Complications and survival rates of subtrochanteric fractures are similar between short and long intramedullary nail fixation and independent of weight-bearing.

PURPOSE: Intertrochanteric fractures are treated surgically, allowing rapid weight-bearing to improve ambulation and lower complications and mortality. Subtrochanteric fractures are mechanically less stable and are traditionally treated with a non-weight approach and longer intramedullary nails. This study compared immediate weight-bearing versus limited weight-bearing and different intramedullary nail lengths regarding patient outcomes. METHODS: We analyzed all consecutive cases of low-energy subtrochanteric fractures treated surgically at our institution between January 2016 and November 2020. One hundred and nine patients were found. We compared nail length and immediate versus delayed weight-bearing concerning the length of stay, time to painless ambulation, time to radiographic fracture union, and revision rates. Fracture severity was also examined using the Seinsheimer classification. RESULTS: Length of stay and time to painless ambulation were shorter in the immediate weight-bearing group. Time to radiographic union and rate of complications were lower; however, they were not statistically significant. Conversely, no significant difference in revision rates was found. Regarding nail length, the length of stay was shorter, and the time to painless ambulation was faster in the short-length group. The rate of complications and time to union were similar. No difference in revision rate was found. Seinsheimer classification of the fracture did not influence the decision to allow weight-bearing or nail selection (p = 0.65). CONCLUSIONS: This study demonstrates that immediate weight-bearing as tolerated and short intramedullary nails allow a quicker time for painless ambulation and hospitalization, with possibly fewer perioperative complications and faster radiographic union, without increasing complications.

Gender and lung cancer-SEER-based analysis.

BACKGROUND: Lung cancer remains a major cause of death worldwide. While in the past it was considered to primarily afflict males, in recent decades the number of female patients has risen, such that rates among females are similar to those among males. Nevertheless, it has been found previously (e.g., in cardiovascular disease) that when there is a sex-specific stereotype to a disease, it may remain entrenched in medical diagnostic processes, so as to cause belated diagnosis among the other sex. Gender-based differences in incidence and diagnosis are likely to exist with respect to lung cancer because of smoking habits and stereotypes, geographic and socioeconomic differences, and past epidemiologic differences between the sexes. Here we aim to characterize the effects of gender on lung cancer diagnosis and whether such effects have changed over time. METHODS: The SEER (Statistics, Epidemiology, and End Results) database was used to check for sex-based differences by tumor type and stage at diagnosis and to investigate whether these patterns have changed with time by comparing staging data in different age cohorts over time. Results were stratified by location and analyzed with data regarding possible confounders such as smoking and socioeconomic factors. RESULTS: We examined 458,132 cases of lung cancer from the years 2004-2012; 243,021 (53%) in males and 215,111 (47%) in females. Lung cancer rates were 73.8 (73.5-74.1) per 100k in males and 51.6 (51.4-51.8) per 100k in females. Of these, 400,800 had the stage listed, 214,479 (54%) in males, and 186,321 (46%) in females. Total lung cancer rates were higher in males than females at all disease stages. Male patients were more likely than female patients to be diagnosed at stage 3-4, consistent across lung cancer types, cancer registries, smoking, and socioeconomic backgrounds. The difference between the percentage of males versus females diagnosed in stages 3-4 correlated negatively with increased female ever-smokers and with squamous and small cell carcinoma and were not correlated with the rate of cancer in females, or the difference between male and female cancer rates. CONCLUSIONS: Our study showed that there is no belated diagnosis of lung cancer in females. Results appear to point to the fact that smoking females are more likely to be diagnosed at later stages, which is consistent with the current literature.

Increased Incidence of Lung Cancer Among Patients With Superficial Transitional Cell Carcinoma: A Potential Risk Cohort for Lung Cancer Screening.

BACKGROUND: Smoking is a major risk factor for lung cancer (LC) and transitional cell carcinoma of the bladder (TCC). Current recommendations for LC screening do not include TCC as a risk factor for determining screening eligibility. In this study we aimed to evaluate whether TCC patients constitute a population who might benefit from LC screening. PATIENTS AND METHODS: The Surveillance, Epidemiology, and End Results 18 database was used to determine the incidence, standardized incidence ratio (SIR), and the average time to diagnosis of LC in patients with localized TCC of the bladder (American Joint Committee on Cancer, sixth edition, stages 0-1). RESULTS: On the basis of 91,606 patients with localized TCC, The SIR for LC in men was 1.89 (95% confidence interval [CI], 1.8-1.97), significantly different from the risk for all solid tumors. The SIR for LC in women was 2.43 (95% CI, 2.22-2.65), significantly higher than for men. The 5-year incidence of LC was 3.2%, and the 10-year incidence was 5.94%. The average time to diagnosis of LC was 3.4 years, with >80% of LC cases occurring within 5 years of TCC diagnosis. CONCLUSION: Patients with localized TCC have a higher incidence of LC than the general population. The risk is significantly increased among women compared with men. Considering this increased risk, patients with early stage TCC might stand to benefit from LC screening. Additional differences were noted between male and female TCC patients, which bear further study.