Effects of Gamification on Surgical Duration and Outcomes in Patients Undergoing Fixation of Intertrochanteric Hip Fractures.

OBJECTIVE: To compare surgical duration and clinical outcomes with associated complications in surgeons using gamification techniques for resident education versus those surgeons who do not. DESIGN: Retrospective, cohort study. Level III evidence. Surgical interventions included long cephalomedullary nailing with gamification techniques compared to long cephalomedullary nailing alone. Main outcome measurements were total fluoroscopy time, operative time, hospital length of stay, discharge status, and complications. SETTING: Urban Level 1 Trauma Center. PARTICIPANTS: One fourty-eight adult patients with operative intertrochanteric femur fractures from January 2010 to January 2019. RESULTS: There were lower total operative times (45.6 vs. 57.1 minutes, p =< 0.01) and fluoroscopy times (1.6 vs. 2.1 minutes, p = 0.01) in the gamification group. There were no significant differences between groups in patient demographics, fracture pattern, postoperative complications, length of hospital stay, total follow-up, total ICU stay time, or discharge to extended care facility versus home. CONCLUSIONS: Gamification techniques with use of long cephalomedullary nails are a valid approach to the treatment of intertrochanteric femur fractures. This approach demonstrates equivalent outcomes postoperatively to nongamification treatment of intertrochanteric femur fractures, with the potential advantage of decreased operative and fluoroscopic times.

Dental implants in patients treated with antiresorptive medication - a systematic literature review.

OBJECTIVE: Bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is triggered by inflammatory processes. Typical trigger factors are periodontal disease, denture pressure sores, and surgical interventions such as tooth extractions. Unfortunately there is only little data on how to proceed with implant therapy in patients with bisphosphonate treatment. This topic is not addressed in the German guidelines on medication-associated osteonecrosis. Therefore a systematic literature review was performed. METHODS: The PICO design was used: (Patients) For which subclientel of patients with antiresorptive therapy (intervention) do dental implants have a benefit (control) compared to forgoing dental implants (outcome) in regards to oral rehabilitation and quality of life without having a substantial risk of BP-ONJ development? A PubMed search was performed including all studies dealing with this topic. Case reports and studies with less than 5 cases were excluded. RESULTS: There is only very little data available, mostly retrospective case series. 50 articles were analyzed in detail. BP-ONJ can be triggered by dental implants and by dentures in patients with benign and malignant primary diseases. In most studies, analyzing osteoporosis patients only, no cases of BP-ONJ were observed in patients with implant therapy in the time span observed. There are no studies about implant therapy in patients with malignant diseases. Many case series analyzing the trigger factors for BP-ONJ describe dentures as one of the main causes. Perioperative antimicrobial prophylaxis has a benefit in the prevention of BP-ONJ development. CONCLUSION: Successful implant therapy is possible in patients receiving antiresorptive therapy. The possibility of osteonecrosis development needs to be explained to the patient. An individual risk assessment is essential, taking the primary disease with the medication and further wound-healing-compromising diseases and medications into account. If possible, bone augmentations should be avoided, and a perioperative antimicrobiological prophylaxis is strongly recommended in these patients.