Open reduction internal fixation versus hemiarthroplasty versus total hip arthroplasty in the elderly: a review of the National Surgical Quality Improvement Program database.

BACKGROUND: Total hip arthroplasty (THA), hemiarthroplasty (HA), and open reduction internal fixation (ORIF) are treatment options for femoral neck fractures. However, the optimal surgical treatment remains unclear. The present study aimed to describe the 30-d postoperative outcomes of THA, HA, and ORIF among patients aged ≥65 y with femoral neck fractures within a national surgical database. MATERIALS AND METHODS: A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program for January 2005 through December 2009 was conducted. We included patients aged ≥65 y who had undergone THA, HA, or ORIF for femoral neck fractures. We collected information on patient demographics, comorbidities, risk factors, and complication rates. A logistic regression model was used to assess the variation in overall morbidity and mortality after surgery. RESULTS: Overall, 3423 patients met the inclusion criteria: 674 underwent ORIF, 428 HA, and 2321 THA. Most patients were white (83.6%, n = 2862), female (64.4%, n = 2204), and >70 y old (78.4%, n = 2682). On adjusted multivariate analysis, no differences were found in the 30-d mortality rates among the ORIF, HA, and THA groups. Patients who underwent ORIF (odds ratio 0.51, 95% confidence interval 0.27-0.94) and HA (odds ratio 0.43, 95% confidence interval 0.22-0.84) had a lower likelihood of developing respiratory complications compared with those who underwent THA. CONCLUSIONS: No differences were found in the 30-d mortality rates among the ORIF, HA, and THA groups. ORIF and HA resulted in a lower likelihood of developing respiratory complications than THA.

A freehand ultrasound elastography system with tracking for in vivo applications.

Ultrasound transducers are commonly tracked in modern ultrasound navigation/guidance systems. In this article, we demonstrate the advantages of incorporating tracking information into ultrasound elastography for clinical applications. First, we address a common limitation of freehand palpation: speckle decorrelation due to out-of-plane probe motion. We show that by automatically selecting pairs of radio frequency frames with minimal lateral and out-of-plane motions, combined with a fast and robust displacement estimation technique, greatly improves in vivo elastography results. We also use tracking information and image-quality measures to fuse multiple images with similar strains that are taken from roughly the same location so as to obtain a high-quality elastography image. Finally, we show that tracking information can be used to give the user partial control over the rate of compression. Our methods are tested on a tissue-mimicking phantom, and experiments have been conducted on intraoperative data acquired during animal and human experiments involving liver ablation. Our results suggest that in challenging clinical conditions, our proposed method produces reliable strain images and eliminates the need for a manual search through the ultrasound data in order to find radio frequency pairs suitable for elastography.

Circumcision in the United States: where are we?

Circumcision is one of the most common surgical procedures performed on males in the United States. Ethical considerations of the procedure have been considered for many years and, recently, research on the topic has shed more light on the debate. The purpose of this study was to review the history and emergence, current demographics, and practices of male circumcision, specifically, nonreligious, nonmedically indicated routine neonatal circumcision. A review of the current literature was conducted using PubMed and current practices from guidelines of major professional societies. Physicians should consider the various ethical concerns and provide the patient's guardians with unbiased counsel. There is a lack of evidence both in favor of and against recommending routine neonatal circumcisions in the United States. The question remains whether we should continue unwarranted male circumcisions, especially when the major tenet of medical ethics is "do no harm."