New tip-apex distance and calcar-referenced tip-apex distance cut-offs may be the best predictors for cut-out risk after intramedullary fixation of proximal femur fractures.

Cut-out is one of the most common mechanical failures in the internal fixation of trochanteric hip fractures. The tip-apex distance (TAD), and the calcar-referenced tip apex distance (CalTAD) are the radiographic parameters that most predict the risk of cut-out. The optimal CalTAD value has not yet been defined, but the optimal TAD value is reported as 25 mm or less. However, this cut-off is highly specific but poorly sensitive. The aim of this study was to determine highly specific and sensitive TAD and CalTAD values and shed light on the role of other clinical variables. A total of 604 patients were included in this retrospective cross-sectional study. For each patient the following data were recorded: number of cut-out, AO/OTA classification, quality of the reduction, type of nail, cervicodiaphyseal angle, type of distal locking, post-operative weight-bearing, TAD and CalTAD values, and the position of the screw head in the femoral head according to the Cleveland system. The incidence of cut-out across the sample was 3.1%. The median TAD in the cut-out group was 38.72, while in the no cut-out group it was 22.16. The median CalTAD in the cut-out group was 39.34, while in the no cut-out group it was 22.19. The cut-off values for TAD and CalTAD with highest value of sensitivity and specificity for the risk of cut-out were 34.8 and 35.2, respectively. The incidence of cut-out can be reduced by performing careful minimal reduction and ensuring stable fixation by avoiding TAD > 34.8 mm and CalTAD > 35.2 mm.

Is Propionibacterium acnes related to disc degeneration in adults? A systematic review.

BACKGROUND: The aim of this paper was to systematically review the evidence linking Propionibacterium acnes (P. acnes) with the development of symptomatic degenerative disc disease. EVIDENCE ACQUISITION: Data were obtained from MEDLINE from their inception to October 2015. Two authors independently conducted the searches, extracted data and completed methodological quality assessments. Articles were included if they investigated the presence of P. acnes in symptomatic degenerative disc disease through intra-operative cultural examination. The methodological quality of the studies was evaluated using the Newcastle-Ottawa Scale. EVIDENCE SYNTHESIS: Overall 641 articles were retrieved with 9 cross-sectional studies being included in the review. All selected studies revealed an association between P. acnes and disc degeneration. CONCLUSIONS: This study shows that there is a relationship between P. acnes and development of symptomatic degenerative disc disease. Despite this, we cannot support that P. acnes and development of symptomatic degenerative disc disease due to the low quality of the results according Grading of Recommendations Assessment, Development and Evaluation (GRADE).