Complications Following Short Femoral Nail Fixation for Intertrochanteric Hip Fractures: A Retrospective Study.

The incidence of proximal femur fractures is increasing due to aging of the population. Intramedullary nails are the mainstay of treatment for intertrochanteric hip fractures mainly due to their better biomechanical properties compared to dynamic hip screw devices, shorter operative time, and less blood loss during surgery. However intramedullary nail fixation is not devoid of complications. The purpose of this study is to look at complications related to intramedullary nailing for intertrochanteric hip fractures in a major trauma center. A retrospective study was conducted including all patients having suffered an intertrochanteric femur fracture and treated with intramedullary nails from October 1, 2020, to October 1, 2022, in the Orthopaedic Surgery Clinic. The intramedullary hip systems used were the Stryker Gamma3 Nail and the VITUS PF Nail. All complications following the postoperative period were recorded in detail. Overall, 240 patients with a mean age of 82.3 years treated with hip intramedullary devices were identified. Superior cutout of the lag screw in two patients (females 90 and 87 years old) was identified 8 and 10 weeks following initial surgery. Avascular necrosis (AVN) of the femoral head was identified in one patient (male 81 years old) which occurred 12 weeks postoperatively. All three cases were revised by replacing the nail with cemented hemiarthroplasty. Periprosthetic fractures occurred in an 88-year-old male and a 73-year-old female following an injury distal to the stem and were managed by replacing the nail with a long stem device (Long Gamma3). One case of metalwork fracture was also recorded. There are many advantages in managing intertrochanteric hip fractures with intramedullary hip devices such as shorter theater time, less blood loss, and improved biomechanical properties. However, complications such as cutout of the lag screw, AVN, and periprosthetic fracture are serious and require complex revision surgery.

The Impact of COVID-19 Pandemic in Orthopaedic Surgery Hospital Admissions and Workload in a Major Trauma Center.

The coronavirus disease 2019 (COVID-19) pandemic has led to important restrictions in social life of civilians worldwide and there were lower admission rates mainly in surgical departments in many hospitals. This study presents how COVID-19 pandemic affected admissions at the orthopaedic and trauma surgery department of a major trauma center. A retrospective study was conducted that recorded all patients examined at the outpatient orthopaedic clinic and the emergency orthopaedic department, as well as patients admitted to the orthopaedic surgery clinic and patients that underwent operative procedures between March 23 and May 4, 2020 (first lockdown period) and between March 23 and May 4, 2019 (control period). In addition, all patients with hip fractures that required hospitalization and underwent hip surgery were identified during the same time periods. During lockdown period 1 compared with the lock-down period 2 were observed: 70% and 61% decrease in the number of patients examined at the outpatient clinic and the emergency orthopaedic department respectively. The number of patients admitted to the orthopaedic surgery clinic declined by 41%, whereas operative procedures decreased by 22%. Regarding hip fractures timing to surgery during the first period was significantly less compared with second lockdown period, however, hospitalization days remained almost unchanged over the two time lockdown periods. Restrictions during the first lockdown period due to COVID-19 pandemic caused an important decrease in the number of patients and theaters in all orthopaedic departments in one of the major trauma centers in Athens. However, the incidence of hip fractures in elderly was not significantly decreased. Further similar studies are needed to identify variations and patterns of these parameters in other trauma centers.

Is CT-A Always Reliable in Detecting Active Bleeding in Closed Pelvic Fractures? Management of a Case with Multiple Closed Pelvic Fratures and Internal Iliac Artery Bleeding.

One of the most important complications of pelvic injuries is hemorrhage which can be attributed to the venus plexus of the pelvis, the damaged bone on the fracture site, or in 15% of cases to arterial cause. In the last case mortality could reach 70%. Clinical case presentation, a 77-year-old man, presented in the emergency department of our hospital hemodynamically unstable due to fall from height (3 meters) with comminuted bilateral fractures of the pubic rami, right sacral and iliac wing fracture, right acetabular fracture, fractures of transverse processes of the first, second, and fifth lumbar spine vertebrae and a periprothetic fracture of the right femur. Advanced trauma life support (ATLS) protocol was followed throughout. Computed tomography (CT) scans and CT angiography performed, showed the above mentioned pelvic fractures that did not require stabilization, without further injuries, and a well described retroperitoneal hematoma without any evidence of active bleeding. During the resuscitation process the patient developed cardiac arrest and cardiopulmonary resuscitation (CPR) protocol was followed. The patient was intubated and retained his cardiac rhythm. However, he remained unstable and an angiography was then performed that revealed internal iliac artery bleeding and embolism of the internal iliac artery was performed. The patient was stabilized and was transferred to the intensive care unit for further management. Arterial hemorrhage due to pelvic injury is less common, however presents with high rates of mortality. CT angiography may in some cases not reveal existing active bleeding, misleading the clinician. Therefore, in patients with high clinical suspicion of arterial pelvic hemorrhage who remain unstable during the initial resuscitation and do not present with other primary source of bleeding, an angiography and embolism should be performed as soon as possible.

The Facts and Myths for the Use of Lasers in Orthopedic Surgery.

For the past three decades, laser use has been investigated, mainly on implant applications, as well as hard and soft tissue processing on orthopedics. However, despite significant technological advances and achievements in Biophotonics, lasers have yet to emerge as a successful tool for hard-tissue manipulation (e.g., osseous tissue). Indeed, a careful search in relevant literature reveals a limited number of laser-based clinical applications in orthopedics, except for the low-level laser therapy applications. In this review article, we give a brief overview of the biophysical mechanisms of bone tissue and biocompatible implants laser surgery and, in parallel, we summarize some specific pre-clinical and clinical laser applications in orthopedics. Taking into consideration the complexity of laser-based applications in inhomogeneous musculoskeletal biostructures and/or implants, it is justified to state that applying laser radiation is still an open field of multidisciplinary research before performing interventions in clinical praxis. The evidence from this study indicates the need for more experimental and theoretical studies regarding light transport on soft and hard tissues, in order to further enhance safe and efficient laser applications in orthopedics. This undoubtedly implies the need for developing modern light delivery devices for laser surgery, by means of implementing robotic guidance, specialized for medical procedures on various anatomic structures. The aforementioned studies could eventually revolutionize the clinical applications of laser technology in orthopedics.

Distraction Osteogenesis Technique for the Management of a Gustillo Type I Tibial Shaft Fracture Initially Managed with an Intramedullary Nail Device.

Fractures of the tibia shaft are the most common long bone fractures, especially in young male adults. Due to specific anatomical features, these fractures are more common than any other long-bone fracture. This is one of the main reasons they are associated with twice the incidences of deep infection compared with any other bone and can be combined with the presence of segmental bone defect. Many reconstruction techniques have been used to manage such cases, including Ilizarov technique, Masquelet technique, vascularized fibula transfer, and the monolateral external fixator. We present a case of a 21-year-old male patient who was admitted to our hospital for a Gustillo type I tibial shaft fracture which was initially treated by an intramedullary nail device. Two months postsurgery the patient presented with clinical signs of infection in the area of the fracture site, confirmed by an osteolytic lesion revealed radiographically. A surgical operation was performed that included a tibial osteotomy proximal to the defected bone, bone excision, and application of a LRS external fixation device. Antibiotic therapy was administrated based grown cultures, and regular follow-up X-ray revaluation was performed. After six months, the bone was radiologically united, the frame was removed, and the leg was protected in a walking boot while the patient used only partial weight bearing. The treatment of segmental bone defects associated with infection and soft tissue loss presents a great challenge, and the choice of the appropriate method requires further study.