Predictor of hip fracture type: a systematic review.

BACKGROUND & AIM In literature, many risk factors have been related to proximal femur fracture, but most of the studies do not explore differences between femoral neck fractures (FNF) and pertrochanteric fractures (PF). The aim of the paper is to review the current literature n order to assess risk factors associated with a specific pattern of proximal femur fracture.   METHODS Nineteen studies met the inclusion criteria and were taken into consideration in the review. Data reported from the included articles were age, gender of the patient, type of femoral fracture, BMI, height, weight, soft tissue composition, BMD, vitamin D levels, PTH levels, hip morphology and hip osteoarthritis.   RESULTS Bone mineral density (BMD) of the intertochanteric region result significant lower in PF, while BMD in femoral neck regione was lower in FNF. Low levels of Vit D with high PTH are observed in TF whereas low levels of vit D and normal PTH in FNF. Hip osteoarthritis (HOA) is significant less present and less severe in FNF, while in PF is usually more frequent or higher grade.   CONCLUSIONS Patients with pertrochanteric fracture are older, with a low cortical thickness in the femoral isthmus, low BMD in the intertrochanteric region, severe HOA, low mean haemoglobin and albumin levels and hypovitaminosis D with a high PTH levels. Patients with FNF are younger, taller, with higher body fat mass, with lower BMD levels in femoral neck region, mild HOA, hypovitaminosis D without PTH response.

Efficacy of postoperative drainage in total knee arthroplasty: Review of the literature.

Postoperative drainage after total knee arthroplasty (TKA) is an established routine procedure for orthopedic surgeries, and is considered a useful practice in postoperative, but the use of drainage is controversial. Our study aims to clarify this aspect of knee prosthetic surgery. A systematic review of the literature was performed in the electronic databases to investigate the risks and the benefits of wound drainage in total knee arthroplasty: 30 articles were included in our review for eligibility. After the analysis of the literature performed, we found no significant advantages related with the use of wound drain following total knee replacement (TKR) in terms of pain, transfusion rate, blood loss, swelling, postoperative range of motion, wound complications, deep infection and hospital stay, while no drainage means a significant cost saving compared to drainage use. Thus, the use of drainage after TKA cannot be justified on the basis of the results of this study.

Surgical approach for fracture of distal humerus: Posterior vs lateral.

Humeral fractures have an incidence of 3-5% and a bimodal age distribution. They may occur in young patients after highenergy traumas or in elderly osteoporotic patients after low-energy injuries. In nondisplaced fractures or in elderly patients, humeral fractures are treated by conservative methods. Open reduction and internal fixation (ORIF) should be the treatment of choice in case of multi-fragmentary fractures associated with radial nerve palsy or not. ORIF is usually regarded as the gold standard treatment, but, depending on the different types of fracture, the surgical approach can change. In this review, we compare results and complication rates between lateral and posterior surgical approaches in the management of extraarticular distal humeral shaft fractures. An internet-based literature research was performed on Pubmed, Google Scholars and Cochrane Library. 265 patients were enrolled: 148 were treated by lateral or antero-lateral approach, while 117 by posterior or postero-lateral approach. The literature shows that no differences between the posterior and lateral approach exist. Certainly, the posterior approach offers undoubted advantages in terms of exposure of the fracture and visualization of the radial nerve. In our opinion, the posterior approach may also allow better management of complex and multi-fragmentary fractures.

Fibrin sealant reduces need for transfusions after hip hemiarthroplasty for femoral neck fractures.

INTRODUCTION: Every year more than 300,000 proximal femur fractures are diagnosed. Their number will double within 30 years. In femoral neck fractures treated with hip hemiarthroplasty 90-days mortality is 29.5-51.6%. Haemorrhage is one amongst other complications that is associated with increasing postoperative mortality. Transfusion rate in these patients ranges from 25.7% to 39%. Blood transfusions expose to complications. Fibrin sealants are useful in reducing perioperative need for transfusions, total blood loss, blood loss from drainage. The aim of this study is to assess whether the use of a fibrin sealant during hip hemiarthroplasty implant reduces the need for transfusion. PATIENT AND METHODS: All patients admitted with a proximal femur fracture from September 2018 to May 2019 were reviewed. Inclusion criteria were: femoral neck fracture AO 31B2-3, hip hemiarthroplasty. Exclusion criteria were: previous surgery on the affected hip, coagulation disorders, hematopoietic disorders. Patients were divided in fibrin sealant group and control group. All patients underwent partial hip replacement through a posterolateral approach. 4 ml of fibrin sealant (EVICEL, Omrix Biopharmaceuticals, Diegem, Belgium) were sprayed on the soft tissues of patients included in the fibrin sealant group. Primary outcome of our study was need for perioperative transfusion. Secondary outcomes were: mean red blood cell transfused volume, variations in haematocrit and haemoglobin and total blood volume loss. RESULTS: Eighty-one consecutive patients were enrolled. EVICEL was used on 19 patients, standard haemostatic care on 62 patients. Two patients were transfused in the fibrin sealant group, 22 in the control group (p 0,0371). Mean transfused volume was 21,05 ml in the fibrin sealant group and 116,16 ml in the control group (p 0,0017). No significant difference could be found in haematocrit and haemoglobin variation and total blood loss. DISCUSSION: A reduction in transfusional need with the use of fibrin sealants was reported in studies on total hip arthroplasty and was confirmed by our study. CONCLUSION: EVICEL reduces need for transfusion in patients undergoing hip hemiarthroplasty for a femoral neck fracture. It must be held among the options when a stricter control on transfusional requirement is needed.