Is Modular Prosthesis Superior to Monoblock Variant in Hemiarthroplasty for Fracture Neck of Femur?

Background: The incidence of hip fractures is increasing every year worldwide. Even though hemiarthroplasty is one of the most common procedures performed for a fractured neck of the femur, there is very little research comparing the outcomes of monoblock and modular systems, the two most commonly used prostheses in neck of the femur fractures. It was hypothesized that in narrow femoral canals, the single-size monoblock stem would be more difficult to insert and lead to complications like limb lengthening and intra-operative calcar fractures. The objective of our study was to compare the outcomes of a modular prosthesis with that of a monoblock prosthesis in a fractured neck of the femur. Materials and Methods: This study analyzed the surgical outcomes of 192 cases of hemiarthroplasties performed over a 4-year period using a modular system and compared it to 192 cases performed using a single-sized monoblock system. Results: The monoblock systems were more likely to cause post-operative limb lengthening compared to their modular counterparts (P = 0.01). The incidence of intra-operative fractures was also more in the monoblock system, although it was not statistically significant. Up to 45% of patients required a femoral stem size smaller than the single-sized monoblock system as the optimum size for their femoral canals, which was available only in the modular system. Conclusions: Modular prosthesis was found to have lower chances of post-operative limb lengthening and lower chances of intraoperative calcar fractures compared to monoblock prosthesis. Careful pre-operative radiologic planning is essential in cases where monoblock systems are used, and the modular system might serve as a viable solution in such scenarios.

The Rise of Artificial Intelligence: Implications in Orthopedic Surgery.

Artificial intelligence (AI) is slowly making its way into all domains and medicine is no exception. AI is already proving to be a promising tool in the health-care field. With respect to orthopedics, AI is already under use in diagnostics as in fracture and tumor detection, predictive algorithms to predict the mortality risk and duration of hospital stay or complications such as implant loosening and in real-time assessment of post-operative rehabilitation. AI could also be of use in surgical training, utilizing technologies such as virtual reality and augmented reality. However, clinicians should also be aware of the limitations of AI as validation is necessary to avoid errors. This article aims to provide a description of AI and its subfields, its current applications in orthopedics, the limitations, and its future prospects.

Pregnancy-Associated Osteoporosis - A Rare Cause of Subchondral Fracture of Femoral Head: A Case Report.

Introduction: Pregnancy- and lactation-associated osteoporosis (PLAO) is a rare cause of back pain during pregnancy and puerperium. We report a rare case of PLAO with subchondral fracture of the femoral head. Case Report: A 19-year-old second gravida presented with severe back pain and an inability to ambulate due to pain in the right buttock during the puerperium. The pain started during the last trimester and was aggravated after delivery. Her radiogram showed multiple compression fractures with osteopenia in the dorsolumbar spine. A magnetic resonance imaging scan of the pelvis showed bone marrow edema with subchondral fracture involving the right femoral head. A diagnosis of PLAO was made thorough investigations and excluding other possibilities. Conclusion: PLAO is a rare cause of back pain. Subchondral fracture of the femoral head is an extremely rare occurrence in PLAO. A high index of suspicion is needed for its diagnosis. Early diagnosis and treatment are essential to avoid complications such as vertebral fractures.

Delay in time from fracture to surgery: A potential risk factor for in-hospital mortality in elderly patients with hip fractures.

PURPOSE: To estimate the Impact of delay in surgery for elderly hip fractures on short term outcome measured in terms of in-hospital mortality. METHODS: Retrospective study involving patients above 60 years of age with a primary diagnosis of hip fracture treated by surgery to analyze the relation between timing of surgery and in-hospital mortality. RESULTS: There were 144 patients who met the criteria. Delayed surgery more than 48 h was associated with higher in-hospital mortality risk. (OR:8.3, 95% CI 1.04-66.64, p = 0.01). CONCLUSIONS: Delay in hip fracture surgery increases in-hospital mortality risk.