Distal femur fractures in elderly treated with internal fixation or distal femoral replacement - retrospective cohort study on 75 patients assessing functional outcomes, reoperations, and mortality.

PURPOSE: This cohort study aimed to describe the functional outcomes, complications, and mortality of patients over 65 with acute distal femur fractures treated with open reduction and internal fixation (ORIF) or distal femoral replacement (DFR). METHODS: We retrospectively analyzed all patients older than 65, operated consecutively for a distal femur fracture treated with ORIF or DFR. We included 75 patients (9 33A, 5 33B, and 61 33C AO/OTA fractures), 55 treated with ORIF, and 20 with DFR. We used Parker's mobility index (PMI) to assess functional outcomes at 1, 3, and 12 months and study closure. We analyzed complications, reoperations, and mortality at 30 days, one year, and at the end of the study. RESULTS: The PMI was significantly higher in the DFR group at months 1 (p = 0.023) and 3 (p = 0.032). We found no significant differences between cohorts at one year and the end of follow-up. Postoperative complications were significantly more frequent in the ORIF group (38.10% vs. 10%, p = 0.022). Reoperations were similar in both cohorts (p = 0.98). Mortality at one month was 4% and 20% at one year, and at the end of follow-up, there were no significant differences between groups. CONCLUSION: The outcomes of this study suggest that DFR offers a faster functional recovery with lower complication rates than those treated with ORIF. Additionally, both options have similar reoperation and mortality rates. Appropriately designed studies are needed to define the best treatment strategy for this type of patient.

Bilateral simultaneous total knee arthroplasty with and without patellar resurfacing. A prospective single surgeon series with a minimum follow-up of 7 years.

BACKGROUND: Total knee arthroplasty (TKA) is the most effective treatment for end-stage adult knee osteoarthritis, but it has been reported that patient satisfaction may vary. A malfunction of the patellofemoral joint may produce anterior knee pain (AKP) for several reasons. While some surgeons systematically resurface the patella despite the risk of potential complications such as fracture, loosening, or wear of the patella, others prefer to preserve it to reduce AKP and revision rates. This study aimed to evaluate whether patellar resurfacing had better clinical and functional outcomes, complications, and revision rates in patients undergoing simultaneous bilateral total knee arthroplasty. METHODS: We conducted a prospective cohort study, including patients who underwent bilateral simultaneous TKA in which the patella was replaced in one knee and preserved in the other, with a minimum follow-up of 7 years. We assessed clinical and functional outcomes with the Knee Society Score (KSS) and Visual Analogue Scale (VAS); complications and revision rates were also registered. RESULTS: The final series consisted of 43 patients with 86 knee arthroplasties. After a mean of 7.6 years of follow-up, no significant differences were found regarding KSS (clinical: 82.8 ± 7.4 versus 83.2 ± 3.4, p = 0.92; functional 89.1 ± 8.2: versus 90.4 ± 6.8; p = 0.99), VAS (2.0 ± 0.9 versus 1.8 ± 1.0; p = 0.84), complications (10.5% versus 8.1%; p = 0.57), or revision rates (2.3% versus 2.3%; p = 0.99) when comparing patellar resurfacing versus retention. CONCLUSION: In the context of total knee arthroplasty, patellar replacement did not demonstrate statistically significant differences concerning patellar retention in clinical nor functional outcomes, AKP, complications, or revision rates after a minimum of 7 years of follow-up.

The polymicrobial infection affects the infection recurrence rate (not failure) in treating femoral and tibial bone defects with the Masquelet technique-a comparative retrospective analysis of 54 patients with mono- and polymicrobial infections.

INTRODUCTION: This study evaluated whether polymicrobial infection affects reoperation rates due to infection recurrence and treatment failure with the Masquelet technique in infected posttraumatic segmental bone defects of the femur and tibia. METHODS:  We retrospectively analyzed patients treated between 2012 and 2021 in two trauma referral centers. We evaluated demographic data, injury, treatment, infection recurrence, failures, and bone healing rates according to whether the infection was mono- or polymicrobial. After uni-bivariate analysis between patients with polymicrobial and monomicrobial infection, we identified the variables associated with infection recurrence and failure through multivariate analysis. RESULTS:  We analyzed 54 patients, 30 (55.55%) with tibial and 24 (44.44%) femoral segmental bone defects, with a mean follow-up of 41.7 ± 15.0 months. Forty-four (81.48%) presented monomicrobial, and 10 (18.51%) polymicrobial infections. Comparatively, the need for soft tissue reconstruction and the infection recurrence rate was significantly higher in patients with polymicrobial infections. There was no significant difference in the failure rate (20 vs. 6.81% p = 0.23). Multivariable logistic regression analysis identified the polymicrobial infection as the only independent variable associated with infection recurrence (Odds Ratio = 11.07; p = 0.0017). CONCLUSION:  Our analysis suggests that polymicrobial infection is associated with a higher risk of infection recurrence in treating the femur and tibia segmental bone defects with the Masquelet technique. This information can help surgeons to inform patients about this and give them a realistic expectation of the outcome and the possibility of reoperation.

Does the type of medial plate fixation matter for supplemental fixation of distal femur fractures manage with a lateral pre-contoured locked plate? A Biomechanical study.

INTRODUCTION: Fixation of distal femur fractures with a lateral pre-contoured locking plate provides stable fixation and is the standard treatment in most cases, allowing early range of motion with a high rate of union. However, in situations, the stability achieved with the lateral plate alone may be insufficient, predisposing to fixation failure. The objective of the study was to compare, in synthetic bone models, the biomechanical behaviour of the fixation with a distal femur lateral pre-contoured locking plate solely and associated with a 3.5 mm proximal humeral locking plate applied upside down or a 4.5 mm helical locking compression plate on the medial side. MATERIAL AND METHODS: A total of 15 solid synthetic left femur samples were used. A metaphysical defect at the level of the medial cortex was simulated. The samples were randomly distributed into three groups equally. All groups received a 4.5/5.0 mm single lateral 9-hole distal femur lateral pre-contoured locking plate. Group 1 had no supplementary plate. Group 2 received a supplementary 6-hole 3.5 mm proximal humeral locking plate and Group 3 received a supplementary 4.5/5.0 mm helical 14-hole narrow locking compression plate. RESULTS: Both supplementary plate types used in groups 2 and 3 contributed to increase the apparent stiffness of the construct, but pairwise comparison showed statically significant difference only between group 1 and 3. No significant difference was observed between groups 2 and 3. CONCLUSION: Both supplementary plates might be considered for improving the fixation in distal femur fracture in selected cases.

Reconstrucción de defectos óseos en la región del tobillo mediante la técnica de Masquelet. Presentación de casos / Use of Masquelet technique for the reconstruction of bone defects in the ankle. Case report

Los defectos óseos segmentarios en la región del tobillo y el pie representan un desafío dadas sus características anatómicas con limitada vascularización y pobre cobertura muscular. La técnica descrita por Masquelet para el tratamiento de defectos óseos segmentarios en huesos largos ha logrado excelentes resultados. Sin embargo, se han publicado pocos estudios sobre su uso en la región del pie y tobillo. La técnica de la membrana inducida ofrece una alternativa terapéutica válida para resolver problemas de difícil solución en Ortopedia, como los defectos óseos. Permite tratarlos sin necesidad de procedimientos complejos, como el uso de injertos óseos vascularizados o de callotasis, con una alta tasa de consolidación, conservando la longitud del miembro y con una buena función. Entre enero de 2016 y diciembre de 2018, tres pacientes con defectos óseos segmentarios fueron tratados mediante la técnica de Masquelet en nuestra institución. Pese a que no podemos probar que este procedimiento es el más indicado en este tipo de casos, sí podemos afirmar que se logró la consolidación en todos los pacientes y se resolvió el defecto óseo, lo que nos anima a seguir utilizando esta misma técnica. Nivel de Evidencia: IV

Segmental bone defects in the foot and ankle represent a challenge due to their anatomical characteristics, limited vascularization, and poor muscle coverage. The technique described by Masquelet has shown excellent results for the treatment of segmental bone defects in long bones. However, there are few studies in the literature on its use in the foot and ankle. The induced membrane technique offers a valid treatment alternative to solve bone defects. It allows treatment without the need for complex procedures, such as vascularized bone grafts or distraction osteogenesis, with a high rate of consolidation, preserving the length and function of the limb. Although we cannot prove that this procedure is the most indicated for the treatment of bone defects, we can affirm that all our patients have achieved consolidation, which encourages us to continue performing this same technique. Level of Evidence: IV

Two-Stage Treatment of Chronic Periprosthetic Knee Infections With the Use of Gentamicin-Articulated Spacers: Success Rate and Predictors of Failure at the Minimum Seven-Year Follow-Up.

Background: The purpose of this study was to assess the survivorship rates of 2-stage treatment with gentamicin-impregnated polymethylmethacrylate articulated knee spacer in patients with chronic periprosthetic joint infection and to identify risk factors associated with failure. Methods: We conducted a retrospective study among 73 patients with chronic periprosthetic joint infection after primary total knee replacement with articulated polymethylmethacrylate gentamicin-impregnated spacers (Subiton, Medical Labs, Ind Argentina), performed in a single institution with a minimum follow-up of 7 years. Clinical and functional assessment was performed with Knee Society Score and Western and Ontario McMaster Universities Osteoarthritis Index. A univariate and multivariate analysis was performed to identify the variables that influenced the success and failure rates. Results: We included 73 patients. There were 53 (71.3%) monomicrobial, 11 (15%) polymicrobial, and 10 (13.7%) negative cultures infections. The success and failure rates were 90.5% (n = 66) and 9.5% (n = 7), respectively. Multivariate analysis identified that age (odds ratio = 1.77; P = .039), greater erythrocyte sedimentation rate values prior to the first stage (odds ratio = 1.04; P = .006), and polymicrobial infections (odds ratio = 7.32; P = .0003) were independent variables associated with failure. Conclusions: Two-stage revision with polymethylmethacrylate gentamicin-impregnated knee spacers is an effective strategy for the treatment of chronic periprosthetic joint infection after total knee arthroplasty. Age, higher erythrocyte sedimentation rate values prior first stage, and polymicrobial infections were independent risk factors for treatment failure.

Effectiveness of two-stage revision with commercial polymethylmethacrylate articulated hip spacer: similar outcomes against monomicrobial and polymicrobial hip periprosthetic joint infections.

Background: orthopaedic surgeons still struggle against a devastating complication - periprosthetic joint infection (PJI). A two-stage revision is considered the gold standard for chronic PJI for several authors, with success rates over 90 %. This strategy implies the remotion of the prosthesis and the implantation of an antibiotic-impregnated cement spacer in the joint. The primary objective of this study was to assess the effectiveness of a two-stage revision approach using a commercial prefabricated antibiotic-impregnated cement hip spacer for the treatment of hip PJI regarding monomicrobial and polymicrobial infections. Secondly, to assess risk factors for failure of two-stage revision. Material and methods: we conducted a retrospective study on patients that underwent revision of total hip arthroplasty (THA) between January 2002 and January 20218. We included adult patients with a diagnosis of chronic hip PJI that underwent two-stage revision using a prefabricated gentamicin-impregnated cement of polymethylmethacrylate (PMMA) hip spacer. We assessed whether it was monomicrobial or polymicrobial infections and comorbidities. Treatment success was defined when eradication of the infection was observed and no further procedures or mortality were registered after the second stage. Persistence or recurrence of infection was considered a failure of treatment. Results: the final series consisted of 84 patients treated with the same hip spacer: 60 (71.4 %) monomicrobial and 24 (28.6 %) polymicrobial joint infections with an overall follow-up of 59.0 (36.0-84.0) months. The overall success rate was 90.5 %. Eight (9.5 %) patients failed. Smoking and BMI greater than 30 m kg-2 were identified independent risk factors for failure in multivariate analysis. Conclusion: our study suggests that prefabricated gentamicin-impregnated PMMA spacer is an effective tool for the treatment of PJI, achieving similar outcomes whether it is monomicrobial or polymicrobial infections. Randomized prospective studies are needed to obtain more reliable conclusions.

Does the distal nail position impact the rates of misalignment and bone union in distal tibial fractures?

PURPOSE: This retrospective study aimed to assess the impact of distal nail placement on misalignment and healing rates in distal tibial fractures. METHODS: We reviewed all patients with distal tibial fracture treated with intramedullary nailing between 2015 and 2021, and a minimum follow-up of 12 months. Distal nail positioning was determined according to the Triantafillou zones. We related these positioning zones to misalignments (alignment ≥ 3°) and too bony union disorders (delayed union, non-union). RESULTS: Out of the 62 patients included, 56 (90.3%) show bone union without additional procedure, 3 (4.8%) with dynamization, and 3 (4.8%) showed non-union. Twenty-one (33.8%) presented misalignment, with valgus in the coronal plane being the most frequent (76.19%). In patients with and without misalignment, the most frequent distal nail position was 2-2 in 47.6% and 80.5%, respectively (p = 0.01). In multivariate analysis, distal nail positioning in the 2-2 zone showed a significant protective effect against misalignment (OR 0.18; p = 0.018), while nail positioning in the 3-2 zone generated a significant risk of misalignment (OR 18.55; p = 0.009). CONCLUSION: In intramedullary nailing of distal tibial fractures, distal positioning of the nail slightly lateral to the center of the talus in the coronal plane and slightly posterior in the sagittal plane (zone 2-2) allows high alignment percentages to be obtained. Positioning medial to this point in the coronal plane (zone 3) is associated with more significant misalignment and should be avoided.

Pre-fracture ambulation capacity, Charlson comorbidity index, and dementia as predictors of functional impairment after bipolar hemiarthroplasty for unstable intertrochanteric fracture. A retrospective analysis in 158 octogenarian patients.

Background: the primary purpose of this study was to assess the ambulatory capacity 12 months after surgery in patients that underwent bipolar hemiarthroplasty (BH) due to unstable intertrochanteric fractures (UITF). Secondly, to identify which preoperative variables influenced these modifications. Methods: We retrospectively analyzed a consecutive series of patients older than 80 years with UITF treated with BH between 2010 and 2019. Ambulatory capacity was assessed before surgery, at 3 and 12 months postoperatively, using Koval's classification and the modified Harris Hip Score (mHHS). The registered variables were: gender, age, osteoporosis, Charlson comorbidity index (CCI), ASA classification, body mass index (BMI), and dementia. The identification of variables that impaired postoperative functionality was performed by uni- and multivariate analysis. Results: 158 patients were included with a median age of 87 (range 80-102) years and a follow-up of 29.2 (range 12-56) months. The 1-year overall ambulatory capacity impairment was 28.5% and significantly affected pre-fracture community walkers (p = 0.001). A CCI >4 (OR 2.72; p = 0.044), dementia (OR 14.13; p = 0.0001), and a Koval 2-3 (OR 12.84; p = 0.001) were identified as risk factors for this impairment. Conclusion: Ambulation impairment at one year was 28.5%. The predictive characteristics found in this study help to identify patients with a greater risk of ambulation impairment and to focus rehabilitation plans to reduce this impact.

Periprosthetic fracture management of the proximal femur.

The most common periprosthetic fractures occur around the hip. The most widely used classification is the Vancouver classification, and management requires careful planning and skill in both arthroplasty and fracture surgery. This article presents an overview of the diagnosis, classification, and management of periprosthetic fractures of the proximal femur. This work represents a summary review from Latin American Society Members of the International Orthopaedic Trauma Association.

Antibiotic cement-coated rigid locked nails in infected femoral and tibial nonunion. Reoperation rates of commercial versus custom-made nails.

INTRODUCTION: The objective of this study is to assess bone union, infection control, and reoperation rates in a series of patients with infected femoral or tibial nonunion treated with antibiotic-cement-coated rigid nails and to compare the results obtained with custom-made nails versus commercial nails. METHODS: We retrospectively analyzed a series of consecutive patients with infected nonunion of the femur or the tibia treated with antibiotic-cement-coated rigid nails between January 2010 and 2020. We assessed patients' distinctive characteristics, initial injury, type of nail used (custom-made nail with vancomycin or commercial nail with gentamicin), success rate (bone union + infection control), reoperation rate, and failure rate. Comparative analyses were conducted between reoperated and non-reoperated patients regarding the type of nail used. A multivariate regression analysis was performed to assess the risk variables that impacted reoperation rates. RESULTS: We included 54 patients with 22 (40.74%) infected femoral nonunions and 32 (59.25%) tibial nonunions, who were treated with 38 (70.37%) custom-made antibiotic-cement coated nails and 16 (29.62%) commercial nails. Bone union and infection control were achieved in 51 (94.44%) cases. The reoperation rate was 40.74% (n = 22), and the failure rate was 5.55% (n = 3). The use of custom-made nails was associated with a higher risk of reoperation (Odds Ratio 4.71; 95% Confidence Interval 1.10 - 20.17; p = 0.036). CONCLUSION: Antibiotic-cement-coated nails reached a 94.44% success rate. Nails manufactured in the OR coated with vancomycin cement were associated with a higher risk of reoperation than commercial nails loaded with gentamicin cement. LEVEL OF EVIDENCE: III comparative, observational, non-randomized.

Definitive fixation in the first stage of the induced membrane technique for septic segmental bone defects. Why not?

Background: Infected segmental bone defects (I-SBD) are challenging and complex to manage. This study aimed to show the outcomes achieved in I-SBD of the femur and tibia, treated with the induced membrane technique performing a definitive bone stabilization in the first stage. Methods: We retrospectively reviewed 30 patients with infected non-articular segmental bone defects of the femur (n = 11) and tibia (n = 19), operated consecutively between January 2015 and May 2021. The need for fixation exchange, bone defect length, allo/autograft ratio used, bone healing, reoperation (discriminating between mechanical and infection-related causes), and failure rates (graft resorption or nonunion) were recorded. Results: Fixation in the first stage was performed with 28 (93.33%) intramedullary nails, ten coated with antibiotic cement, and 2 (6.67%) locked plates. None were removed during the second stage of the technique. The mean length of the bone defects was 5cm (range 3.5-12). The most commonly used allo-/autograft ratio was 50-50. The bone healing rate was 93.33% (n = 28), with a median follow-up of 7 months (range 3-12). The reoperation rate due to mechanical instability was 3.33% (n = 1) and for recurrence of infection was 10.0% (n = 3). The overall failure rate was 6.67% (n = 2). The median follow-up was 42 months (range 12-85). Conclusion: Masquelet technique appears feasible and effective in treating infected segmental bone defects of the femur and tibia. Definitive fixation at the first stage showed a success rate of 93.33%, with a re-operation rate of 10.0% related to infection.

Distal articular involvement in tibial shaft fractures: an evaluation of 125 consecutive cases.

PURPOSE: To report the incidence and morphology of ipsilateral distal articular involvement (DAI) in a consecutive series of tibial shaft fractures. METHOD: A retrospective review was performed on 115 patients who underwent intramedullary nailing for tibia shaft fractures. Ankle evaluations included preoperative radiographs and computed tomography (CT) scans in all patients. RESULTS: Thirty-two patients (27.8%) in our series presented with tibial shaft fractures associated with DAI. Tibial spiral fractures (42A1) were significantly related to DAI (RR: 1788). In 28 (87.5%; 28/32) articular fractures, posterior malleolus fractures (PMF) were present; 22 were isolated, and six (18.8%) occurred in combination with medial malleolus or anterolateral fractures. The remaining (12.5%; 4/32) were isolated medial malleolus fractures. Ten (31.2%; 10/32) articular fractures were occult on the radiographs and only detected on CT scan. CONCLUSION: DAI is common in tibial shaft fractures. CT evaluation is mandatory due to the high number of occult fractures. Although isolated PMF is the most frequent pattern of DAI involvement, 31.3% of the cases exhibited different patterns.

The relevance of the number of distal locking planes and nail to canal ratio in bone healing after intramedullary nailing in tibial shaft fractures.

INTRODUCTION: The objective of this retrospective study was to assess the effect of the nail to canal ratio and the number and configuration of distal locking screws in bone healing in tibial shaft fractures. METHODS: We analyzed 223 consecutive tibial shaft fractures treated with reamed intramedullary nailing between January 2014 and December 2020. We recorded and evaluated the nail to canal ratio (NCR) and the number and configuration of distal locking screws. Median NCR was 0.87 (IQR 0.82-0.94). Ten (4.48%) fractures were treated with one distal locking screw, 173 (77.57%) with two, and 40 (17.93%) with three. Uniplanar fixation was used in 63 (28.25%), biplanar in 150 (67.26%), and triplanar in 10 (4.48%) cases. Uni-, bi-, and multivariate analyses were performed to compare patients who achieved bone union with those who did not. RESULTS: Bone union was achieved in 195 (87.44%) patients. Uni- and bivariate analyses showed that bone union increased significantly with larger NCR (p = 0.0001) and a greater number of locking planes (p = 0.001) and distal screws (p = 0.046). NCR > 0.78 (OR 48.77 CI 95% 15.39-154.56; p = < 0.0001) and distal locking screw configuration (OR 2.91 CI 95% 1.12-9.91; p = 0.046) were identified as independent variables for union. CONCLUSION: Our findings suggest that in tibial shaft fractures treated with intramedullary nailing, NCR should be equal to or greater than 0.79. Additionally, distal locking screws should be used with a biplanar or triplanar configuration.

Peri-implant femoral fractures: Challenges, outcomes, and proposal of a treatment algorithm.

PURPOSE: Non-prosthetic peri-implant fractures are challenging injuries. Multiple factors must be carefully evaluated for an adequate therapeutic strategy, such as the state of bone healing, the type of implant, the time and performed personnel of previous surgery, and the stability of fixation. The aim of this study is to propose a rationale for the treatment. METHODS: The peri-implant femoral fractures (PIFFs) system, a therapeutic algorithm was developed for the management of all patients presenting a subtype A PIFF, based on the type of the original implant (extra- vs. intra-medullary), implant length and fracture location. The adequacy and reliability of the proposed algorithm and the fracture healing process were assessed at the last clinical follow-up using the Parker mobility score and radiological assessment, respectively. In addition, all complications were noticed. Continuous variables were expressed as mean and standard deviation, or median and range according to their distribution. Categorical variables were expressed as frequency and percentages. RESULTS: This is a retrospective case series of 33 PIFFs, and the mean post-operative Parker mobility score was (5.60 ± 2.54) points. Five patients (15.1%) achieved complete mobility without aids (9 points) and 1 (3.0%) patient was not able to walk. Two other patients (6.1%) were non-ambulatory prior to PPIF. The mean follow-up was (21.51 ± 9.12) months (range 6 - 48 months). There were 7 (21.2%) complications equally distributed between patients managed either with nailing or plating. There were no cases of nonunion or mechanical failure of the original implant. CONCLUSION: The proposed treatment algorithm shows adequate, reliable and straightforward to assist the orthopaedic trauma surgeon on the difficult decision-making process regarding the management of PIFF occurring in previously healed fractures. In addition, it may become a useful tool to optimize the use of the classification, thus potentially improving the outcomes and minimizing complications.

Morbimortalidad en pacientes con fracturas intertrocantéricas de cadera tratadas con clavos cefalomedulares. Valor predictivo del Índice de Movilidad de Parker / Morbidity and mortality in intertrochanteric hip fractures treated with cephalo-medullary nailing. Predictive value of the Parker mobility score

Introducción: La fractura de cadera es un factor independiente que aumenta la morbimortalidad. El objetivo de este estudio retrospectivo fue determinar la morbimortalidad en ancianos con fracturas intertrocantéricas de cadera tratadas con clavos cefalomedulares. Materiales y métodos: Se analizó a pacientes tratados con clavo cefalomedular por fractura intertrocantérica de cadera, entre 2018 y 2021, y un seguimiento mínimo de 12 meses. Se registraron: datos demográficos, comorbilidades, capacidad funcional con el Índice de Movilidad de Parker, complicaciones y tasa de mortalidad a los 12 meses y al final del seguimiento. Se identificaron las variables independientes relacionadas con complicaciones o muerte. Resultados: Se incluyó a 68 pacientes (seguimiento medio 23 meses). La tasa de complicaciones fue del 8,8%: infección urinaria, neumonía, trombosis venosa profunda y tres pérdidas de fijación del tornillo cefálico. Al comparar pacientes con complicaciones o sin ellas, hubo diferencias significativas en la edad cuando se produjo la fractura. Las tasas de mortalidad anual y al concluir el estudio fueron del 2,9% y 29,4%, respectivamente. Las diferencias fueron significativas en la incidencia de comorbilidades renales, demencia, el Índice de Comorbilidad de Charlson >4 y el puntaje de Parker <5 en quienes fallecieron. El puntaje de Parker <5 fue la variable independiente relacionada con muerte. Conclusiones: Las tasas de complicaciones y de mortalidad a los 12 meses del tratamiento de las fracturas intertrocantéricas inestables de cadera con clavos cefalomedulares es aceptable en ancianos. El riesgo de muerte aumenta significativamente si el puntaje de Parker es <5 antes de la fractura. Nivel de Evidencia: IV

Introduction: Hip fracture represents an independent predictor of morbidity and mortality. The aim of this retrospective study was to assess the morbidity and mortality associated with intertrochanteric hip fractures fixed with cephalomedullary nails. materials and methods: We analyzed all patients treated between 2018 and 2021 with a cephalomedullary nail for an intertrochanteric hip fracture, with a minimum follow-up of 12 months. We evaluated the demographic data, comorbidities, functional level through the Parker Mobility Score (PMS), complications, and mortality (12 months and at the end of follow-up). Variables related to postoperative complications or death were identified by bivariate and multivariate regression analyses. Results: 68 patients were included. The mean follow-up was 23 (range 12-40) months. The rate of complications was 8.8% (n=6), 1 urinary tract infection, 1 pneumonia, 1 deep vein thrombosis, and 3 (4.4%) cephalic screw fixation losses. Patients who had complications presented significant differences in age at the time of fracture. Mortality at 12 months and at the end of the study was 2.9% (n=2) and 29.4% (n=20) respectively. Those patients who died presented significant differences in the incidence of kidney comorbidities, dementia, a Charlson Comorbidity Index > 4, and a PMS < 5. PMS < 5 was the only independent variable related to mortality. Conclusions: Cephalomedullary nailing in unstable intertrochanteric hip fractures in elderly patients represents a treatment option that offers an acceptable complication rate and a low 12-month mortality rate. The risk of death is significantly increased in patients with low functional scores (Parker < 5) pre-fracture. Level of Evidence: IV

Resultados iniciales del uso de cotilos de doble movilidad en pacientes >65 años con fractura de cadera. Análisis retrospectivo de 102 casos / Preliminary outcomes with dual mobility cups in patients older than 65 with hip fractures. A retrospective analysis of 102 patients

Objetivo: El objetivo de este estudio retrospectivo fue evaluar los resultados funcionales y la tasa de luxación en pacientes >65 años con fractura de cadera operados con prótesis de doble movilidad. materiales y métodos: Se analizó a los pacientes tratados por una fractura de cadera entre 2017 y 2021. Se incluyó a pacientes >65 años, tratados con copas de doble movilidad y un seguimiento mínimo de 24 meses. Se analizaron los datos demográficos, las comorbilidades, los resultados funcionales (Parker y puntaje de Harris), las complicaciones (infección, luxación, aflojamiento), las reoperaciones y revisiones. Resultados: Se trataron 102 fracturas de cadera (75 mediales y 27 intertrocantéricas) en 102 pacientes. El 72,5% eran mujeres (media de la edad 80.59 ± 6.92 años), el Índice de Comorbilidad de Charlson promedio fue de 4,71 y el puntaje ASA, 2,47. El 93,1% comenzó a caminar al segundo día de la cirugía. Según el puntaje de Harris, los resultados fueron excelentes o muy buenos en el 94,1%; los puntajes de Parker preoperatorio y posoperatorio no difirieron significativamente (p <0,05). El seguimiento promedio fue de 30 meses. Hubo 8 (7,84%) complicaciones: 2 (1,9%) casos de trombosis venosa profunda, 4 (3,9%) de tromboembolismo pulmonar, tres infecciones (2,9%) y una (0,9%) luxación. La tasa de reoperaciones fue del 2,9%. Conclusiones: Con el empleo de copas de doble movilidad se obtuvieron resultados funcionales aceptables y una tasa de luxación relativamente baja (0,9%). Esto sugiere que estos implantes representan una opción en el tratamiento de estas lesiones. Nivel de Evidencia: IV

Objective: This retrospective study aimed to assess the functional outcomes and dislocation rate in the treatment with dual mobility prostheses in patients older than 65 with hip fractures. materials and methods: We analyzed all patients treated between 2017 and 2021 for hip fractures in our service. We included patients older than 65 years, treated with dual mobility cups, and a minimum follow-up of 24 months. We analyzed demographic data, comorbidities, functional outcomes (Parker score and Harris Hip Score, HHS), complications (infection, dislocation, loosening), reoperations, and revisions. Results: We included 102 hip fractures (75 medial and 27 intertrochanteric) in 102 patients. Seventy-four (72.5%) were women, the mean age was 80.59 ± 6.92 years, the mean Charlson index was 4.71 (range 3-10), and ASA was 2.47 (1-4). 93.1% started walking on the second postoperative day. 94.1% presented excellent or very good outcomes according to the HHS, the postoperative Parker index did not show significant differences in comparison to the preoperative one (p < 0.05). The average follow-up was 30 months (range 24-60). There were 8 (7.84%) complications: 2 (1.9%) deep vein thrombosis, 4 (3.9%) pulmonary thromboembolism, 3 infections (2.9%), and 1 (0.9%) dislocation. The reoperation rate was 2.9%. Conclusions: We obtained acceptable functional outcomes using dual mobility cups with a relatively low dislocation rate (0.9%). This suggests that these implants are an option to consider in treating these lesions. Level of Evidence: IV

Open tibial shaft fracture management in Argentina: an evaluation of treatment standards in diverse resource settings.

Background: Argentina is a country with varying access to orthopedic surgical care. The Argentine Association of Trauma and Orthopedics (AATO) "Interior Committee" was developed to address potential regional differences and promote standardization of orthopedic trauma care. The paper assesses the level of national standardization of the management of open tibia fractures across 9 provinces in Argentina. Methods: Utilizing a matched-comparison group design, management of these injuries were assessed and compared between 3 groups: an "AATO Exterior Committee" consisting of surgeons that practice in Buenos Aires, and 2 "Interior Committees," comprising surgeons that practice in outlying provinces, 1 of which is affiliated with the AATO, and 1 that is not affiliated with the AATO. The study was conducted in 2 phases: phase 1 assessed open tibia fracture management characteristics, and phase 2 evaluated the management of soft-tissue wound coverage following open fractures. Results: Soft-tissue coverage procedures for Gustilo Anderson Type IIIB fractures were more commonly performed by orthopedic surgeons in Interior Committees than the AATO Exterior Committee. Greater rates of definitive wound coverage within 7 days post-injury were reported in both Interior Committees compared to the Exterior Committee. Plastic surgeons were reported as more available to those in the AATO Exterior Committee group than in the AATO Interior Committees. Conclusion: While treatment patterns were evident among groups, differences were identified in the management and timing of soft-tissue coverage in Gustilo Anderson Type IIIB fractures between the Exterior Committee and both Interior Committees. Future targeted educational and surgical hands-on training opportunities that emphasize challenges faced in resource-limited settings may improve the management of open tibia fractures in Argentina.

Culture-negative Peri-prosthetic Joint Infection after Total Hip Arthroplasty Treatment Protocol and Outcomes in Acute and Chronic Cases.

The treatment of culture-negative periprosthetic joint infections (CN PJI) of the hip represents complex entities. We, as a result of this, report on 12 cases. Irrigation and debridement (I&D) with implant retention were performed in acute cases and two-stage revisions in chronic infections. Combined antibiotic therapy was administered in all cases for 12 weeks. Infection control was achieved in all patients with an infection-free rate of 100% at 7.5 years of average follow-up.