Analysis of mortality between 2019-2020 at the Neuroorthopedic and Traumatic Orthopedic Departments.

The number of deaths from skeletal injuries is still significant, but is declining with advances in emergency medicine. The adopted principles of emergency procedures and the availability of specialist centres enable the treatment to be effective. AIM: The aim of the study was to analyse the deaths of patients with spine and limb injuries who required surgery. MATERIALS AND METHODS: The analysis covered 22 deaths in the years 2019-2020. The assessment took into account: the cause of admission, the condition of the patient and comorbidities, the medical scales which were used to assess the possible risk of complications, the diagnostic correctness and qualification for surgical treatment, the waiting time for surgery and the cause of death and prior course of action. RESULTS: It can be stated that in 2019, the mortality rate was 0.21 (10 deaths out of 4658 hospitalized), in 2020, the mortality rate was 0.31 (12 deaths out of 3852 hospitalized). The mortality rate in the Department of Traumatic Orthopedics was: 0.30 in 2019 (8 deaths out of 2625 hospitalized) and 0.39 in 2020 (8 deaths in 2020 hospitalized). 10 patients with hip fractures (trochanteric and femoral neck) underwent surgery within 2.7 days (from 1 to 4 days). The causes of death within 1-9 days (average 4.86 days) from admission in this group were complex, and associated with the presence of chronic diseases, including: circulatory failure (9), septic shock (1), heart rhythm disturbances (7), renal failure (6), pulmonary congestion (4), hyperkalemia (1), coagulation disorders (1). In patients after spinal injury with quadriplegia, decompression (1), stabilization (1) and disc removal (1) were performed on the day of admission to the hospital. The patients were hospitalized in the ICU, and deaths occurred on days 9, 15 and 187 from admission due to respiratory and circulatory failure and sudden cardiac arrest. Patients after arthroplasty of the knee (1) and hip (2) were operated on day 2 from admission, and deaths occurred on day 4, 22 and 53 due to: sepsis (1), pulmonary embolism (1), respiratory failure in the course of pneumonia (1). CONCLUSIONS: The deceased were admitted in a serious general condition, burdened with numerous concomitant chronic diseases and their age ranged from 66 to 97 years. The surgical treatment was undertaken for life saving reasons but 5 of the deceased did not undergo surgery due to the extreme general condition leading to respiratory and circulatory failure.

[Analysis of pre-operative loads and their relation to postoperative mortality in patients with proximal femur fracture]. / Analiza obciazen przedoperacyjnych i ich zwiazku z umieralnoscia pooperacyjna u chorych ze zlamaniem blizszego konca kosci udowej.

Good functional efficiency of patients after surgical treatment of proximal femur fracture may be associated with the presence of preoperative loads. AIM: The aim of the study was to analyze the impact of preoperative loads on the functional outcome of surgical treatment and the presence of complications observed in the perioperative period in patients with previous BKKU fractures. MATERIALS AND METHODS: A retrospective analysis included 202 patients with proximal femur fractures undergoing surgery, including 146 women aged 80.1 +/- 15.4 years and 56 men aged 74.3 +/- 13.2 years. The patients were divided according to the type of fracture into two groups. The first group consisted of 120 patients (91 women and 29 men) with intertrochanteric fractures and the second group consisting of 82 patients (55 women and 27 men) with femoral neck fractures. The analysis takes into account the influence of chronic co-morbidities on the treatment method used and the outcome of the treatment, taking into account the greatest possible independence in the daily activities of the operated patients. RESULTS: In 85% of surgical patients treated for proximal femur fractures, concomitant diseases were observed in the pre-operative period. 28 of them were disqualified from surgery. In the remaining 38 patients perioperative complications were observed, including prolonged bleeding, infection and exacerbation of renal failure. The most unfavorable complication in the analysis was renal failure. CONCLUSIONS: Patients in the age group predisposing to proximal femur fractures should be carefully monitored for co-morbid chronic diseases. This action may reduce the percentage of disqualification from surgical treatment and the risk of perioperative complications.

[Analiza postepowania w zlamaniach okoloprotezowych kosci udowej po endoprotezoplastyce stawu biodrowego]. / Analysis of management of periprosthetic fractures of the femur after hip arthroplasty.

Fracture around the femoral shaft after hip arthroplasty is rarely trauma. On the other hand, the surgical supply of this fracture is a very demanding process, because we deal with older, often patients with risk factors, with poor bone quality and a broken bone canal filled with a prosthesis stem. AIM: The aim of the study is to analyze the frequency of these fractures over the years 2005-2011 and examples of surgical solutions (plate fixation, revision stems). MATERIALS AND METHODS: In the discussed period, 12 patients were treated for periprosthetic fracture of the femur. The analysis excluded patients with intraoperative fractures performed during primary arthroplasty. The analysis involved the mechanism of injury, the primary cause of the prosthesis, the fracture morphology (according to Vancouver classification). RESULTS: 11 patients were treated surgically and 1 conservatively. In 10 cases, a good or very good treatment result was obtained. In 2 patients, complications occurred and surgical treatment was necessary. CONCLUSIONS: Periprosthetic fractures are characterized by a high percentage of failures (18%) requiring reoperation.