spine Osteotomy using the Two-level Reconstruction Technique.

Introduction: A case of anterior column (AC) and anterior dome marginal impaction acetabular fracture with concomitant injury of the common femoral artery (CFA) is presented. Case Report: A 31-year-old patient suffered an anterior hip dislocation with ipsilateral fracture of the AC of the acetabulum and anterior dome impaction along with CFA injury. The fracture was treated utilizing the Smith-Petersen approach along with Anterior Superior Iliac Spine osteotomy. The impacted anterior dome and was stabilized using the two-level reconstruction technique. The patient was mobilized the first post-operative day and toe-touch weight bearing was exercised for 12 weeks. At 36 months post-operative, the patient was free of any hip symptoms and no radiographic signs of hip arthritis were present. Conclusions: This above surgical approach provided adequate exposure of the anterior dome impaction fracture with subsequent excellent reduction and secure fixation. Surgeons treating these types of injuries should be aware of this surgical option.

International trauma care: initial European approaches during the COVID 19 pandemic.

The world was not prepared for the global of pandemic in early 2020 with the arrival of COVID 19. Europe has some of the most developed health care systems in the world and this article explains the initial response to the pandemic from an orthopaedic and trauma viewpoint from 8 nations. Italy reported the first cluster in February, which then rapidly spread around the continent, requiring a rapid reorganization of services. The reports highlight how elective surgery was universally stopped, surgical services were reconfigured, and new practices, such as the widespread use of telemedicine, may well become permanent. It also emphasizes how the pandemic has re-educated us on the importance of a consistent and central approach to deal with a global health crisis, and how medical services need to remain flexible and responsive to new ways of working.

Fracture blisters: pathophysiology and management.

Open fractures are considered an orthopaedic emergency due to the severe soft tissue disruption that might potentially lead to devastating complications. On the other hand, closed fractures, and especially those resulting from high-energy mechanisms, are also often accompanied by severe soft tissue trauma. Soft tissue envelope compromise can have a detrimental effect on the final outcome of the patients. Fracture blisters in particular, develop as a sign of significant local tissue trauma and appear in a time period between 6 to 72 hours post-injury. They can delay the definitive fracture treatment for a considerable amount of time and at the same time they also increase the risk for post-operative wound complications. Awareness of fracture blisters pathophysiology and their management options are crucial for orthopaedic surgeons, in order to achieve a favorable clinical outcome. In the herein study we present a concise synopsis of the pathophysiology pathways and management options of fracture blisters.

Polyphenolic compounds and antioxidants of skin and berry grapes of Greek Vitis vinifera cultivars in relation to climate conditions.

The Greek vineyard is home to many minor, indigenous grape cultivar whose diverse polyphenolic content has remained largely unexploited. The study aimed at assaying and assessing the polyphenolic content and antioxidant capacity of: (a) five obscure cultivars; (b) Six biotypes of cultivar 'Liatiko'; (c) Five prominent cultivars; and (d) three French varieties included for comparison reasons. Results revealed all samples exhibiting high polyphenol content and antioxidant capacity levels. 'Vertzami' recorded the highest concentrations in berry skins total anthocyanins, flavanols, flavonols, antioxidant capacity. 'Mandilaria' scored the highest value in seed total flavanols compared to all biotypes and cultivars. All 'Liatiko' biotypes scored the highest concentrations in seed total flavonoids and flavonols. 'Liatiko' and its biotypes exhibited different polyphenolic profiles between them. Owing to the climate change, those indigenous varieties' substantial polyphenol amounts, and the differences between biotypes, will allow viticulturists to select the varieties/biotypes most appropriate for obtaining higher quality products.

Ulnar Nerve Injuries Post Closed Forearm Fractures in Paediatric Population: A Review of the Literature.

Ulnar nerve injury as a result of closed forearm fractures in children is a rare but disastrous complication, affecting significantly the function of the upper extremity. The management of these injuries is still controversial in the literature. This is a review of small case series and case reports, in which an algorithm of treatment is proposed. A brief description of a relative case, which was treated successfully in our department, is presented as well. This case motivated the authors to perform this study.

Hand compartment syndrome as a result of intravenous contrast extravasation.

Hand compartment syndrome is a rare condition which can result from crush injuries, fractures, burns, intravenous fluid extravasation, etc. Failing to recognize and treat it early leads to significant functional deficits of the hand. Few cases of iatrogenic hand compartment syndrome have been described in the literature so far. We present a case of a hand intravenous (IV) contrast medium extravasation injury in a 72-year-old female patient, during a CT scan. As soon as the swelling of the hand was noticed, elevation of the limb was suggested and ice was applied. Few hours later though the patient developed compartment syndrome of the hand with paresthesias and severe pain with passive movement of the fingers. Left hand emergent fasciotomies were performed leading to a good functional outcome.

Expansionary Adaptive Transformations of Socio-Hydrological Systems (SHSs): The Case of Drought in Messara Plain, Crete, Greece.

The paper attempts to document the ontology of socio-hydrological systems (SHSs), propose approaches of delimitation of SHSs' (territorial) boundaries, and investigate operational aspects of their adaptation to drought including repercussions on sustainability. To this end, a series of hypotheses are tested: (a) SHSs contain social subsystems with different expectations regarding water resources, different adaptive capacities, adaptation limits and prospects of sustainability, (b) SHSs do not adapt homogenously; some of their subsystems manage optimum adaptation, others fail to adapt and (c) territorial transformation of SHSs (e.g., through expansion of SHSs) may be the result of differential adaptation and sustainability potential within the SHS owing to power relations. After testing above hypotheses in the SHS of Messara Plain, Crete, the authors found out that powerful and dynamic sub-SHSs expand or break the boundaries of the initial SHS by establishing new relationships with other SHSs for the sake of resilience resources. Conversely, powerless sub-SHSs incapable to adapt descend and disappear. Therefore, territorial transformation of SHSs comes about from a combination of successful and failed adaptations, or in other words from different adaptation limits within SHSs. Consequently, water management and local development planning to guarantee adaptability to drought for all should be based on SHSs' analysis and management, not on jurisdictional areas or hydrological basins.