One-year mortality in displaced intracapsular hip fractures and associated risk: a report of Chinese-based fragility fracture registry.

BACKGROUND: The purpose of this registry-based retrospective study was to investigate the risk factors related to one-year mortality in displaced intracapsular fragility hip fracture patients. METHODS: Patients were screened from the Fragility Fracture Registry. Inclusion criterion was displaced intracapsular hip fracture patients with atypical or pathological fractures excluded. One-year mortality was investigated against risk factors including age, gender, past medical history, pre-fracture mobility (PFM), pre-operation ASA grade, delayed surgery over 48 h, post-surgical complications, and length of stay at acute orthopedic ward (LOS). RESULTS: A total of 1050 patients were included for further analysis. Gross one-year mortality was 14.9%. One-year mortality was significantly higher in patients who received non-operative treatment and those who received surgery but delayed over 48 h after admission (both p <  0.001). Male gender (OR = 2.708), advanced age (OR = 1.359), higher risk ASA grades (III to V) (OR = 1.990), past history of gastrointestinal disease (OR = 1.671), and renal impairment (OR = 1.984) were related to higher one-year mortality. The mortality of patients in PFM grade 3 and LOS group 3 was significantly higher (OR = 2.240 and 1.722, respectively). CONCLUSIONS: Higher age, male gender, past gastrointestinal disease and renal impairment, ASA grade over 3, indoor confined pre-fracture ambulatory, and stay at hospital over 15 days were risk factors related to higher one-year mortality in surgically treated displaced intracapsular hip fracture patients. A multi-disciplinary approach is advised to patients identified with these risks factors and co-managed by orthopedic surgeons, geriatricians, and fracture liaison nurses.

Endoscopic Superior Peroneal Retinaculum Reconstruction.

Post-traumatic peroneal tendon subluxation or dislocation is most commonly due to injury to the superior peroneal retinaculum. Acute repair of the retinaculum is an option for active athletes who desire quick return of sport activity. In general, conventional open surgeries require extensive exposure of the injured superficial peroneal retinaculum and have potential risks of scar formation, sural nerve injury, limited range of movement, peroneal tendon re-subluxation, and tendon irritation. The purpose of this Technical Note is to describe the details of endoscopic superior peroneal retinaculum reconstruction. This has the advantages of minimally invasive surgery of better cosmesis, less soft tissue dissection, less postoperative pain, less peritendinous fibrosis, and less subjective tightness at peroneal tendons. The endoscopic view allows better assessment of retinaculum integrity, grading of injury, and detection of coexisting pathology.

Endoscopic Management of Calcaneofibular Impingement and Posterior Ankle Impingement Syndrome Caused by Malunion of Joint Depressed-Type Calcaneal Fracture.

Identification of the correct source of symptoms is the key in formulating the correct treatment plan for heel pain after calcaneal malunion. Calcaneofibular and posterior ankle impingements can occur due to malunion of a joint depressed-type calcaneal fracture. The purpose of this Technical Note is to report the technical details of posterior and lateral decompression through the posteromedial and posterolateral portals using posterior ankle endoscopy.

Acute calcification of intervertebral disc and posterior longitudinal ligament in a 7-year-old girl: a case report.

A 7-year-old girl presented with a 2-day history of acute neck pain without any preceding injury. The pain was around the left posterior paraspinal muscle and was aggravated by neck movement. There was no neurological abnormality; white cell count and inflammatory markers were slightly elevated. Radiology of the cervical spine showed calcification of C3/4 and C4/5 discs as well as the posterior longitudinal ligament over C3/4. She was treated conservatively with a neck collar and Panadol syrup. No non-steroidal anti-inflammatory drug was prescribed. Two months later, calcification of the posterior longitudinal ligament had resolved and calcification at C3/4 and C4/5 discs and the C4 lower endplate had decreased. After one year, she was painfree with no tenderness over her neck and had full range of neck motion and complete resolution of the calcification.

Post-traumatic elbow rotational stiffness.

BACKGROUND: The elbow is an important but complex structure, with movement in both the sagittal plane in flexion and extension, as well as the rotational plane in forearm supination and pronation. Trauma is a common cause of elbow stiffness, which significantly hampers daily function. There are currently no gold-standard management guidelines for post-traumatic elbow stiffness, and most of the published literature focuses solely on the sagittal plane of motion. METHODS: This is a retrospective case series reviewing all patients who underwent a surgical release for treatment of post-traumatic elbow stiffness during a 36-month period. Motion range and the shortened version of the Disabilities of the Arm, Shoulder and Hand scores were serially measured and analyzed. RESULTS: The results obtained showed that both the sagittal and rotational range of motion directly influenced upper limb function; however, the relationship between these two motion planes was weak, meaning that both sagittal and rotational motion in the elbow need be addressed individually. Post-traumatic elbow stiffness could be aptly managed by various surgical approaches, including arthroscopic-assisted procedures; these were all effective in increasing both the sagittal and rotational range of motion. More importantly, this gain in range translated to a statistically significant improvement in upper limb function. CONCLUSIONS: Management of elbow stiffness needs to be tackled in both the sagittal and rotational motion planes.

Breakage of the radiopaque wire from the medullary tube during closed antegrade intramedullary nailing for femoral shaft fracture.

We report a complication of radiopaque wire breakage from the medullary tube during closed antegrade intramedullary nailing for a femoral shaft fracture. To avoid such complication, the medullary tube should be checked carefully for colour changes and surface defects, and tested for flexibility before each use. The medullary tube should also be replaced before 100 exposures to autoclaving.

Arthroscopy-assisted correction of hallux valgus deformity.

PURPOSE: Our purpose was to evaluate the clinical and radiologic results of arthroscopy-assisted hallux valgus deformity correction with percutaneous screw fixation. METHODS: Ninety-four feet underwent arthroscopy-assisted hallux valgus deformity correction. Patients in whom the 1,2-intermetatarsal angle could be reduced manually and who had no significant abnormality of the distal metatarsal articular angle were included, and an endoscopic distal soft tissue procedure was performed. Those patients with first tarsometatarsal hypermobility, in whom the 1,2-intermetatarsal angle cannot be reduced manually, or those who had a significantly abnormal distal metatarsal articular angle were excluded. Patients were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale. The pre- and postoperative hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and sesamoid position were measured. RESULTS: The mean score on the AOFAS scale was 93 +/- 8 out of 100 points. The hallux valgus angle improved from 33 degrees +/- 7 degrees (range, 20 degrees to 58 degrees ) to 14 degrees +/- 5 degrees (range, 4 degrees to 30 degrees ). The intermetatarsal angle improved from 14 degrees +/- 3 degrees (range, 10 degrees to 26 degrees ) to 9 degrees +/- 2 degrees (range, 5 degrees to 18 degrees ). Complications of hallux varus, skin impingement, screw breakage, and first metatarsophalangeal stiffness were experienced. Two patients with symptomatic recurrence had revision operation performed. CONCLUSIONS: Our study shows that arthroscopic correction of the hallux valgus deformity can achieve good clinical and radiologic results, provided that careful preoperative clinico-radiologic assessment is made to exclude patients contraindicated for the procedure. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Ankle stiffness after Bosworth fracture dislocation of the ankle.

PURPOSE: The purpose of this study is to review the result of patients with Bosworth fracture dislocation of ankle. TYPE OF STUDY: Retrospective case series. METHODS: Four patients with Bosworth fracture-dislocation of ankle are evaluated clinically and radiologically. RESULT: All four cases have failed initial closed reduction of the ankle and open reduction is required. Three patients with delayed presentation suffered from post-traumatic ankle stiffness and subsequently developed ankle degeneration. CONCLUSION: Early recognition and prompt reduction of the dislocated ankle is important in case of Bosworth fracture dislocation in order to prevent late complication. Closed reduction of dislocated ankle is usually not helpful and repeated attempts may be harmful. Emergency operation of open reduction and internal fixation is usually required to reduce the ankle joint without delay.