RESUMO
BACKGROUND: The incidence of fragility hip fractures, intracapsular and extracapsular, has been increasing worldwide. Fracture stability is important for treatment decision-making and is related to the expected rate of complications. It is unclear whether metabolic therapy explains the increased incidence of unstable fractures. OBJECTIVES: To investigate the possible association between treatment with bisphosphonates and the various patterns encountered with intertrochanteric hip fractures. METHODS: Patients with fragility hip fractures who were treated in our department between 2013 and 2014 were included in this study. They were classified into three groups: group 1 had a stable extracapsular fracture, group 2 had an unstable extracapsular fracture, and group 3 had an intracapsular fracture. Collated data included: osteoporosis preventive therapy and duration, fracture-type, history of previous fractures, and vitamin D levels. RESULTS: Of 370 patients, 87 were previously treated with bisphosphonates (18.3% prior to fracture in group 1, 38.3% in group 2, and 13.8% in group 3). Of those treated with bisphosphonates, 56.3% had an unstable fracture, 21.8% had a stable fracture, and the rest an intracapsular fracture. In contrast, only 27.9% of patients who were not treated with bisphosphonates had an unstable fracture and 30.0% had stable fractures. CONCLUSIONS: Our findings show a higher proportion of complex and unstable fractures among patients with fragility hip-fractures who were treated with bisphosphonates than among those who did not receive this treatment. The risk for complex and unstable fracture may affect the preferred surgical treatment, its complexity, length of surgery, and rehabilitation.
Assuntos
Difosfonatos/uso terapêutico , Fraturas do Quadril , Efeitos Adversos de Longa Duração/epidemiologia , Osteoporose , Fraturas por Osteoporose , Complicações Pós-Operatórias , Idoso , Conservadores da Densidade Óssea/uso terapêutico , Duração da Terapia , Feminino , Fraturas do Quadril/classificação , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/fisiopatologia , Fraturas do Quadril/cirurgia , Humanos , Incidência , Israel/epidemiologia , Masculino , Osteoporose/tratamento farmacológico , Osteoporose/epidemiologia , Fraturas por Osteoporose/sangue , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prognóstico , Medição de Risco , Vitamina D/sangueAssuntos
Traumatismos do Tornozelo/cirurgia , Queimaduras Químicas , Clorexidina/efeitos adversos , Fármacos Dermatológicos/administração & dosagem , Procedimentos Ortopédicos/métodos , Cuidados Pré-Operatórios , Administração Cutânea , Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/efeitos adversos , Queimaduras Químicas/tratamento farmacológico , Queimaduras Químicas/etiologia , Queimaduras Químicas/fisiopatologia , Queimaduras Químicas/prevenção & controle , Clorexidina/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/efeitos adversos , Cuidados Pré-Operatórios/métodos , Índices de Gravidade do Trauma , Resultado do TratamentoRESUMO
Corals are marine animals that live in compact colonies. They secret calcium carbonate to form a skeletal structure. Coral sting or abrasions usually cause erythema and localized pain with a mild local toxic reaction. We describe a large bony injury in the hallux due to retained coral fragments in a young patient who sustained a mild injury during water sports in the Red Sea. The coral fragment was not removed during the first visit to ER, causing chronic local inflammation and ultimately a large bony injury. Vigorous localized debridement must be performed in all marine injuries to remove all possible fragments that can lead to irreversible local bony injury.
