Proximal femur fractures in patients taking anticoagulants.

Thirty per cent of patients presenting with proximal femoral fractures are receiving anticoagulant treatment for various other medical reasons. This pharmacological effect may necessitate reversal prior to surgical intervention to avoid interference with anaesthesia or excessive peri/post-operative bleeding. Consequently, delay to surgery usually occurs.Platelet inhibitors (aspirin, clopidogrel) either alone or combined do not need to be discontinued to allow acute hip surgery. Platelet transfusions can be useful but are rarely needed.Vitamin K antagonists (VKA, e.g. warfarin) should be reversed in a timely fashion and according to established readily accessible departmental protocols. Intravenous vitamin K on admission facilitates reliable reversal, and platelet complex concentrate (PCC) should be reserved for extreme scenarios.Direct oral anticoagulants (DOAC) must be discontinued prior to hip fracture surgery but the length of time depends on renal function ranging traditionally from two to four days.Recent evidence suggests that early surgery (within 48 hours) can be safe. No bridging therapy is generally recommended.There is an urgent need for development of new commonly available antidotes for every DOAC as well as high-level evidence exploring DOAC effects in the acute hip fracture surgical setting. Cite this article: EFORT Open Rev 2020;5:699-706. DOI: 10.1302/2058-5241.5.190071.

Flexor Hallucis Longus Tendon Single-Incision Transfer Stabilized With Autologous Bone Fixation.

Flexor hallucis longus transfer is routinely used as a technique to salvage a chronic or neglected Achilles tendon rupture. The single-incision (or short harvest) technique provides adequate graft suitable for fixation with interference screws. We have used a bore corer instead of a drill to establish the tendon tunnel and at the same time use the harvested autograft for interference fit and avoid the use of screws, providing what we consider to be a more biologic form of fixation.

Physical Health and Psychological Outcomes in Adult Patients with Long-bone Fracture Non-unions: Evidence Today.

BACKGROUND: Research has suggested that bone fractures can hinder the health status of patients' life. However, limited research has examined the impact that the healing process of a fracture has on the physical health and psychological state of individuals, particularly in considering the short- and long-term impact of having a fracture that fails to heal and drops into a non-union. The aim of this systematic review is to better understand the impact of fracture non-union to physical health and to respective psychological outcomes. METHODS: Electronic databases 'PubMed', 'Cochrane', 'PsycInfo', 'Medline', 'Embase', 'Web of Science', and 'CINAHL' were used. Search terms used were nonunion OR non-union OR "non union" OR "long bone" OR "delayed union" AND "quality of life" OR qol OR depression OR anxiety OR psycholog* OR PTSD OR "post-traumatic stress disorder". Studies published in the years 1995 to 2018 were included. Two independent reviewers carried out screening and data extraction. Studies were included if (1) participants were adult (human) patients with a traumatic non-union secondary to fracture/s; (2) outcomes measured included physical health and psychological wellbeing (e.g., PTSD, psychological trauma, depression, anxiety, etc.). Studies received emphasis if they compared those outcomes between: (1) The "non-union" group to a normative, matched population and (2) the "non-union group" to the same group after union was achieved. However, studies that did not use comparison groups were also included. RESULTS: Out of the 1896 papers identified from our thorough literature search, 13 met the inclusion criteria. Quality assessment was done by the Methodological Index for Non-Randomized Studies (MINORS). Findings suggested that non-unions had a detrimental impact on physical health, and psychological difficulties often after recovery. CONCLUSIONS: Patients who experience a long bone non-union are at risk of greater psychological distress and lower physical health status. There is a need for early identification of psychological distress in patients with fracture non-unions and psychological provision should become part of the available treatment.

Hip arthrodiastasis combined with core decompression and diamond concept for postcollapse femoral head avascular necrosis.

In postcollapse hip avascular necrosis (AVN), the femoral head cannot be salvaged, necessitating total hip replacement. We report a case of a 39-year-old woman who developed idiopathic femoral head AVN with marked symptoms and radiological evidence of articular surface collapse. We treated her with core decompression combined with the 'diamond concept' (implantation of bone marrow concentrate, a growth factor and bone graft substitute) and distracted the hip joint with external fixator. Four years postoperatively the articular surface has been restored and the patient reports excellent quality of life. Hip arthrodiastasis with core decompression and 'diamond concept' regeneration could be considered a treatment option in advanced AVN of the femoral head.

Arthroscopically-assisted removal of distal centraliser of an MS-30 femoral stem using a cannulated reamer in revision hip arthroplasty.

BACKGROUND: Revision hip arthroplasty can be challenging especially when difficulties to remove distal centralisers arise. CASE: We report a case where we removed a well-fixed 1st-generation solid MS-30 distal centraliser combining standard cannulated trauma reamers and arthroscopical guidance. Such case has not been reported in the past and this technical tip can be useful in revision procedures of the specific implant.

Treatment of Incarcerated Impaction of Acetabular Fractures With Concomitant Osteochondral Femoral Head Fractures by the Use of a Posterior Wall Osteotomy and Surgical Hip Dislocation: A Novel Technique.

Acetabular articular impaction may well accompany acetabular fractures. Anatomic restoration of acetabular congruence is imperative to achieve longevity of the hip joint. Combination of incarcerated acetabular impaction with osteochondral femoral fracture is a true challenge for the pelvic surgeon to address. We describe a technique to treat a posterior column acetabular fracture in association with incarcerated articular impaction and concomitant osteochondral femoral fracture. Posterior wall osteotomy combined with surgical hip dislocation facilitates the restoration of femoral head anatomy and acetabular surface integrity. This technique should be considered when dealing with this difficult scenario.

Tibialis anterior tendon traumatic rupture secondary to a closed talar neck fracture: A case report.

A case of a 22 year-old woman who sustained a closed Hawkins type II talar neck fracture after her left foot was caught in a rope while rock climbing outdoors is described. She presented to emergency department with a swollen and neurovascularly intact foot and a displaced talar neck fracture was identified. Intraoperatively a traumatic rupture of tibialis anterior tendon was found and was primarily repaired after the talar fixation. Revisiting the mechanism of injury it was evident that the jagged fracture ends ruptured the tibialis anterior tendon while she was hanging upside down on the strapping with the foot in forced equinus. This is the first case of such complication associated with a talar fracture and signifies the importance of tibialis anterior examination in such fractures.

Riddles in the diagnosis and treatment of osteoid osteoma in child foot: A concisive study.

BACKGROUND: Osteoid osteoma in child foot is very unusual. We investigate its polymorphism and difficulties in approach. METHODS: We retrospectively studied 12 children (7 girls, 5 boys) treated in our department from February 1995 until February 2010. Mean age was 12 years (range 8-16 years) and average follow up time 5 years (3-8 years). The lesion affected mostly the talus (8 cases), calcaneus in 3 and once the fourth metatarsal. En bloc excision of lesion was the surgical method of choice. RESULTS: Children's symptoms lasted average 2 years (14 months to even 4 years). Nocturnal pain and relief with NSAIDs occurred only in half cases. Atypical symptoms were hip referring pain, tenosynovitis of foot extensors and achilles' tendon atrophy. Complete cure and no recurrencies were noted. CONCLUSIONS: Diversity of symptoms and delay in diagnosis still remain troublesome and the absolute modality of treatment for child foot osteoid osteomas urges further investigation. Minimally invasive surgical techniques have recently emerged but orthopaedic surgeons must not forget that open excision remains the most safe and documented method for pediatric foot osteoid osteomas.

Osteoid osteoma of the pisiform. Can it exist in a child?

Carpal osteoid osteomas are extremely rare, and only six cases in the pisiform have ever been described, but all concerned exclusively adults. We have treated a unique case of osteoid osteoma in the pisiform of a 13-year-old girl. We excised en bloc the nidus, which resulted in total excision of the pisiform. At follow-up after 15 years there was no recurrence and the patient remains asymptomatic with equal functionality of both hands. Henceforth, we must include osteoid osteoma in the differential diagnosis of pisiform lesions in children. En bloc resection prevents its recurrence and even the complete pisiform excision renders excellent results.