Injury
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While the importance of timely surgery and early mobilization are understood in geriatric fracture populations, the relationship between timing of initiation of physical therapy (PT) postoperatively on length of stay (LOS) and mortality has not been well delineated. The purpose of this investigation was to determine the effect of PT initiated on postoperative day zero (POD0) on LOS and mortality in geriatric hip fracture patients. ⋯ Earlier initiation of PT postoperatively is associated with significantly shorter total and postoperative LOS and initiation of PT before POD2 is associated with decreased 30-day mortality. Each day that initiation of PT is delayed is associated with a two- to three-day increase in LOS.
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Despite the plausibility that diabetes may increase the risk of motor vehicle crashes (MVCs) due to various diabetes related complications and co-morbidity, findings from epidemiological studies on the relationship between diabetes and MVCs remained inclusive mainly due to heterogeneity in the study design and failure to complete consideration of potential confounders. This study re-visited this putative association with an improved study design. ⋯ T2D diagnosis was associated with a moderate but significant increase in the risk of MVCs among scooter drivers, but not among car drivers.
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Ankle fractures are one of the most common injuries sustained worldwide, with the majority being isolated lateral malleolus fractures. The majority of the world's population live in Low and Middle Income Countries (LMIC), where implant cost may limit surgical treatment of ankle fractures. We investigate if Weber B ankle fractures could be effectively treated with a lower-cost technique using two screws between the fibula and the tibia to neutralize an interfragmentary lag screw. ⋯ We introduce proof of concept of a novel lower-cost fixation strategy for Weber B ankle fractures that maintained a stable mortise with clinical union at six weeks post-surgery. However, there was a significantly higher rate of hardware removal following fixation with a screw-only construct.
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A large proportion of hip fractures involve inter-trochanteric fractures which are managed by cephalomedullary nails. There is ongoing debate about the advantages and disadvantages of locked versus unlocked long cephalomedullary femoral nails in the treatment of intertrochanteric fractures. The objectives of our study are to evaluate the biomechanical effects of a distal interlocking bolt on the type of peri-implant fractures in a healed intertrochanteric fracture with long cephalomedullary nail fixation. ⋯ Distal-locked long cephalomedullary nails in a healed intertrochanteric fracture model are able to tolerate higher compressive stress at the point of failure but demonstrate more complex peri-implant fracture patterns in the femoral head-neck region as compared to unlocked specimens.