Analysis of surgical delay and its influence on morbimortality in patients with hip fracture. / Análisis de las causas de demora quirúrgica y su influencia en la morbimortalidad de los pacientes con fractura de cadera.

INTRODUCTION: Surgical delay for hip fractures (>48h) has been associated with greater adverse clinical events. However, the influence of the reasons for delay is unclear. The objective of this study was to analyse the causes of surgical delay and its influence on morbidity and mortality, in patients with hip fracture with indication for surgical treatment. MATERIAL AND METHOD: A cohort of 376 hip fractures operated at our centre between January 2012 and December 2016 was retrospectively reviewed. Patients younger than 65 years and pathological fractures were excluded. Of these, 280 patients were operated with a surgical delay>48h. The causes of the delay were: antiaggregation (AG), anticoagulation (AC), medical reasons (MM), preoperative cardiac tests or administrative/organizational reasons. Surgical wound complications, general complications and mortality were compared. RESULTS: There was a greater proportion of surgical wound complications in the AC group (P=.063). Patients in the AG, AC, and MM groups had higher rates of general associated complications (P=.3). Seven point fifty-one percent of the patients included died one year after surgery. The mortality rate at one year was highest in the MM group (P=.005). CONCLUSION: The mortality rate was statistically significantly higher in the MM group. When comparing results, patients in the AG, AC, and MM groups presented higher rates of general complications.

Accessory Extraocular Muscle as a Cause of Restrictive Strabismus.

Restrictive strabismus resulting from the presence of an accessory extraocular muscle has rarely been reported in the literature. Most articles written on this topic are isolated case reports. The purpose of this paper is to describe a series of 7 similar patients presenting with atypical restrictive strabismus associated with enophthalmos in the affected eye, which was found to be caused by an accessory extraocular muscle attached to the posterior globe near the optic nerve. The medical records of 7 patients who shared these clinical characteristics were retrospectively analyzed. Orbital imaging was obtained in the 7 cases, which were compared. Three of the patients were females and four were males. The left eye was affected in all 4 males and the right eye was affected in the 3 females. The 7 patients presented with the following clinical characteristics: enophthalmos, restriction to eye movements in most fields of gaze, and presence of an anomalous orbital structure that was interpreted on magnetic resonance imaging (MRI) to be an accessory extraocular muscle inserting onto the posterior surface of the globe in the affected eye. The fellow eye was normal in all cases. Five of the 7 patients underwent surgical correction with partial improvement in only one patient. The presence of an accessory extraocular muscle should be included in the differential diagnosis of patients with atypical restrictive strabismus. Orbital computed tomography or MRI are essential for correct diagnosis in these cases.