Prognostic factors of in-hospital complications after hip fracture surgery: a scoping review.

INTRODUCTION: To examine prognostic factors that influence complications after hip fracture surgery. To summarize proposed underlying mechanisms for their influence. METHODS: We reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Scoping Review extension. We searched MEDLINE, Embase, CINAHL, AgeLine, Cochrane Library, and reference lists of retrieved studies for studies of prognostic factor/s of postoperative in-hospital medical complication/s among patients 50 years and older treated surgically for non-pathological closed hip fracture, published in English on January 2008-January 2018. We excluded studies of surgery type or in-hospital medications. Screening was duplicated by two independent reviewers. One reviewer completed the extraction with accuracy checks by the second reviewer. We summarized the extent, nature, and proposed underlying mechanisms for the prognostic factors of complications narratively and in a dependency graph. RESULTS: We identified 44 prognostic factors of in-hospital complications after hip fracture surgery from 56 studies. Of these, we identified 7 patient factors-dehydration, anemia, hypotension, heart rate variability, pressure risk, nutrition, and indwelling catheter use; and 7 process factors-time to surgery, anesthetic type, transfusion strategy, orthopedic versus geriatric/co-managed care, multidisciplinary care pathway, and potentially modifiable during index hospitalization. We identified underlying mechanisms for 15 of 44 factors. The reported association between 12 prognostic factors and complications was inconsistent across studies. CONCLUSIONS: Most factors were reported by one study with no proposed underlying mechanism for their influence. Where reported by more than one study, there was inconsistency in reported associations and the conceptualization of complications differed, limiting comparison across studies. It is therefore not possible to be certain whether intervening on these factors would reduce the rate of complications after hip fracture surgery.

Flexible memory-alloy instrumentation for unilateral transpedicular kyphoplasty and guided cement augmentation of the thoracic spine.

The purpose of this novel study was to investigate the feasibility of unilateral transpedicular balloon kyphoplasty particularly of the upper thoracic vertebrae using an 11- gauge balloon and cement inserter, and to study the morphological parameters of the thoracic spine pedicles. We used four fresh frozen cadaveric thoracic spines with intact rib cages and skin for kyphoplasty from T1 to T12 vertebrae under C-arm fluoroscopy. The most limiting width of the pedicles 2.46+/-0.32mm was in the middle levels (T5-T8). The absolute minimum height of the pedicles was at T1 (3.80-3.87mm). All regions of the vertebral body were effectively targeted for cement augmentation. The average cement load of all the vertebral bodies was 43,22%. Using the kyphoplasty technique in combination with the pre-bent 11mm memory-alloy cement inserter allowed targeting of the desired position of the vertebral body for effective vertebral body cement augmentation.

Lizard Tail Autotomy: Function and Energetics of Postautotomy Tail Movement in Scincella lateralis.

Handling of autotomized, thrashing and autotomized, exhausted tails of the lizard Scincella lateralis by mammals and snakes was tested to examine the function of postautotomy tail movement. Tail movement attracted a mammal's attack to the tail, permitting the lizard to escape and increased the time required for a snake to subdue a tail before swallowing it, increasing the lizard's escape time by 40 percent. Lactate concentrations of autotomized tails after movement were compared to those of intact tails after rest in S. lateralis, a species with a high rate of autotomized tail thrashing, and Anolis carolinensis, a species with a low rate of thrashing. Postautotomy movement increased tail lactate concentration in both species, but mean tail lactate concentration in S. lateralis was 60 percent higher than that in A. carolinensis, and a third higher than that reportedfor whole-body lactate content of the very mobile lizard Dipsosaurus dorsalis.

Brain hemorrhage from intracranial tumor.

Brain hemorrhage from an intracranial tumor was encountered in 7 males and 6 females during a 4-year period. In 5 patients, hemorrhage was responsible for the first signs of a previously unsuspected neoplasm. The intracranial lesion was demonstrated by computed tomography (CT scanning) in each patient. Characteristic CT scan findings included: a neoplastic core (high or low density); small, multifocal clots usually at the margin of the tumor; and, surrounding, often extensive, edema. Enhancement of the tumor tissue with intravenous injection of 60% Hypaque was observed in the 8 patients so studied. The regions which were enhanced had a peripheral distribution corresponding to the site of hemorrhage. Microscopic examination demonstrated 7 glioblastoma multiforme, 1 oligodendroglioma, 4 metastatic carcinomas (including 1 each of bronchogenic carcinoma, melanoma, hypernephroma, and adrenal carcinoma), and 1 hemangiopericytoma. High-grade malignancy and extensive, abnormal vascularity appeared to be predisposing factors.