Treatment of periprosthetic supracondylar fractures after CR total knee arthroplasty with retrograde intramedullary nailing in an elderly population: a long term evaluation.

Retrograde intramedullary fixation has been proposed to improve the rate of union providing greater stability in patients with a posterior cruciate ligament retaining femoral TKA component and decreasing soft-tissue trauma. This study assessed the clinical and radiographical outcome of retrograde intramedullary nailing (RIN) for the treatment of periprosthetic supracondylar fractures of the femur in an elderly population. Between January 2014 and December 2018, 16 patients with PSF underwent RIN. The clinical outcome was evaluated using the Knee Society Score (KSS) and the Short-form health survey (SF-12). The radiographic outcome was evaluated directly on the X-rays. Complications were also described. 13 patients (11 females and 2 males) with a mean age of 84 years old (range, 77-89) were evaluated clinically and radiographically, after a mean of 48.3 months (range, 24-73 months). The SF-12 scores were similar to normative values for subjects in the comparable age group. Radiographic union was obtained in all patients after an average of 14,8 weeks (range, 12-40 weeks) postoperatively. RIN is a safe and effective treatment for PSF, above all in the elderly population. The overall clinical and radiographic result was satisfactory.

Assessment of deep vein thrombosis using routine pre- and postoperative duplex Doppler ultrasound in patients with pelvic trauma : a prospective study.

AIMS: The aims of this study were to assess the pre- and postoperative incidence of deep vein thrombosis (DVT) using routine duplex Doppler ultrasound (DUS), to assess the incidence of pulmonary embolism (PE) using CT angiography, and to identify the factors that predict postoperative DVT in patients with a pelvic and/or acetabular fracture. METHODS: All patients treated surgically for a pelvic and/or acetabular fracture between October 2016 and January 2020 were enrolled into this prospective single-centre study. The demographic, medical, and surgical details of the patients were recorded. DVT screening of the lower limbs was routinely performed using DUS before and at six to ten days after surgery. CT angiography was used in patients who were suspected of having PE. Age-adjusted univariate and stepwise multiple logistic regression analysis were used to determine the association between explanatory variables and postoperative DVT. RESULTS: A total of 191 patients were included. A DVT was found preoperatively in 12 patients (6.3%), of which six were proximal. A postoperative DVT was found in 42 patients (22%), of which 27 were proximal. Eight patients (4.2%) had a PE, which was secondary to a DVT in three. None of the 12 patients in whom a vena cava filter was implanted prophylactically had a PE. Multivariate logistic regression analysis indicated that the association with the need for spinal surgery (odds ratio (OR) 19.78 (95% confidence interval (CI) 1.12 to 348.08); p = 0.041), intramedullary nailing of a long bone fracture (OR 4.44 (95% CI 1.05 to 18.86); p = 0.043), an operating time > two hours (OR 3.28 (95% CI 1.09 to 9.88); p = 0.035), and additional trauma surgery (OR 3.1 (95% CI 1.03 to 9.45); p = 0.045) were statistically the most relevant independent predictors of a postoperative DVT. CONCLUSION: The acknowledgement of the risk factors for the development of a DVT and their weight is crucial to set a threshold for the index of suspicion for this diagnosis by medical staff. We suggest the routine use of the DUS screening for DVT in patients with a pelvic and/or acetabular fracture before and six to ten days after surgery. Cite this article: Bone Joint J 2022;104-B(2):283-289.

Surgical results and factors influencing outcome in patients with posterior wall acetabular fracture.

The purpose of this study was to evaluate the results of open reduction and internal fixation in a large series of posterior wall fractures of the acetabulum and to identify the factors that affect the outcomes in this case series. One hundred twenty-one patients who had undergone open reduction and internal fixation of a fracture of the posterior wall of the acetabulum were assessed at a mean of 53 months (range, 24-163) after surgery. The functional outcome was evaluated with use of the modified Merle d'Aubigne scoring system, the Harris Hip Score (HHS), and the Short Form-36 Health Survey (SF-36) questionnaire. Final follow-up radiographs were graded according to Matta's radiologic criteria. Patient, fracture, and radiographic variables were analyzed to identify possible associations with functional and radiographic outcome. The quality of fracture reduction on postoperative radiographs was anatomical in 115 hips (95.0%), satisfactory in 6 cases (5.0%), and unsatisfactory in none. Final modified d'Aubignè scores were excellent in 45 hips (40.2%), good in 52 (46.4%), fair in 7 (6.3%), and poor in 8 (7.1%). Mean HHS was 91.5±8.9 (48-100). The SF-36 scores were similar with respect to age and sex-matched norms, but physical domains in males remained lower in comparison with the normal population. The early reduction of an associated hip dislocation and quality of surgical reduction were strong positive predictors of functional and radiographic outcomes at follow-up, whereas associated injuries and the existence of pre-operative nerve palsy were negative predictors of patients' functionality. This study of surgically treated fractures of the posterior wall of the acetabulum has shown that functional and radiographic results are satisfactory in most patients, provided that prompt reduction of an associated hip dislocation and anatomical reduction of the fracture are carried out. Associated injuries and nerve lesions affect the final functional outcome.

Factors Predicting Mobility and the Change in Activities of Daily Living After Hip Fracture: A 1-Year Prospective Cohort Study.

OBJECTIVES: To assess the change in ambulatory ability, need for walking aids, and activities of daily living (ADL) after femoral neck, intertrochanteric, or subtrochanteric fractures and to examine the determinants of these functional outcomes. DESIGN: A prospective observational cohort study. SETTING: A multicenter study involving 1 university hospital and 2 community hospitals. PATIENTS: A consecutive cohort of 552 patients (mean age, 78.3 years; range, 50-105) who underwent surgery for a hip fracture. MAIN OUTCOME MEASURES: Ambulatory ability, need for walking aids, and ADL index, 4 and 12 months after surgery. RESULTS: At both 4 months and 1-year follow-up time points, there was a significant decrease in ambulatory ability and the ADL index score and also an increase in the need for walking aids in comparison with the prefracture status. Ambulatory ability, but not ADL, significantly recovered between the 4-month and 1-year follow-up. One year after fracture, the prefracture functional status was regained by 57% of the patients, but approximately 13% of the formerly ambulating patients were unable to walk. The prefracture status was the most important determinant of ambulatory ability, need for walking aids, and ADL. Comorbidities, a poor cognitive status, and non-weight-bearing status after surgery were also negative predictors. Neither the fracture pattern nor its specific surgical treatment was predictive of any functional outcomes. CONCLUSIONS: Regardless of the type of fracture or surgical treatment used, 57% of the patients do not regain their prefracture ambulatory ability. Recovery of ambulatory ability can occur until 1 year postoperatively. The prefracture status and cognitive level are the most important determinant of all functional outcomes. LEVEL OF EVIDENCE: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.