Association of Length of Stay With the Clinical Trajectory of Hospitalized Patients With Atrial Fibrillation: Staying Less Is More?

Data predicting the length of stay (LOS) in patients with concurrent atrial fibrillation (AF) are scarce. This study aimed to investigate the potential predictors for prolonged LOS and its prognostic value. In this observational post hoc analysis of the MISOAC-AF (Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with non-valvular Atrial Fibrillation) randomized trial logistic regression analyses were conducted to identify the parameters associated with prolonged LOS (defined as >7 days according to diagnostic accuracy analyses). Kaplan-Meier and Cox regression analyses were performed to generate survival curves and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for the primary end point of all-cause mortality and for the secondary end points during a median 3.7-year follow-up. Of the 1,057 patients studied, 462 (43.7%) were hospitalized for ≥7 days. Heart failure with reduced ejection fracture (aHR 1.75, 95% CI 1.17 to 2.63), permanent AF (aHR 1.72, 95% CI 1.29 to 2.31), history of coronary artery disease (aHR 2.32, 95% CI 1.59 to 3.39), and advanced or end-stage chronic kidney disease (aHR 1.54, 95% CI 1.15 to 2.06) were independently associated with prolonged hospitalization. Prolonged LOS was independently linked with increased all-cause mortality rates (aHR 1.68, 95% CI 1.25 to 2.26), cardiovascular mortality (aHR 1.92, 95% CI 1.36 to 2.72), major bleeding (aHR 3.07, 95% CI 1.07 to 8.78), and the composite outcome of cardiovascular death or rehospitalization (aHR 1.31, 95% CI 1.04 to 1.66). Each extra day of LOS was an independent predictor of all-cause mortality (aHR 1.03, 95% CI 1.02 to 1.04). Hospitalized patients with concurrent AF carry a substantial morbidity burden being prone to extended LOS. A jointed approach seems reasonable to reduce the LOS in patients with AF.

A New Alternative Surgical Treatment of Hallux Valgus, in Moderate to Severe Cases of the Disease With a Two-and-a-Half-Year Follow-Up.

The study aims to evaluate the treatment of moderate to severe forms of hallux valgus with the lowest invasiveness in soft tissues and especially with an alternative modified Chevron osteotomy of the first metatarsal. Additionally, it emphasizes the necessity of the modified McBride procedure (capsuloplasty and release of specific concrete soft tissue structures) and the importance of the soft tissue manipulation in the particular surgery intra-operatively, as well as postoperative medical and personal care and duration of rehabilitation. Patients with an average age 58 years (range 51-65), who underwent a Chevron type osteotomy with combination of soft tissues interventions laterally and medially of the first metatarsophalangeal joint, for symptoms they had of systematic hallux valgus without any other degenerative problems in metatarsophalangeal joint between 2017 to the beginning of 2018, were retrospectively reviewed with an average follow-up of 29 months (range 26-31).

Treatment of humeral shaft fractures with antegrade intramedullary locking nail.

Antegrade interlocked humeral nailing for stabilization of humeral fractures was introduced many years ago, and studies on this method in the orthopedic literature have shown mixed results. The purpose of this investigation was to document the clinical outcome and complications associated with the use of an antegrade intramedullary nail (T2, Stryker) for the humeral fractures. Between 2005 and 2008, 52 fractures of the humeral shaft were treated operatively with this intramedullary nail in our department. Eight patients were polytraumatized, and four patients had an open fracture. The mean age of patients was 51.7 years. Forty-eight patients had an adequate duration of clinical follow-up (a mean of 18 months) for analysis. Complications were recorded, and the time to union was measured. Shoulder and elbow functions were assessed using the Constant Score and the Morrey Score, respectively. Forty-six fractures healed, with a mean time to clinical union of 10.3 weeks. Two patients developed pseudarthroses. There were four adverse events: two proximal screws backed out, one superficial infection at the insertion point, and one fracture at the distal end of the nail. Ninety-one percentage of patients had an excellent or good shoulder function. Five further operations were necessary: two for treatment of pseudarthroses, two for removal the backed out proximal screws, and one wound debridement for superficial infection. Antegrade humeral nailing is a valid therapeutic option for stabilization of humeral shaft fractures. By strictly adhering to the operation technique, the number and the severity of complications can be reduced. When good fracture alignment and stability are obtained, uneventful bone healing with good functional results is the rule.

Ankle fracture classification: an evaluation of three classification systems : Lauge-Hansen, A.O. and Broos-Bisschop.

The interobserver variability and the ability of the Lauge-Hansen, A.O. and Broos-Bisschop classification systems to encompass all the ankle fracture patterns were investigated in a study of the radiographs of 293 patients with a total of 294 malleolar fractures. Three different orthopaedic surgeons independently evaluated the sets of ankle radiographs. The examiners classified the ankle fractures using the Lauge-Hansen, A.O. and Broos-Bisschop systems. The overall percentage of unclassified fracture patterns was 0.7% with the Broos-Bisschop system, 10% with the Lauge-Hansen system and 8.7% with the A.O. system. The concordance rate using Kappa coefficient ranged from 0.327 to 0.408 for the Broos-Bisschop system, from 0.174 to 0.476 for the Lauge-Hansen system and from 0.397 to 0.483 for the A.O. system. These results show that these three classification systems have in common a considerable interobserver variability deficiency which restricts their validity in selection of treatment options, prognosis and comparison between different materials.

Elution of ciprofloxacin from acrylic bone cement and fibrin clot: an in vitro study.

The purpose of this study was to investigate the release of ciprofloxacin from acrylic bone cement and fibrin clot. Under sterile conditions, bone cement and fibrin clot were individually mixed with ciprofloxacin. Ten specimens of each complex were placed in 1 ml of nutrient broth and incubated at 37 degrees C. The nutrient broth was changed daily, and the removed samples were stored at -70 degrees C until the antibiotic concentration in each sample was determined by a microbiological method. The maximum level in bone cement specimens was obtained at the second day (80.80 microg/ml) and its diffusion was rapid at first, decreasing gradually over a period of 365 days. Fibrin clot biodegradable specimens released high concentrations of ciprofloxacin (1.52-49.91 microg/ml) in vitro for the period of time needed to treat bone infections (i.e. 65 days). We conclude that the high release of ciprofloxacin in vitro from acrylic bone cement and fibrin clot is very promising since the obtained levels are much higher than the required minimal inhibitory concentration (MIC) against the implicated pathogens in soft tissue and bone infections. The in vivo relevance of the obtained results requires carefully performed studies in animal models.