Does delay from injury to surgery increase the risk of dislocation of a hip hemiarthroplasty?

Dislocation of a hip hemiarthroplasty used to treat a hip fracture is a serious complication. The aim of this study was to identify whether a delay in the time from fracture to surgery causes an increase in the rate of post-operative hip dislocation. From a single center, data from intracapsular neck of femur patients treated with hip hemiarthroplasty was collected between October 1986 to August 2021. The time from both fall to surgery and admission to surgery was recorded. Surviving patients were followed up for one year. The overall dislocation rate was 51 out of 4155 patients (1.2%). The 3019 patients who had surgery within two days of the injury had a lowest dislocation rate (29 dislocations, 0.96%). For the 197 patients with no history of a fall, there were 5 (2.5%) dislocations (p=0.036, 95% confidence interval of difference 0.15 to 0.97 for comparison with surgery within two days). For the 399 patients with a delay of more than four days from injury till surgery, there were nine dislocations (2.3%) (p=0.045, 95% confidence intervals of difference 0.20 to 0.89 for comparison with surgery within two days). This study demonstrates an increase in the risk of dislocation for those patients with no history of a fall and those with a delay of more than four days from injury to surgery.

The floating hip injury: a descriptive study and case-control analysis.

PURPOSE: A "floating hip" (FH) injury is a rare injury describing the simultaneous ipsilateral fracture of the femur and pelvis or acetabulum (P/A). We describe our experience with patients presenting with FH injuries and compare them to controls with similar P/A fractures but without femoral involvement. METHODS: Medical records and radiographs of FH patients and controls presenting to our tertiary centre between 2015 and 2020 were reviewed. Follow-up data from outpatient clinical records were also extracted. The control group were extensively matched by age, sex, body mass index, fracture classification and energy of injury. RESULTS: From 1392 recorded P/A fractures, 42 FH cases were identified (average age 39 years, 78.6% males). The most common femoral fracture was the midshaft (35.7%), followed by the neck of femur (26.2%). 90.5% of FH injuries were due to high-energy mechanisms. 64.3% of P/A fractures, and 100% of femoral fractures were managed surgically. Compared to controls, FH cases were more likely to have additional orthopaedic injuries (73.8% vs. 40.5%, p = 0.002), more total theatre admissions (mean 2.5 vs. 1.19, p < 0.001), longer hospital stays (28.3 vs. 14.9 days, p = 0.02), and a higher rates of post-op complications (53.8% vs. 20%, p = 0.025). CONCLUSIONS: We report differences in the presentation, management, and outcomes of FH injuries versus controls, even after extensive matching for confounders. These differences may inform future treatment strategies for the FH injury.

Diagnostic value of full-length femur radiographs in patients with neck of femur fracture and co-existing malignancy.

PURPOSE: In the UK, it is common practice to obtain full-length femur radiographs in patients admitted with neck of femur fractures (NOF) and co-existing malignancy. Limited literature exists studying this topic. Our aim was to identify whether full-length femur radiographs are of diagnostic and therapeutic value in this demographic. METHODS: A retrospective observational analysis of the patients admitted with a neck of femur fracture over a 5-year period (2015-2020) using the National Hip Fracture Database was performed at a major trauma centre. Electronic patient records were accessed to screen the NOF patients who had co-existing malignancy and subsequently underwent a full-length femur radiograph. In addition to patient demographics, we also identified the plan and whether it was affected by findings of the full-length radiograph, the operation performed, any additional investigations undertaken for malignancy, the type of cancer, complications and 1-year mortality. RESULTS: Of the 2416 patients screened, 18% had a co-existing malignancy (n = 431). Of the 431 with underlying malignancy, 424 patients underwent a full-length femur radiograph while only seven of these radiographs identified lesions. From the seven patients with findings of metastatic deposits on full-length radiographs, none required an alternative operation to that which they normally would undergo. Furthermore, no patients required a longer stem arthroplasty or longer internal fixation. One in four fractures was associated with co-existing breast malignancy (26.5%, n = 114), followed by prostate cancer (14.8%, n = 64). Colorectal, lung, bladder and skin (squamous cell carcinoma) contributed 6-10% (n = 44, 40, 33, 29, respectively). Other malignancies contributed to the rest of the 25%. CONCLUSION: To conclude, full-length radiographs had no diagnostic or therapeutic value in our cohort of patients regardless of the full-length femur findings.

Large adrenal mass heralding the diagnosis of occult extra-adrenal malignancy in two patients.

We report two cases highlighting the role of fluorine-18-fluorodeoxyglucose positron emission tomography/computerised tomography (18F FDG PET/CT) in the diagnostic and preoperative workup of indeterminate adrenal masses. Case 1: a 60-year-old man was diagnosed with a large left-sided adrenal mass with indeterminate radiological characteristics on CT. Biochemical investigations ruled out tumour hypersecretion. 18F FDG PET/CT was performed to exclude metastases and identified a pulmonary nodule in the left upper lobe. Histology of the resected adrenal tumour demonstrated a secondary metastasis from an adenocarcinoma of the lung. Case 2: an 88-year-old male was found to have a heterogeneous and vascular left-sided suprarenal mass and a smaller right-sided adrenal nodule. Both adrenal nodules had indeterminate radiological characteristics. Biochemical investigations were negative. PET/CT demonstrated high avidity in the bilateral adrenal nodules but no extra-adrenal FDG avid disease. Histology demonstrated a metastatic carcinoma of pulmonary origin.